Supporting Bowel Health in Children with SCI

Establishing a continuous bowel program for children with SCI, head injury, or other neurological conditions is an essential element for maintaining their health even throughout adulthood. Neurogenic bowel occurs when the autonomic nervous system fails to signal the sensations for toileting, and/or the urge to empty the bowel is not felt. With neurogenic bowel, transit time is slower, which allows the body more time to remove fluid from the stool. Your child can become constipated, but constipation treatment will not help a child with neurogenic bowel.

A bowel program allows regular bowel movements and takes advantage of normal bowel function to maintain health. Not having a reliable bowel program can lead to incontinence, skin breakdown, embarrassment, and impaction. Overfilling the bowel with stool leads to loss of tone, which makes the bowel work less. Less stretch can lead to a lifetime of complications.

The most critical part of the bowel program is to accept this as normal for your child’s needs. If you are upset and embarrassed about the procedure, your child will likely be as well. Most children do not realize that they toilet differently until school age. The better you accept the bowel program, the more your child will. Your attitude will make a difference, especially in teenage sensitivity.

• Teach your child by telling them the steps of the bowel program as you are performing it, even as an infant. When older, they should help by gathering supplies, eventually cleaning up, and doing the program independently if they are able. Knowing the steps will help them direct a caregiver.
• Adaptive equipment can be obtained for the older child with modified hand function.
• Encourage adequate hydration for your child within their health limitations and bladder management program. More moisture will keep the stool softer in the colon.
• Eat a healthy diet including fruits and vegetables for fiber. Natural foods will assist the body in moving stool along. Processed food will lead to dry, hard-to-move stool.
• Stick to a solid routine. Your healthcare professional will indicate how often the bowel program needs to be performed. The schedule is usually every day or every other day. The bowel program should be done at the same time to help train the bowel to work. Switching times or days can upset this routine, leading to slower results, impaction, and incontinence.
• Your healthcare professional will indicate which of the two bowel programs is right for your child. Those with spinal cord injury at the cervical or thoracic level will use option 1, those with lower injury will use option 2. Children with neurological disease or head injury will use one of the two options as needed for their diagnosis.
  
  

Option 1: Children with upper motor nerve injury will need a suppository to start the bowel program. This is gently inserted into the rectum and pushed against the wall of the bowel as body heat causes the suppository to melt. The suppository will not dissolve if it is in the middle of the stool. The suppository should be inserted to the length of your child’s finger, which matches the anatomy of their bowel.

Option 2: Children with lower motor nerve injury will use digital stimulation to manually remove stool.

• Use plenty of lubricant to avoid hemorrhoids, cuts, and irritation of the bowel.
  
  

Bowel programs are highly successful when performed on a schedule. Teaching your child how to perform their own bowel program or how to direct a caregiver provides independence and success in life.

Learn more about bowel management here.