Goals of bowel management
The goals of bowel management following spinal cord injury are to:
- achieve regular and predictable bowel emptying at a socially acceptable time and place
- use a minimum of physical and pharmacological interventions to completely empty the bowel within an acceptable timeframe
- avoid bowel accidents, constipation, autonomic dysreflexia1 (which can be life threatening) and other complications.
Initial bowel symptoms following spinal cord injury
The onset of paralytic ileus (a motility disorder of the intestine causing acute failure of peristalsis) may occur soon after acute injury to the spinal cord. There may be signs within minutes of cord injury or they may be delayed for up to 48 hours.
Paralytic ileus generally lasts 48-72 hours.
Unrecognised paralytic ileus can have serious consequences:
- In a person with tetraplegia, decreased cough may lead to aspiration of gastric contents.
- Progressive abdominal distension may contribute to ventilatory insufficiency by pressing up on the diaphragm and limiting its excursion.
Management of paralytic ileus
During paralytic ileus:
- keep the person nil-by-mouth with a nasogastric tube inserted to decompress the stomach
- administer intravenous fluid therapy to maintain hydration
- check the rectum for the presence of stool on a daily basis
- gently remove any stool manually, using a water-based lubricant.
After resolution of the paralytic ileus, when bowel sounds have returned and flatus passed, fluids and food can be gradually reintroduced, and a bowel management program commenced.
Self-management and self-determination
Self-management of bowel care is ideal. However, not all people with spinal cord injury (SCI) will have the ability to perform their own bowel care procedures.
It is important to allow the person with SCI to be as involved as possible in decisions about their care. This is known as self-determination.
Provide education to the person with SCI and their carer to ensure they are able to make informed decisions, and support self-management and self-determination.
Education topics
- Anatomy and physiology of the gastrointestinal tract
- How SCI impacts on defecation
- Common bowel problems following SCI
- Role of diet
- Fluid intake
- Activity and exercise
- Medications and side-effects
- How to establish an effective bowel management program
As defecation can be a sensitive topic, it is important to take this into account with education about this topic.
- Cosgrave M, Ash D, Adcock C, et al. Guidelines for management of neurogenic bowel dysfunction in individuals with central neurological conditions. Multidisciplinary Association of Spinal Cord Injured Professionals. 2012.