Bowel Management

The bowel, also called the colon, is the large intestine, the last part of your digestive system.The waste products of digested food are stored in it until you have a bowel movement.

How the Digestive System Affects Bowel Movement

Your diet, the amount of exercise you do, and the regularity of your bowel movements play an important role in keeping you healthy. The following is a description of the digestive system and how some parts can affect your bowel movements.  

For more informantion see Yes, You Can! – A Guide to Self Care for Persons with Spinal Cord Injuries, Page 33, 4th Edition, Paralyzed Veterans of America, Chapter 8, Nutrition

 

 

Additional Points About Bowel Management (supplement material)

General

• Keep a record, in the beginning at least, of what your bowel pattern is so that you will know how long it takes for your program to work, how certain foods affect you, how a cold or flu may influence your bowel routine, etc. (See sample Bowel Plan later in this document.
• Be wary of many of the over-the-counter bowel remedies. Some may have bad effects if used regularly. Regular use of mineral oil, for instance, can interfere with absorption of important vitamins.
• Be aware of your bowel type. Is it spastic or flaccid? Many of the recommendations in the section on bladder management are more effective for spastic bowel. A flaccid bowel may require you to hook and remove stool manually rather than try to stimulate a reflex emptying via suppository or digital stimulation. A flaccid bowel may also benefit from abdominal massage and a forward leaning position while seated on the toilet. See sample bowel protocols for spastic versus flaccid bowel later in this section. Talk to your nurse or doctor to figure out your bowel type.
• If stimulator or suppository inserter is used, wash thoroughly with soap and water. Then soak in 1:10 bleach for 10 minutes. Rinse and dry well. Store in a clean, dry area.
• If you have any questions about your bowel program, call the SCI outpatient nurse at the Glenrose Rehabilitation Hospital or the Calgary Health Region (for those living in other parts of the country, contact your rehab centre).

Sample bowel management protocols

1. A large intake of water is recommended if using COLACE and/or METAMUCIL. Intake will need to be based on bladder program.
2. Your food intake should be rich in dietary fibre. Ask a dietitian for more information.
3. Daily use of METAMUCIL, FRUITLAX or COLACE is often required. May require COLACE twice per day or more often.
4. Bowel movements should be planned, daily every other day, or 3 times per week. You should not go longer than 3 days without a bowel movement.
5. Start with 2 tablets glysennid (Senokot) the evening before scheduled bowel movement. Increase to 3 to 4 tablets, or decrease to 1 or none as required.
6. Insert a suppository the morning of the planned movement. Eventually the goal is to eliminate the need for a suppository. If you have been using a dulcolax suppository, change to a glycerine suppository, prior to eliminating the suppository. This is possible by maintaining a high fibre diet and drinking enough fluids.
7. Use commode if possible.
8. Apply digital stimulation approximately 10 minutes after suppository. Repeat every 10 minutes, up to 3 times. Continue until bowels are clear on final check. Avoid sitting longer than 60 minutes, this may cause hemorrhoids and/or skin breakdown.
9. If unable to have bowel movement on scheduled day, problem solve to determine probable causes and ways to compensate, and then repeat the next day.
10. If no bowel movement for 2 consecutive bowel days, repeat routine with increased glysennids and/or other medications and diet modifications until bowels move.
11. Adjust bowel routine after 1- or 2-week trial as needed. Make only one change to bowel routine at a time so that you know what worked.
12. Consistent timing is important.

Factors that affect bowel movements

• Food and fluid intake
• Alcohol
• beer - laxative
• Emotional Stress
• Medications – i.e.: vitamins, supplements
• Please see dietary effects on bowel management for suggestions regarding foods that harden or soften stools. Ensure that you continue to follow the Canada Food Guide to Healthy Eating.

Sample Flaccid Bowel Protocol

1. Your food intake should be rich in dietary fibre.
2. For a flaccid bowel, you will want to keep your stool firm but not too hard.
3. Use 2 tablets glysennid every evening. Decrease to 1 and none as required. Goal is to use no glysennids.
4. Use commode if possible.
5. Daily bowel check and manual disimpaction if needed. Repeat after 10 to 15 minutes as needed.
6. Consider a suppository if routine is ineffective. If a suppository is required, insert while lying down.
7. If no bowel movement, consider repeating routine with increased glysennids.
8. Adjust bowel schedule after 1- to 2-week trial as needed.
9. If you are having frequent bowel accidents, consider sitting on the toilet after meals.

 What is diarrhea?

• are sick
• feel stress
• change your daily eating, exercise and living habits.

Tips to help with diarrhea

•  Eat small meals and snacks throughout the day.
• Drink 8 to 10 glasses of fluid each day to replace lost fluids. Drink fluid between meals so that your stomach is never too full.
• Some foods might not affect your bowel as much as others. Try lean meats such as chicken, fish or eggs, cheese and smooth peanut butter.
• Eat low fibre breads and cereals such as: white bread, pasta and rice; English muffins; melba toast; muffins without nuts, seeds or fruit; Cheerios™, Special K™, Rice Krispies™, Cream of Wheat™ and oatmeal.
• Eat cooked or canned fruit such as applesauce, fruit cocktail, apricots and peaches.
• Eat cooked or canned vegetables such as carrots, green/yellow beans, potatoes, mushrooms, zucchini, beets, squash, green peas and eggplant.
• Also avoid:
  • Higher fat and fried foods, rich sauces and highly spiced processed food
  • Alcohol, chocolate, coffee, tea and soft drinks that contain caffeine
  • Nuts, seeds, popcorn and cooked dried peas, beans and lentils
  • Very hot or very cold foods—warm or room temperature food is best
• Try to relax before and at mealtimes.
• Keep activity to a minimum after meals.
• Avoid foods or spices that might cause gas, cramps and diarrhea. Some possibilities include dried beans, onions, cauliflower, broccoli, corn, brussel sprouts, turnip, garlic and cabbage. 
• If lactose in milk is the problem, try lactose-reduced milk. Add Lactaid drops to regular milk or use Lactaid tablets to help you digest the lactose.

If you have severe diarrhea

• See a doctor or nurse.
• Rest your bowels for 12 to 24 hours by taking only clear fluids such as water, flat clear soft drinks (no bubbles or colas), dilute fruit juice (no pulp), chicken or beef broth, Gatorade™, Tang, Quench, Kool-Aid™, Jello™ and Popsicles
• Gradually add plain cooked cereals (cream of wheat, farina, infant cereals), strained vegetable and fruit juices (no pulp), pureed cream and broth soups (no lumps), pudding, yogurt, custard, ice milk, ice cream sherbet, milk and canned drinks such as Boost or Ensure.
• Go back to your regular diet as soon as possible.

Source: Spinal Cord Injury, Alberta Education Initiative: Glenrose Rehabilitation Hospital & Foothills Medical Centre