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SCI Forum


Taking Care of Business: Your Bowel Program

Presented on October 8, 2013 at the University of Washington Medical Center, Seattle, WA.

Most people with spinal cord injuries have changes in bowel function and are not able to empty their bowels normally. Newly injured individuals must learn how to use medications, diet, timing and other means to avoid incontinence or constipation, empty their bowels predictably, prevent medical complications, and feel confident out in the community. Learn about bowel problems and solutions at this Forum featuring an overview by Beth Hall, RN, rehab nurse at Harborview Medical Center, followed by a panel of individuals with SCI discussing their different bowel management situations. Watch the video below or read the report.

After watching the video, please complete our two-minute survey!

Presentation time: 72 minutes. You can also watch this video on YouTube.

See all of our streaming videos at http://sci.washington.edu/info/forums/forum_videos.asp.




One of the unfortunate complications of a spinal cord injury is damage to the nerves that allow a person to control bowel movements, called “neurogenic bowel.” After injury, most people need to adopt a new method of emptying their bowels that is safe and effective. The term “bowel program” refers to the method a person uses to accomplish this task.

People with SCI repeatedly rate bowel dysfunction as one of the most distressing aspects of spinal cord injury. A successful bowel program is very important for a good quality of life.

A successful bowel program is:

A bowel program must be individualized to a person’s particular injury, type of bowel dysfunction, medical conditions and lifestyle.

Types of bowel dysfunction

What type of bowel dysfunction you have depends on your level and completeness of injury.

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What are the different parts of a bowel program?

Keep records

When first establishing a bowel program or when difficulties come up, keep a record of all aspects of your bowel care: timing, position, medications and stimulation method (stool softeners, suppositories, etc.), assistive techniques (abdominal massage, pushups, etc.), stool results (amount, firmness/softness), incontinence episodes, and diet.  This information can help you pinpoint what you might need to change to improve results. Only change one component at a time so you can understand what effect the changes might have.

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Common problems



People with SCI have slower passage of stool through the system and often take medications that have a constipating effect, so it is no surprise that constipation is a common problem.

Symptoms: Bowel care takes too long; small quantity of stool is produced; stools are dry and hard; or there has been no bowel movement for more than three days.

When symptoms first start, try the following:

If things don’t improve after three days, you may try adding or increasing a laxative. Untreated and prolonged constipation can lead to fecal impaction.

Fecal impaction

Symptoms: No stool or small amounts of liquid stool for days because hard, dry stool is stuck in the colon.

What to do:


Symptoms: Swollen rectal veins that bleed during bowel care routine. They can be caused by damage from suppositories, enemas, or digital stimulation.

What to do: If they cause bleeding, pain, mucus accidents or autonomic dysreflexia (AD), try these steps:

Autonomic dysreflexia (AD) during bowel care

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Bowel program takes too long



Mucous accidents

A word about laxatives

Although regular use of laxatives by people with SCI is common, you need to be cautious. A health care provider should supervise the use of laxatives because of possible negative side effects. Longtime use of some kinds of laxatives can even worsen the problem they were used to treat in the first place.

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Additional Options


Transanal irrigation (Peristeen® by Coloplast)

This is a promising new method that introduces water into the bowel using a rectal catheter, causing stool to come out. It is designed to be “quad-friendly” and has been shown to reduce constipation, incontinence and time needed to produce a bowel movement. It has recently become available in the US after years of use in Europe, but may not be covered by all insurance companies.  Find out more at www.coloplast.com (enter “peristeen” in the search box).


A surgical procedure that connects the colon to the surface of the abdomen, providing a new path for stool and gas to leave the body. This can be a good option for people whose bowel care has become unacceptable (takes too long or too many accidents) or causes health problems.

Cancer screening

People with SCI do not have an increased risk for colon cancer. Therefore, you should follow the same screening guidelines as for the general population.

Final thoughts

It takes a period of trial and error and working with your rehab provider to arrive at the specific bowel program that works for you. Furthermore, your bowel management needs may change over time and as you age. Regular visits with your rehab provider can help you monitor and address those changes as they arise.


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