Frazier Rehab Institute Spinal Cord Medicine Program The Digestive System Consists of mouth pharynx esophagus stomach small amp large intestines rectum and anus Major functions Break down food to be absorbed as nutrients ID: 913020
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Slide1
Bowel Management After Spinal Cord Injury
Frazier Rehab Institute
Spinal Cord Medicine Program
Slide2The Digestive SystemConsists
of mouth, pharynx, esophagus, stomach, small & large intestines, rectum and anus
Major
functions:
Break down food to be absorbed as nutrients
Help get rid of waste products
Slide3What is the Bowel?
Last
portion of the digestive tract
Also know as large
intestine or colon
Stores waste products until they are excreted from the body (bowel movement)
Slide4Bowel MovementThe
bowel fills with stool, stretches, and triggers a message that travels up the spinal cord to the brain
The brain then sends a message back down the spinal cord to the bowels
One message tells the muscles to move the stool down the bowels
Other message tells us it’s time to use the bathroom, which is controlled by the sphincter
Slide5Neurogenic BowelAfter a spinal cord injury the communication between the brain and spinal cord is interrupted by the injury
Two
common types:
Reflexicor
Areflexic
Slide6Neurogenic Bowels
Reflexic
Bowel
AKA
Spastic bowel
SCI
above Lumbar 1
Reflex
is present but may not feel the urge to have a bowel movement
Bowel
gets full and the anal sphincter
relaxes
Areflexic
Bowel
AKA
Flaccid bowel
SCI
below Lumbar 1
Peristalsis
is decreased
Cannot
feel the urge to have a BM
Anal
sphincter remains relaxed and may not be able to hold in bowel movement
Slide7Bowel Program GoalsHave predictable and regular bowel movements
Minimize
or eliminate accidents
Prevent complications
Improve quality of life
Slide8Successful Bowel Program Management
Consistency
of timing
Same time daily
20-30 minutes after meals
Less than 1 hourPosition
Upright and seated
Left side if unable to tolerate seating
Consistency of stool
Balanced diet with plenty of fluids
Stool softeners if needed
Stay active
Slide9Bowel Program
Reflexic
/Spastic
Usually involves taking routine stool softeners
Suppository
Digital stimulation
Areflexic
/
Faccid
Manual removal (
disimpaction
) of stool
Valsalva maneuver
Abdominal massage
Suppository
Usually involves needing firmer stool
Stool
softeners as needed to prevent hard stool
Slide10How to Perform Bowel Program
Check
rectum for any stool and remove if present
Insert suppository along rectal wall
Transfer to toilet or lie on left side
Perform digital stimulationWait 10 minutes and repeat digital
stimulation
Bowel program should be individualized to fit your needs
Slide11Digital Stimulation
Also
called dig.
stim
.
Relaxes and opens the sphincterIncreases peristalsisGentle, circular rotation of the finger in the rectum
Perform about 30 seconds
Important not to stop while stool is coming out otherwise sphincter will close
Repeat every 10-15 minutes
Continue until no results for 2 consecutive rounds
Slide12Assistive Devices for Bowel CareLong/short
handled suppository inserter
Long/short
handled digital stimulator
Long
handled and flexible mirror
Slide13Durable Medical Equipment
Slide14Complications Associated with Bowel Management
Constipation/Obstipation
Diarrhea
Hemorrhoids
Autonomic
Dysreflexia
Slide15Bristol Stool Chart
Ideal for flaccid
bowel
Ideal for spastic bowel
Slide16Constipation/ObstipationConstipation
Hard & infrequent stool that is difficult to pass
Obstipation
Loose/watery stool moving around hard stool
Causes
Immobility
Not drinking enough water
No eating enough fiber
Medications
Slide17Signs and Symptoms of Constipation/Obstipation
Hard
, loose, or watery stools
Irregular BM’s
Accidents
Swollen or hard stomach
Loss of appetite
Nausea and/or vomiting
AD
Slide18How to Prevent ConstipationDrink
at least 8-10 glasses of water daily
Eat well-balanced diet high in fiber
Exercise/stay active
Routine bowel program
DO NOT skip bowel program even if you had a good bowel accident
Take
stool softeners or laxatives as needed
Slide19DiarrheaIncrease in frequency (>3) of BM’s that are usually a
loose and/or watery consistency
.
Causes
Diet
Medications
Slide20Some Solutions for DiarrheaStop
taking stool softeners/laxatives until diarrhea stops
Do not eat foods that disagree with you
Drink plenty of fluids
Call your doctor if diarrhea last more than 24 hours
Slide21HemorroidsSwollen
and inflamed veins in rectum and anus that causes discomfort, bleeding or
AD
May use Preparation H to help reduce swelling
Causes
Frequent constipation
Dig.
Stim
Slide22ConclusionBowel dysfunction after a spinal cord injury should not prevent a healthy, active life
Goal is to achieve proper bowel management to improve quality of life
Slide23To poop is to live.-
Dr
. Castillo
Slide24Questions or Concerns
PLEASE
CONTACT:
Frazier Rehab
Spinal Cord Medicine Program
www.spinalcordmedicineresources.org
-or-
Heather Conner, RN, CRRN
Spinal Cord Injury Nurse Navigator
502-587-4619
Slide25ReferencesGastrointestinal Disorders in Spinal Cord Injury. (2018).
In
S.
Kirshblum
, & V. W. Lin,
Spinal Cord Medicine
(
pp. 387-410). Demos Medical; 3 edition.
Paralyzed Veterans of America
. (2019, February).
Retrieved
from Bowel Management Following Spinal
Cord
Injury: What You Should Know:
https
://www.pva.org