Bowel Considerations with Spinal Cord Injury

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Introduction

The pattern of bowel dysfunction varies depending on the level of injury. The complications of neurogenic bowel dysfunction include constipation, obstructive defecation, and fecal incontinence.  Bowel dysfunction can cause major restrictions in person's social activities and quality of life.  There is no single program that can work for every patient, but bladder and bowel dysfunction management program is a fundamental step following the initial spinal cord injury.

This article supplies additional information for the Bladder and Bowel Consideration with Spinal Cord Injury course.

Bowel Dysfunction in Spinal Cord Injury

Patient's symptoms in neurogenic bowel dysfunction vary depending on the injury level. One classification defines three neuropathological patterns in patient with a complete spinal cord injury:

• Patter A: Patients with spinal cord injury above T7
  • Loss of voluntary control of abdominal muscles
  • Preserved spinal sacral reflexes
• Pattern B: Patients with spinal cord injury below T7
  • Voluntary control of abdominal muscles
  • Preserved sacral reflexes
• Pattern C: Patients with spinal cord injury below T7
  • Voluntary control of abdominal muscles
  • Absent sacral reflexes.

Spastic Bowel

• Observed in people with a SCI above T12 (Upper motor neuron SCI)
• Loss of feel the need to have a bowel movement
• Loss or impairment of voluntary control of the external anal sphincter
• The reflex that makes stool move out of the body is intact and can be stimulated
• Complications include constipation usually with faecal retention but uncontrolled evacuation of the rectum can occur.

Flaccid Bowel

• Observed in people with a SCI below T12 (Lower motor neurone SCI)
• Loss of feel the need to have a bowel movement
• Loss or impairment of voluntary control of the external anal sphincter
• Loss of the bowel reflex . The rectum cannot easily empty by itself and the sphincter muscles may relax and stay open.
• Complications include constipation and incontinence

Bristol stool chart

Bristol Scale

Bristol scale or Bristol Stool Chart is an assessment tool used by healthcare professionals and designed to classify stools. It helps to diagnose constipation, diarrhoea and irritable bowel syndrome.

Type 1 through 7 indicates the following:

• Type 1-2 indicate constipation
• Type 3-4 indicate ideal stools
• Type 5-7 may indicate diarrhoea and urgency

Management of Bowel Dysfunction

"The overall goal of bowel management is to achieve secondary continence with regular and sufficient bowel emptying within an individually acceptable time frame and at the right time according to the patient’s agenda."

Spastic Bowel Management

The following strategies are recommended to manage spastic bowel:

• Routine
• Suppository
• Digital rectal stimulation
• Abdominal massage

Resources

• Kurze I, Geng V, Böthig R. Guideline for the management of neurogenic bowel dysfunction in spinal cord injury/disease. Spinal Cord. 2022 May;60(5):435-443.