Effective Bowel Management

Patients with spinal cord injury, amyotrophic lateral sclerosis, spina bifida, multiple sclerosis, and diabetes mellitus report that next to lack of mobility, reduced bowel function is their second greatest concern. It can also be a concern for those who have had stroke, traumatic brain injury, or brain tumors. Any of these conditions can lead to neurogenic bowel dysfunction, in which the nerves that provide reflex control and enable people to feel and voluntarily control their bowel function are damaged. It may take longer for stool to pass through the large bowel, leading to constipation. It can also cause fecal incontinence, especially during physical activity.

To manage bowel activity, it’s important to develop a daily bowel routine to maintain bowel health and predictability.  This is a highly personal and individual process and the early stages may involve trial and error, especially when trying to find the most effective methods and medication. In time, however, a bowel routine that complements the person’s daily activity can be successful.

Bowel management comes in two stages. The first is to move the stool through the colon. Then comes techniques and therapies to evacuate stool from the lower bowel and rectum. These should be discussed with your health care provider before adopting them into your routine.

Promoting stool transit through the colon

Physical activity/exercise – Depending on the patient’s stage of recovery and capabilities, exercise at specific times of day can help move stool through the colon on a predictable schedule. Even passive movements such as stretching or standing can aid in this.

Diet – Proper diet, both solid food and liquid is very important to bowel management.  As soon as your ingest food or a warm drink, the digestive system begins its work. Stool may be pushed down to the rectum within 20-40 minutes of eating or drinking. A diet rich in fruit, vegetables, bread and cereal ensures fiber intake which holds water and adds bulk to the stool, helping it pass through the colon. Dairy products, meat, fish, fats and sugars need to be moderated. Eating at the same time each day is also essential to keeping on a bowel management schedule. It is recommended to drink about two liters of water daily as well.

Abdominal massage - Gentle massage of the abdomen using the heel of the hand or a tennis ball can help the colon push the stool along and lessen the chance of constipation. Experts recommend ten minutes of massage following the path of the colon – up the right-hand side of the abdomen, across the abdomen at belly-button level and then down the left side

Oral laxatives – Use of oral medication/laxatives can be used successfully for intermittent bowel management. Long-term use can cause side effects including loose stools, cramps, gas and dehydration. Over time, your body may become tolerant to laxatives, reducing their effectiveness. 

Removal of stool from lower bowel and rectum

Once stool has moved through the colon, the next step in bowel management is to aid in the movement of stool through the lower bowel and rectum. Several routines can help with this.

Posture –Depending on your ability, sitting up with hips and knees flexed and feet supported can relax the pelvic floor and allow gravity to expel stool. Using a toilet with a padded seat will prevent pressure ulcers and hemorrhoids.

Intra-abdominal pressure – You can help to stimulate bowel reflex and push stool out by leaning forward and compressing the abdomen. Extending arms and gently lifting off the toilet seat can also help.

Ano-rectal stimulation – Also used to trigger bowel reflex a gloved, lubricated finger is inserted 2-4cm inside the anal canal and circled gently against the anal wall and lower rectum for 20-30 seconds. The finger should then be removed to allow reflex contractions to move the stool down into the rectum and to push the stool out. The stimulation can be repeated every 5-10 minutes, up to three times until the bowel has emptied and no more stool is felt in the rectum. If stool remains in the bowel after three attempts, manual evacuation should be used to empty the rectum of remaining stool.

Suppositories Glycerin, Carbalax or Bisacodyl suppositories lubricate the stool and rectum and stimulate the rectal lining to promote bowel activity.  Bowel action will usually take place within half an hour after using a suppository. 

Enemas – Enemas deliver liquid or laxative directly to the rectum, much like suppositories. These can be micro-enemas or large volume enemas. 





National Spinal Injuries Center