212 chapter 25
BOWEL MANAGEMENT IN SPINAL CORD INJURY
AND SPINA BIFIDA
When there is damage to the spinal cord, almost always a person loses control over
when he will have a bowel movement (pass stool or shit). This makes it hard to stay
clean, which can be inconvenient or embarrassing. Although he can never get back
complete control over the muscles that hold in or push out the stool, a person can
learn to help the stool come out, with assistance, at certain times of day. This kind
of ‘bowel program’ can greatly increase the person’s self-confidence and freedom for
school, work, and social activities.
Persons with spinal cord damage also often have problems with constipation, or the
formation of hard stools that may wait days before coming out. Some constipation
can be an advantage when a person lacks bowel control. But sometimes it can lead
to serious problems, such as impaction (see p. 214) or dysreflexia (see p. 187). It is
therefore important to prevent serious constipation:
• Drink lots of water.
• Eat foods high in fiber (such as bran, whole grain cereals, fruits, vegetables,
cassava, beans, nuts).
• Stick to a scheduled bowel program.
• Keep active.
Planning a bowel program
Any bowel program will work better if you:
• Do the program every day (or every other day) and at the same hour. Do it
even if the person has had an accidental bowel movement shortly before, or has
diarrhea.
• Do the bowel program at
the same time of day that
the person usually had
bowel movements before
his injury. Often the
bowels move best after a
meal or a hot drink.
• If possible, do the
program on a toilet or pot.
The bowels work better
sitting than lying.
• Be patient. The bowels
sometimes take days or
weeks to change their
pattern.
An 8-year-old paraplegic girl, Vania, helps a 5-year-old
paraplegic girl with her daily bowel program. (See Story
of Jésica on p. 192.)
Disabled village Children