Bowel System: Understanding the Digestive Process and Common Problems

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People with disabilities or who are deconditioned often experience a change in bowel patterns. Some individuals have problems moving their bowels, while others have accidental bowel movements. Understanding how the digestive system works can help with adjusting to bowel changes. 

                                                                                                  Image: geeksforgeeks.org

When eating, the food that is swallowed goes first into the esophagus and then into the stomach. Enzymes (digestive chemicals in the stomach) break down the food. Next, food travels from the stomach into the small intestine, then on to the large intestine, or bowel. During this time, the body absorbs nutrients and fluids and uses them for energy. Food that is not needed for energy becomes solid waste, called stool. Stool passes through the bowel into the rectum, resulting in a feeling that it is time to have a bowel movement (BM).

Gastrointestinal Terms

Bowel: Intestinal area which processes solid waste

Bowel program: Habit that has been created to empty bowels at a certain time, prevent accidents and promote regular bowel movements

Defecation: Passage of solid waste (stool) out of the body.

Peristalsis: Wave-like action in the bowel which helps stool move out of the body

Rectal check: Inserting a gloved, lubricated finger into the rectum to check for stool. (Not appropriate for stroke patients. Please consult health care provider.)

Rectum: Lowest part of the bowel

Sphincter: Muscle surrounding and closing the rectum

Stool: Waste that has passed through the bowel

Bowel Changes after a Disability

Bowel changes occur after a disability for several reasons:

• Decreased activity and immobility slow the movement of stool through the body.

• Nerve damage can interfere with the ability to feel when a bowel movement is about to happen, and with the ability to stop and    start a bowel movement.

• Muscle weakness or paralysis of certain parts of the body can make it hard to manage clothing.

• Cognitive (thinking) problems can keep the brain from knowing that it is time for a bowel movement.

• Speech problems make it hard for a person to ask others for help to go to the bathroom.

• Prescription drugs (such as pain medications), over the counter medicines, supplements, and diet affect bowel patterns.

Common Bowel Problems

Listed below are some common bowel problems, symptoms, and management techniques.

Constipation – the inability to have a bowel movement for three or more days.

• Symptoms:
  • hard stools
  • inability to have a bowel movement in many days
  • feeling full or bloated in the stomach area.
• Causes:
  • Insufficient fluid intake (less than one liter per day)
  • Inactivity
  • Poor diet, low in fiber-containing foods such as fruit, vegetables and whole grains
  • Side effects of medicines – especially iron, codeine and pain medication
  • Repeatedly ignoring the urge to move bowels.
• Treatment:
  • Drink at least six to eight glasses of fluid each day.
  • Eat more foods that contain fiber.
  • Ask the doctor about using a stool softener or laxative. 
  • If constipation persists, ask your doctor about using suppositories or an enema.

NOTE: Any person with a spinal cord injury who experiences the above symptoms along with abdominal pain that does not go away after removal of the stool should contact their physician immediately.  This may be a serious condition called autonomic dysreflexia.   Autonomic dysreflexia can happen to people who have injuries at or above T6.  Some symptoms of autonomic dysreflexia are pounding headache, increased blood pressure, slower or sometimes higher heart rate, facial flushing/sweating to name a few. (Refer to related reading.)

Impaction - Hard stool plugging the rectum

• Symptoms:
  • Hard stools
  • Bloated feeling in the stomach
  • Leaking of loose or liquid stool
• Causes:
  • Insufficient fluid intake
  • Inactivity
  • Poor diet
  • Side effect of medications
  • Chronic constipation.
• Treatment: Many people who experience impactions are able to remove the stool by hand.   Check with your physician or health care provider to find out if this is appropriate. 

Diarrhea - Loose or liquid stool (usually three or more times a day).

• Symptom: Large amounts of loose or watery stool
• Causes:
  • Illness, such as a cold or flu
  • Poor diet, including too much spicy or greasy food
  • Excessive use of laxatives or stool softeners.
• Treatment:
  • Do a rectal check to look for impaction.
  • Check with your health care provider regarding the use of specific fiber supplements.
  • Stop all laxatives and stool softeners.
  • Drink plenty of fluids.

Hemorrhoids – Swelling or bleeding of tissue around the rectum

• Symptoms:
  • Red, bulging areas inside or outside the rectum
  • Pain or rectal bleeding after a bowel movement.
• Causes:

Long history of hard stools or constipation

• Removal of stool by hand.
• Treatment:
  • Use medications ordered by doctor such as Anusol™ or Preparation H™.
  • If stool is hard, follow guidelines for constipation (above).
  • Drink plenty of liquids.

Incontinence - Problems controlling bowel movements

• Symptoms:
  • Inability to start or stop bowel movements
  • Lack of awareness of bowel movements.
• Causes:
  • Decreased mobility
  • Inability to communicate the need to use the toilet
  • Side effects of medication
  • Uncontrolled diarrhea.
• Treatment:
  • Assess bowel habits to find a pattern.  Some people have bowel movements every day; others have bowel movements every two or three days.  Try to anticipate when a bowel movement might occur and sit on   the toilet at that time.
  • Sit on the toilet after eating for 30 minutes up to an hour. 
  • Avoid using a bed pan as much as possible; use the toilet or a commode.
  • Check with your health care provider about using suppositories to regulate bowel movements.

Additional Resources : 

Autonomic Dysreflexia - Wallet Card
Autonomic dysreflexia, also sometimes called autonomic storming, dysautonomia, or sympathic storming, is a condition which may occur in people with spinal cord injuries above the level of T6 which causes an increase in blood pressure in response to a painful stimulus from below the level of injury which the person may not be able to feel.
https://www.sralab.org/lifecenter/resources/msktc-factsheet-and-wallet-card-autonomic-dysreflexia

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This content is for informational purposes only and may not be comprehensive. Information contained does not imply an endorsement from Shirley Ryan AbilityLab, and does not replace the advice of a qualified healthcare professional.  See here for further details. © Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago). Henry B. Betts LIFE Center – (312) 238-5433 – https://www.sralab.org/lifecenter