Hesperian Health Guides

Bowel Management

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HealthWiki > Disabled Village Children > Chapter 25: Urine and Bowel Management > Bowel Management

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 or dysreflexia. 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.
DVC Ch25 Page 212-1.jpg
An 8-year-old paraplegic girl, Vania, helps a 5-year-old paraplegic girl with her daily bowel program. (See the Story of Jésica.)
  • 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.

Types of bowel

Different persons require different types of bowel programs, depending on whether their bowels are ‘automatic’, ‘limp’, or ‘pull back’.

  • Automatic bowel usually occurs in persons who have muscle spasms in their legs, and an ‘automatic bladder’. The muscle or ‘sphincter’ in the anus (asshole) stays shut until there is a stimulation in the bowel to make it open, so that the stool can come out. An automatic bowel will ‘move’ in response to a suppository or stimulation by a finger.
  • Limp or ‘flaccid’ bowel usually occurs in persons with low spinal cord damage who have limp (not spastic) legs and bladder. The sphincter muscle in the anus is also limp. So the person tends to ‘ooze’ or ‘dribble’ shit. A limp bowel does not respond to finger stimulation.
  • A bowel that pulls back is neither automatic nor limp. When you put a finger up the anus, you can feel the stool move back up instead of coming out.
  • Start with a suppository if available. With a finger covered with a glove or plastic bag, and then oil, push the suppository about 2 cm. (1 in.) up the anus. Do not push it into the stool, but push it against the wall of the bowel. (Or try the program without a suppository; usually finger stimulation is enough.)
  • Wait 5 or 10 minutes. Then help the person sit on a toilet or pot. If he cannot sit, have him lie on his left side (on top of old paper).
  • Put an oiled finger into the anus about 2 cm. Gently move the finger in circles for about 1 minute, until the anus relaxes and the stool pushes out.
  • Repeat the finger action 3 or 4 times, or until no more stool is felt.
  • Clean the butt and anus well and wash your hands.

Since the bowel does not push, the stool must be taken out with a finger. It is best done after each meal, or at least once a day.

  • If possible, do it sitting on a toilet or pot, or lying on your left side.
  • With a gloved and oiled finger, remove as much stool as you can.
  • Since a limp bowel tends to ooze stool, eat foods that make the stool firm or slightly constipated (not much stool-loosening foods).
a finger with a fingercot
A thin rubber glove or ‘fingercot’ helps keep the finger clean.
child lying on his side defecating onto platic sheet with help of mirror
plastic sheet
cloth or paper
If possible, have the child lie on his left side.
Children can learn to do their own ‘bowel program’.

For this kind of bowel, the bowel programs already described usually do not work. Finger stimulation makes the bowel act in the opposite direction, and pull the stool back in. The person will have ‘accidents’ during the day. Often it works better to,

  • First, put some anesthetic jelly (such as Xylocaine) up the anus. If you cannot get the jelly, you can mix some liquid injectable Xylocaine (lidocaine) with Vaseline or any other jelly.
  • Wait several minutes. Then do the automatic bowel program.
  • Do not use enemas or strong laxatives regularly. They stretch the bowel, injure its muscles, and make following a regular program more difficult. A mild laxative may be taken occasionally, when needed. However, drinking more liquid and eating food high in fiber is usually enough.
  • If there is bright red blood in the stool, probably a blood vessel was torn during the program. Be more gentle! If there is dark, old blood and the stools are black and tar-like, seek medical advice.
  • A small amount of liquid stool (diarrhea) may be a sign of 'impaction' (a ball of hard stool stuck in the gut). Only liquid can leak around it. Do not give medicine to stop diarrhea; this could make the impaction worse. Try to get it out with a finger.

A bowel program may at first seem difficult and messy. But it soon becomes an easy habit. It is very important both for the person’s health and his social well-being. Start now, do it regularly at the same hour, and DO NOT MISS A DAY.

This page was updated:21 Nov 2019