Why Does S#*T Happen?
The Rollin’ RNs are always in search of new topics to explore and a FB thread of posts on bowel accidents frequently pops up in our spinal cord injury (SCI) groups. So, after discussing it, and being familiar with this ourselves, we decided this would be a great topic to investigate and to share our findings.
First, a little background of the digestive system. In most people with SCI, the gastrointestinal (GI) tract is disrupted. The term for this disorder is Neurogenic Bowel, which simply means loss of bowel function. With normal bowel function, the nerves control muscles to allow for the stool to pass through the intestinal tract. When the nerve signal is interrupted, as is often common with SCI, so is the activity of the intestinal tract. Because neurogenic bowel disrupts the ability to store and get rid of waste, it often causes constipation and/or bowel accidents, a topic we are all too aware of. Allow us to explain the normal occurrences:
The food you eat goes to your gastrointestinal (GI) tract for digestion. You might think of your GI tract as a long drain pipe. Here is how it works:
Muscles around the GI tract push the food by contracting and squeezing the tube in a wave-like pattern (peristalsis).
Starting at the mouth, food goes down the food pipe (esophagus) to the stomach.
It then goes into the intestines or bowel. The first part of the intestines absorbs the nutrients. The food your body can not use then goes on into the large intestine (colon).
Your colon reabsorbs excess water from the undigested food (called stool). The stool is stored in the last part of the GI tract called the rectum. It’s from there, the stool is expelled.
Most of this process is disrupted by that little issue many of us have, SCI. Nerves of the rectum signal when the rectum is full, but when this signal occurs, we may be unable to detect it, so our body tries other methods to get our attention. And if we continue to ignore these subtle little cues from our body, ultimately autonomic dysreflexia (AD) can occur (for those of us with an injury level of T6 and higher). Either we get rid of the excess waste by doing our bowel program or deal with the dreaded stool accident that’s likely to occur, commonly referred to as “code brown”. A show of hands for those of us who have lived through this experience whether it be small or HUGE because regardless, it is an ugly occurrence and usually transpires at the worst time like at a group gathering, on an airplane, at an event, and this list goes on and on.
Because our bowels do not work as they did before our SCI, we may experience some of the following symptoms:
Constipation or diarrhea
Trouble having a BM
Loss of feeling that the bowel is full
Upset stomach (nausea) or belly pain
Stool leaking or frequent BM accidents
What can we do to prevent bowel accidents?
People with neurogenic bowels should have a regular, routine bowel management program in place. This includes scheduled routines to remove the stool from the rectum on a regular basis. This helps prevent accidents, constipation, and bowel blockage. A bowel program also includes diet changes, medicines, and other methods to keep you “regular” and may be the best and easiest solution in preventing accidents. (Click here to see our article on bowel care.) Your healthcare team can help you create a bowel management program. And once your bowel program is established and working well for you, stick with it. Avoid making changes to it, skipping days, or not doing it at all. It’s a big learning curve to get to know how your bowel system works best for you after SCI. But ultimately, with time, trial and error, and lots of patience you can come up with a plan that can help you avoid those untimely “code browns”.
It's all good, so keep on rollin,’
Roberta, RN and Patty, BSN, RNC
The Rollin’ RNs ™
References: Acute Gastric Dilatation in a Patient with Spinal Injury and Multiple Myeloma. Bowel Management After Spinal Cord Injury https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093701/ Neurogenic Bowel https://www.cedars-sinai.org/health-library/diseases-and-conditions/n/neurogenic-bowel.html Bowel Management After Spinal Cord Injury https://www.sci-info-pages.com/bowel-management/