Bowel-Related Complications

An unplanned bowel movement is accidental or involuntary. For many people, this is very stressful and embarrassing. Bowel accidents interfere with daily living activities and should try to be prevented. If they continue to be a problem despite efforts at correcting the issue, notify your doctor.

Causes

Bowel accidents can be caused by:

• Not doing the bowel program on time
• Not emptying the bowel completely
• Not doing the bowel program long enough, if doing digital stimulation
• Illness
• Not eating the right foods, such as eating foods that may upset the stomach
• Impactions
• Drinking alcoholic beverages

Prevention

• Do not miss a scheduled bowel program.
• Do the bowel program for the correct amount of time. If digital stimulation is part of the program, it should be done for about 20 minutes.
• Eat healthy foods.
• Avoid alcoholic beverages.
• Do bowel program early if you are going to be out during your normal bowel program time.

Treatment

• Go to a private place and clean the stool off your skin. Change clothes if necessary.
• Do a complete bowel program.
• Try to figure out what change in your diet or routines may have caused the bowel accident.

Constipation is defined as having hard stool or no stool from your bowel program for two days in a row, and it can lead to impaction. For persons with spinal cord injury above the T6 level, it may also lead to dysreflexia.

Causes

• Not enough fiber in the diet from foods such as fruits, vegetables, whole grain breads, and cereals
• Not doing the bowel program on time or correctly
• Not emptying the bowel completely
• Not exercising
• Changing the time of the bowel program
• Certain foods like dairy, fatty or fried meals
• Not enough water in the diet

Symptoms

• Very hard stool or no stool from your bowel program for 2 days in a row
• Hard, tight, or bloated abdomen
• Poor or no appetite
• Small amounts of blood in the stool

Prevention

• Eat fiber foods such as fruits, vegetables, whole grain breads, and cereals.
• Drink 6 to 8 glasses of water each day.
• Do the bowel program on time and do it right.
• Use a stool softener as ordered by the doctor.
• Stay on an exercise program.

Treatment

Persons having small amounts or hard stool from the bowel program can try these methods:

• Drink 1 to 2 cups of hot liquid, such as coffee or tea, about 30 minutes before the bowel program.
• Continue to drink 6 to 8 glasses of water a day.
• Eat more foods with fiber and fewer fatty, fried foods.
• Fruits, vegetables, and whole grains are great food choices.

If there has not been any stool for more than two days, try adding one stool softener to your program once a day. You may increase your dose to one capsule twice a day as needed.

On day three, try using a rectal suppository, such as Dulcolax or Magic Bullet, about 30 minutes before the bowel program. If a suppository is already part of the program, go to the next treatment. Try taking a mild laxative such as one Dulcolax tablet 6 hours before your next bowel program.

If you are still not having results on day four, try your regular bowel program. If there are no results, use an enema such as a Fleet or a soap suds enema.

If you have not had a bowel movement after four days, call the doctor.

Diarrhea is liquid stool. It occurs when food goes through the intestines too fast for it to be digested and the intestines are unable to absorb enough water from the stool. Diarrhea can cause dehydration and skin sores.

Causes

• Illnesses, such as flu or stomach virus
• Stress
• Possible impaction
• Certain medicines, such as antibiotics
• Too many stool softeners or laxatives

Symptoms

• Loose, watery stool

Prevention

• Eat a well-balanced diet.
• Avoid foods and drinks that cause diarrhea.
• If you are taking antibiotics, try eating yogurt, drinking buttermilk, or taking Lactinex tablets.

Treatment

Try these steps for routine diarrhea:

• Stop taking stool softeners or laxatives until diarrhea has stopped.
• Stop doing your bowel program until diarrhea has stopped.
• Protect your skin with a skin barrier product, such as A&D ointment, Desitin, or Vaseline.
• Avoid foods that make diarrhea worse (spicy foods, raw vegetables, fruits).
• Avoid alcoholic drinks.
• Drink clear liquids more than usual.
• Call the doctor if it lasts longer than 24 hours. If it is OK with your doctor, you may try some over-the-counter diarrhea medications.
• Wait for 24 hours after the last diarrhea stool to begin your regular bowel program.

An impaction is hard stool that is stuck in the bowel. For persons with spinal cord injury above the T6 level, it may also lead to dysreflexia.

Causes

• Impaction is caused by untreated constipation.

Symptoms

• No stool for four days or longer when attempting bowel program
• Hard, tight, or bloated abdomen
• No appetite
• Loose stool leaking out of rectum
• Small amounts of blood in stool

Treatment

• Call the doctor as soon as possible.
• Take the special laxative that the doctor orders.
• Once the laxative begins to work, begin to manually remove the hard stool out of the rectum.
• Gather supplies:
  • Gloves
  • Lubricant
  • Plastic bag to throw away waste
  • Soap, water, washcloth, and towel
  • Toilet paper
  • Underpads
  • Raised toilet seat, commode chair or shower chair
  • Someone to help with the procedure (optional)
• Wash hands and prepare all supplies.
• Do procedure in bed or in the bathroom on commode chair, ActiveAid or raised toilet seat (the location of usual bowel program).
• Put gloves on both hands.
• Place a generous amount of lubricant on tip of finger. You may need to use a numbing gel to prevent dysreflexia.
• Insert finger into the rectum and gently remove pieces of hard stool.
• After the impaction is removed, do the regular bowel program.
• When finished with the bowel program, wipe rectal area and buttocks area with toilet paper, clean with soap and water and dry well.
• Wash hands.
• If dysreflexia occurs, stop impaction procedures to treat it.

Causes

Rectal bleeding can be caused by impaction, constipation, hemorrhoids, or doing digital stimulation too intensely or with long fingernails.

Symptoms

• Blood may be seen in the stool on the glove or the dil stick during a bowel program.
• Blood may also be noted on the washcloth or toilet paper during cleaning times.

Prevention

• Do dils more gently.
• Keep fingernails trimmed short when doing a dil or using a suppository.
• Use lubricating jelly with every dil or suppository insertion.
• If hemorrhoids are present, you may need an Anusol suppository or Preparation H cream before the bowel program to help shrink hemorrhoids.

Treatment

• If doing a dil or manual evacuation, stop.
• Try to find out the cause of the bleeding.
• Call the doctor right away if the bleeding is profuse.
• Call the doctor right away if you continue to bleed small amounts or ooze blood after 1 to 2 hours.
• Call the doctor during regular hours (not on an emergency basis) if you notice small flecks of blood or small streaks of blood on the toilet tissue.

If you notice black stool, you should also call your doctor during regular office hours. Black stool can also be a sign of bleeding. The doctor will be able to give you further instructions.

Depending on your specific situation, the doctor may order a stool softener or anti-hemorrhoidal cream or may ask for you to come in for an office visit.

Call the doctor if prevention and treatment steps do not help stop the bleeding during your bowel program.

Here are some simple tips to keep the bowel working well and help prevent bowel problems.

• Stay on schedule with your bowel program.
• Do the bowel program as you learned it in rehabilitation. Do not skip bowel programs or do them halfway.
• Try doing the bowel program about 30 minutes after a meal, which may help with emptying.
• Drink a hot beverage, such as coffee or tea, about 30 minutes before the bowel program. Sometimes a warm beverage helps the bowel to empty.
• Massage the abdomen during the bowel program.
• Do not take laxatives or enemas unless your doctor tells you to do so.
• Drink 6 to 8 glasses of water daily.
• Eat a balanced diet that includes fruit, vegetables, and whole grain foods. Avoid foods that can cause diarrhea.
• Exercise regularly, as permitted by your doctor.