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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.
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 after a disability can result from reduced activity, nerve damage, muscle weakness, cognitive or speech issues, and medication or diet. These factors may affect awareness, control, and ability to manage toileting.
Constipation is a common issue, defined as no bowel movement for three or more days. Symptoms include hard stools and bloating. Causes include low fluid intake, inactivity, poor diet, medication side effects, and ignoring the urge to go.
To manage constipation, drink six to eight glasses of fluid daily, eat fiber-rich foods, and consult a doctor about stool softeners or laxatives. If needed, ask about suppositories or enemas.
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.
Impaction - Hard stool plugging the rectum
Symptoms of impaction include hard stools, bloating, and leaking of loose or liquid stool. It is often caused by low fluid intake, inactivity, poor diet, medication side effects, or chronic constipation.
Treatment may involve manual removal of stool, but this should only be done after consulting a physician or healthcare provider to ensure it is appropriate.
Diarrhea - Loose or liquid stool (usually three or more times a day).
Symptoms include large amounts of loose or watery stool. Common causes are illness (such as cold or flu), poor diet (especially spicy or greasy foods), and excessive use of laxatives or stool softeners.
To manage symptoms, check for impaction with a rectal exam, stop all laxatives and stool softeners, drink plenty of fluids, and consult your healthcare provider about using specific fiber supplements.
Hemorrhoids – Swelling or bleeding of tissue around the rectum
Symptoms include red, bulging areas inside or outside the rectum, pain, and rectal bleeding after bowel movements. Causes include chronic constipation, hard stools, and manual stool removal.
Treatment may involve using doctor-recommended medications like Anusol™ or Preparation H™. If stools are hard, follow constipation management guidelines and drink plenty of fluids.
Incontinence - Problems controlling bowel movements
Symptoms include difficulty starting or stopping bowel movements and lack of awareness of when they occur. Causes may include reduced mobility, communication challenges, medication side effects, and uncontrolled diarrhea.
To manage symptoms, track bowel habits to identify a pattern—some people go daily, others every few days. Try sitting on the toilet after meals for 30 to 60 minutes. Use a toilet or commode instead of a bedpan when possible. Consult your healthcare provider about using suppositories to help regulate bowel movements.
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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
