4 replies to this topic

[KGO]

Hi all, found this great site while searching for some info and am now posting on behalf of my mom.

She was involved in a car accident about 11 years ago which resulted in her being a paraplegic. She cannot move her legs and has partial movement in her arms/hands.

Anyways, the reason for my post is to see if I can get some more information on bowel movements. My mom spends the greater part of her day doing her bowel movements and trying to get the bowels to come out. As a result of this she doesn't sleep until 7AM and wakes up at 11AM and is always complaining about how tired she is.

Because we are an Asian family, she eats rice for 2 of her meals a day with some fish, vegetables, and some soup. For breakfast she has a small bowel of cereal with milk. Her breakfast is at 12PM, her lunch is at 10PM, and her dinner is at 3AM. She spends are time in between meals doing exercises and sitting on a toilet. I don't think this is very healthy which is why I want to do something to help her change.

Honestly, I think in any given day she spends 10+ hours sitting on the toilet. I would say 80% of her bowels come out in the afternoon during or after her exercise. She spends the rest of the time trying to get out the other 20%. For her urine she uses a catheter, and even with all the toilet sitting she uses an enema (Fleet) at the end of the night.

I tell her maybe since 80% of the stools come out it isn't "necessary" to make the other 20% come out. Obviously I'm not a paraplegic so I don't know what it feels like, but that's just what I'm thinking. However, she says that if all her stools don't come out, she has a lot of gas built up and it's very uncomfortable for her. She has a problem hiccuping/burping out the excess gas and says she always feels bloated if all her stools don't come out.

I've also suggested she look into a stoma/colostomy but she does not want to do it. My mom is 62 this year so she is quite stubborn in her ways. She tells me everyday how miserable she is and that all she does every single day is worry about bowels, gas, and hiccuping/burping. She does not go out and hasn't gone out for the last 6-7 years because of this (except for a 10 minute stroll in the afternoon everyday).

Any help or suggestions would be greatly appreciated. I'm not sure if her condition is normal for a paraplegic or if she is the exception here.

Thanks

[kewlcatkez]

Hi and welcome,

Please check out the recen t thread here on the site: http://www.apparelyz...l=bowel program

Here is what i offered there, repeated for ease of viewing for you, but that thread has advise from many others, fab advice too....:


""With regards to the "training" and developing a Bowel Program/routine, in order to achieve a regular bowel movement, pls read this link: http://www.spinal.co...lmanagement.pdf. It is actually the most comprehensive Bowel Management literature I have come across. A friend shared it with me when I was having my own difficulties. Even as a RN I have never seen such detailed information on this.

Not trying to teach grandma how to suck eggs, but we need to keep in the forefront if our mind that after SCI/D/Neurological deficit, the bowel will not work as it once did no matter what you do and that you can not train it. Instead you CAN develop a routine which will enable you to empty your bowel when it has sufficient faecal matter in there. You may dislike her having medications, but some of the ones you mention are merely to soften the stool and allow it to pass out more easily. It is not necessary to empty the bowel entirely, but that in the lower part of the bowel.

Medications such as antibiotics can screw up things for a while, so when taking them it is important to bear this in mind. Antibiotics which cause diarrhoea can often be changed for another less likely to provoke this.

Anyone with a Neurogenic Bowel (as in anyone with Paralysis affecting their lower body and sacrum) has degrees of slowed Peristalsis. This is why those of us affected by paralysis/neurological deficit need to find a Program..ie methods which allow her to empty our bowel, either independently (dig stim, stool softeners, medication) or with help (from a caregiver/aide). Posture also plays a part, laying on our left side ( where possible) during enema/suppository insertion aids natural emptying of the bowel, and peristalsis. Also warm water sipped just before and during Bowel Routine does help some people. Natural aids to assist with the bloating and gas are peppermint extract and camomille teas etc...

Fruit and vegetables speed up elimination, so eating those more ofeten then perhaps before, would perhaps lead to emptying the bowel more regularly than every 3 or 4 days. To be honest, a routine is still a routine if its every day, every second day or every 3.. A high fibre diet with 'roughage' and plenty of water is essential to maintaining a bowel routine. It takes time to establish a routine and even then things can change due to illness, spicy foods (or foods unusual to you), antibiotics and other medications being started, emotional upset etc. Excess caffeine and alcohol should be avoided due to its affects on the bowel and digestion. Smoking and the toxins introduced into the body via it is also a no no which most of us are aware of. Some authorities state smoking affects cells throughout the body, including the bowel (cell death and reduces cell renewal).

As touched on above, stool softeners,suppositories,enemas, digital stimulation etc are some of the things required to help with a bowel routine. Although in those WITHOUT a neurological deficit this is not recommended, this is not the case in those of us with a one. As our bodies no longer are able to do this alone and automatically, it is essential to assist it. Getting backed up with stool can lead to sever impaction, chronic constipation, (with their own side effects, which can be serious) and an abnormal dilatation of the colon.

Anyway, I have wittered on for far too long. I apologise for the length of this, but hope that its useful to someone. Of course as always,no matter who is giving the opinion/advice, we should always check with our health care provider..

Take care,

K


hope this and the info within the threads helps, it may also be worth asking for advise from the spinal unit/rehab facility and if she isn't seeing them regularly for a referral. Also continence specialist nurses etc also deal with Faecal/bowel issues so that may be another port of call. Its worth remembering that sometimes we can become obsessive about bowel movements each day or something, and that if she didn't used to have a bowel movement each day prior to injury, then it may be right for her to have an every otherday pattern for example now...

Please do ask if anything is unclear..

good luck,

K

[KGO]

Hi K,

Thanks for the link and pasting it here I actually read that thread before I posted, but I guess I still wasn't sure exactly how to approach my mom's situation.

From what I understand, people with SCI will need some sort of bowel program, and for each person it will be different, right?

But is my mom's situation considered normal for someone with SCI? To me it seems like she spends her entire day trying to get her bowels out, and I just can't believe there isn't a better way to go about it than what she's currently doing. From what I read in the thread you linked, it seems like most people only spent a few hours a day, and some don't even do it every single day (which my mom does).

I would say everyday, from about 5PM to 5AM, she is working on her bowels. That's a full 12 hours every single day for the last 5-6 years spent on bowel movement... and I just imagine if she could spend only a fraction of the time on bowels, it would free up so much more time for her to enjoy life or go out or do something else. I mean on top of taking whatever meds she takes, she has 1 Fibregel pack a day, some Chinese medicines, and has the Fleet enema every night. I just want to believe this is not all completely necessary...

And is it normal for the gas to buildup? I'm pretty sure she's exaggerating, but if her bowels are late 1 hour or something she tells me she feels like dying and that her stomach feels so bloated.

I don't really know what to do, all the docs she visits tell her she's healthy and fine and that it's normal to have weak bowel movements because of her spinal cord injury.

[qbounce]

Try this:

!). Use a suppository--either oil or water based stimulant bullet that's inserted into the rectum. It's used to help stimulate and soften the bowel causing the muscles to move. Most of the BM comes out from this.

2). Digitally Stimulate the bowels--aka Dig Stim. After most of the BM has been excreted, you will have to use a finger (gloved and lubricated with petrlium jelly), and insert it in the rectum 2 digits deep. Then gently rotate the finger in a swirling motion around the anus muscles for up to two minutes, causing the remainder of the MB to clear out. Wait 5 minutes and repeat until the glove is clear of any residual BM.

Note: continue using stool softeners if there are no accidents during the day, dut if accidents do occur, you may not need softeners.
Practice a healthy balanced diet.

This method takes SCI's anywhere from 1-3 hrs. depending. Some do their routine's every other day or even every three days.


KGO, This info's listed in what Kewlcat gave you, it's just that with ALL the info it comes off as a bit daunting. So I decided to cut to the chase and give you a method MANY para's/quad's use. Then you can play around with it, what suppository you use, whether you choose to go every other day (eventually), etc. So many options are available to you, but it sounds like she wasn't even told the basics. I hope things work out, but to be honest, ANYTHING'S better than a 12hr. BM!!

[KGO]

qbounce,

Thanks for the reply, I think that's a very helpful start for my mom.

I'm still curious though... a majority of the stools comes out in the afternoon during her exercise routine, but she spends the rest of the night/day getting the remainder out. Is this really necessary? I told her since the majority of her stools have already come out, it's not necessary to get everything out.

But she says she will have the urge to get the remainder out, and that if she leaves it until the next day she is afraid of the stools getting hard and then being impossible to get out. And I guess also the remaining stools will trickle out by themselves over time... is there any way to prevent this?

Lastly, I think the other major problem for her now is gas. If she can't get the gas out by burping/hiccuping or bowel movements then she really feels miserable. Is there a way to get rid of the gas, or will going on a bowel routine result in the gas being cured as well?

Thanks for all the helpful replies so far, I think this is going to be the best thing to happen to my mom since her accident