Bowel and Bladder
After an SCI
Following a spinal cord injury or illness, you may experience bladder and bowel problems. The brain and spinal cord play a key role in controlling bodily functions, so any damage to the spine will result in changes to your bladder. About 80% of people who have sustained an SCI will experience bladder dysfunction.
When no messages to contract the bladder are received, then the bladder is not emptying, and it retains urine. The urine must be emptied to maintain health and prevent damage to the kidneys, this is most often achieved using intermittent catheterisation.
Depending on the level of your injury, your bladder will function differently to how it did before you had an SCI. You will either have a flaccid bladder – where the bladder will not empty automatically when full. Or a reflex bladder – where the bladder empties spontaneously when full.
Typical symptoms of urinary problems associated with an SCI
- Small or large amounts of urine leaking without warning or without feeling the urge to go to the toilet
- Inability of the bladder to empty completely
- Urinary tract infections (UTIs)
A good source of information is the Back on Track handbook, which you will receive while you are in the spinal unit. You will also be assessed by the Urology team who will help you find solutions and give options, so you can get back to a normal life.
Taking care of your bowel
After a spinal cord impairment, the messages sent by the nerves located in your bowel are not able to reach your brain as they did before your injury. This means that stool will pass more slowly through your gut which can lead to constipation and you will not get the message that tells you your bowel is full, and it is time to go to the toilet. Many people with a SCI will experience bowel dysfunction known as neurogenic bowel, which means they have a decreased ability to control their bowel.
A neurogenic bowel can lead to bowel leakage, constipation, or both. The degree of severity of the bowel symptoms depends on the extent and level of the spinal cord injury.
If your spinal cord injury is above T12 your bowel will usually continue to empty when stimulated. The normal sensation which indicates that the bowel is full is lost. The vital messages needed telling you the bowel is full do not reach the brain. Reflexes which partly control bowel movement are still present so the muscles in your lower bowel, rectum and anal sphincter are still active and you or your carer may be able to trigger them to empty your bowel at a convenient time. Care must be taken to ensure that the rectum is properly empty as this will avoid a bowel accident later in the day.
If your spinal cord injury is at or below T12 your bowel will not fully empty, even when stimulated. The nerves between your bowel and spinal cord have been damaged therefore reflexes are lost. Your rectum will continue to fill with faeces which may leak out as the anal muscles stay relaxed.
If your injury is incomplete or is around T12, you may find that your bowel takes on a mix of both the above.
The aim of bowel training is to assist your bowel to empty at regular intervals; this could be every day, alternate days, morning, or night. The intervals that will suit you will depend on your lifestyle, e.g how many hours you work or study, social activities, number of carer hours etc. There are two important factors that will help with caring for your bowel are and diet and regularly emptying your bowel. Diet is very important as eating the ‘right’ food will help you to produce soft bulky stools that are easy to pass. Talk to the dietitian in the spinal unit about what will work best for you. Regularity – how often you apply your bowel cares and establishing a routine will take time, several weeks, the staff in the spinal unit can help with establishing a routine.
Why is it important to carry out good bowel care?
- To maximise your independence
- To help maintain good health
- To prevent complications such as constipation and diarrhoea but of which may necessitate disruption of your daily routines
- Help prevent pressure ulcers and infections by maintaining dry / intact skin
- Minimise damage to the bowel
- Help prevent Autonomic Dysreflexia
- Maintain self-esteem.