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Thread: Bowel Management in Aging Paraplegic

  1. #11
    My husband has a lower motor neuron sci with flaccid paralysis.
    KLD is correct. Fibercon is a bulking laxative and may be appropriate in your condition as it was with his. Try it as your only laxative for a few weeks and see if you notice a change for the better.

  2. #12
    Quote Originally Posted by 2drwhofans View Post
    My husband has a lower motor neuron sci with flaccid paralysis.
    KLD is correct. Fibercon is a bulking laxative and may be appropriate in your condition as it was with his. Try it as your only laxative for a few weeks and see if you notice a change for the better.
    Thank you! What’s the best time to take Fibercon?

  3. #13
    My Dad also is an aging paraplegic with a lower motor neuron injury. When he went through a period with looser stools, his gastroenterologist also recommended Metamucil/fiber and starting a probiotic. For my Dad, it caused a rapid improvement within a couple days. I don't think the time of day he took it was critical, as nothing works too fast for him.

    Check the instructions for whatever you take. Often you need to separate it from any pills/medicines you are taking by a few hours, or it will affect their absorption.

    Let us know how it works for you.

  4. #14
    Thanks for the advice. I started the Fibercon yesterday.

    I don’t have a completely flaccid bowel. I do have some reflex, albeit very little. In researching this, I’ve found some people with SCI in the T11/12 area, like myself, don’t always fit nicely into one type of bowel or the other.

    It does make sense to me that adding consistent bulk might be the solution. I hope the Fibercon helps me develop a consistent stool from start to finish... not just the start with the end turning very soft and runny. I have tried to do this via my diet and eat a lot of fiber, especially insoluble fiber, but it really hasn’t made any difference.

  5. #15
    How do you tell if you have a flaccid or spastic anal sphincter?

  6. #16
    Senior Member lynnifer's Avatar
    Join Date
    Aug 2002
    Windsor ON Canada
    Ahem ... my friend has a spastic one and is prone to accidents. The only time I've had a bowel accident with my flaccid bowel is after the prolapse (could not reach all like the OP).
    When injustice becomes law, resistance becomes duty.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  7. #17
    Quote Originally Posted by CGray255 View Post
    Thank you! What’s the best time to take Fibercon?
    My husband takes most of his medications, including Fibercon, in the early morning. Bowel program is in the early evening
    Can't say if it's the best time, it just worked out for him.

  8. #18
    Quote Originally Posted by wheelman21 View Post
    How do you tell if you have a flaccid or spastic anal sphincter?

    The "index-fingertip handshake".
    Flaccid sphincter won't squeeze tight.

  9. #19
    Senior Member
    Join Date
    Jun 2005
    East Bay in the San Francisco area
    Quote Originally Posted by wheelman21 View Post
    How do you tell if you have a flaccid or spastic anal sphincter?
    The following definitions are based on level of spinal cord injury. It is possible to be a little bit of both, spastic and flaccid.

    A spastic neurogenic bowel is caused when messages between the brain and the colon are interrupted (stopped) when a SCI is at the neck (cervical) or chest (thoracic) level.

    A flaccid, or “limp” neurogenic bowel is caused by a spinal cord injury at the lumbar (lower back) or sacral (tail bone) area of the spinal cord. The nerves that go out from this area to the bowel also may have been damaged, decreasing the reflex (automatic) control of the anal sphincter.

    A SCI may result in a loss of ability to feel when the rectum is full. Bowel movements occur reflexively when the rectum is full. This type of bowel problem is called an upper motor neuron or "reflexic bowel." It can be managed by causing the defecation reflex to occur at a socially appropriate time and place.

    A spinal cord injury level may damage the defecation reflex and relax the anal sphincter muscle. This is known as a lower motor neuron, “flaccid” or “areflexic” bowel. Management of this type of bowel problem may require more frequent attempts to empty the bowel and bearing down or manual removal of stool.

    The following article is a bit more comprehensive:
    How paralysis impacts the digestive and bowel systems
    Christopher and Dana Reeve Foundation

  10. #20
    I posted a few weeks ago seeking advice with my bowel program. My thanks to those who responded with great suggestions. I’m writing again to follow up as I am still wrestling with my bowel incontinence issues. I apologize in advance for this long-winded message. I want to be as detailed as possible so that it may key a critical insight from someone.

    To recap: I’m a T11/12 para, 38 years post injury, age 62. I’m experiencing significant issues and problems with my bowel program. I went years and years without worrying about bowel accidents. The rare accident went with the territory. I started experiencing increased bowel accidents about 3 years ago when shoulder deterioration prevented me from participating in regular aerobic cardiovascular exercise, and has gotten progressively worse.

    I have a bowel that is mostly reflexive but also has some aspects that seem flaccid in nature too. It seems that my bowel might becoming increasingly flaccid with age, if that’s possible. I have never had much spasticity in my legs.

    My routine is: I use 1/3 of a Magic Bullet to initiate my BP every other morning about 1/2 hour after breakfast. That usually produces a 1st pass of Type 3/Type 4 stool that is medium in quantity. After this, I use Valsalva and Digital Stimulation to produce a usually larger amount of Type 4 stool. I then need to resort to deeper Digital Stimulation and Manual Extraction to remove additional stool that gets increasingly softer, often becoming Type 5 by the time I think I’m finished. It’s hard to tell when I’m actually done because I still feel some pressure in my lower left gut even when I think I’m done. This process can take over a hour from start to finish. It’s not unusual now for me so smell bowel emanations without flatulence throughout the day.

    The problem I’m experiencing is that very often, I experience additional, unexpected bowel incontinence later in the day, sometimes as much as 3 or 4 hours after the BP. This stool is usually Type 5 soft stool too. I also occasionally have accidents on non-BP days too. I now often go back on the toilet later in the afternoon to see if I can pass any additional stool before it passes of it’s own accord.

    I have tried several things including changing from a daily BP to my current every other day schedule. This seemed to have some positive affect at first. At the very least, I was able to have a day off in between these BPs which had become so time consuming and frustrating with the accidents.

    The basic essence of my problem seems to be that despite whatever I do, I’m unable to get consistent bulk in my stool throughout my BP and the soft stool is harder to pass, manage, and predict.

    I eat very well, 4 times a day, with a total caloric intake of about 1650 calories. I average about 30g of fiber daily with a good balance of soluble and non-soluble intake. I drink plenty of water. At the recommendations of the SCI Nurse and others in this forum, I take 6 Fibercon a day (eaten 2, 1, 2, 1 with my meals) to add bulk to my stool. That has helped somewhat with the initial passing of stool, but the transition to softer stool as the BP progresses is still the issue. I do keep an accurate food log and BP notes.

    My last colonoscopy was 2 years ago and everything internal was fine though my gastroenterologist did comment of some irritation in my rectum which she said was predictable. My Bowel Transit Time is between 20 to 22 hours. She suggested I could try Imodium proactively to slow my bowel down. I did that and it helped a bit of the front end of the BP but I still had lingering issues with not being able to consistently get all the residual soft stool. I still take Imodium if I experience particularly runny bowels. I have been told that taking it regularly is not good with my solitary kidney, and it wasn’t completely eliminating the problem.

    I believe that there must be something in my diet, my BP techniques or routine, or in the changing dynamics of my paralyzed bowel that I’m missing.

    So, I’m looking for advice and guidance. I would welcome a full workup with someone who has knowledge and experience with bowel management in aging paras. It seems that this particular issue is somewhere in the area between SCI Rehab docs/nurses and GI docs. I have been unable to locate the expert advice I need.

    Do you have any recommendations for me that would address any of the issues I’ve explained? Do you have any knowledge of professionals that have expertise in this area that I might consult?

    Thank you very much.

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