Bowel Programs

bmjcombine · 07-04-2002, 10:46 AM

Is there any healthy way to speed up the bowel program process? I would like to understand more about how the bowels work etc so I can better understand what might be done to speed up the process without causing any damage to the body. It sure would be nice to reduce the time spent.

stephen212 · 07-04-2002, 03:05 PM

Psyllium husk powder (the main ingredient in Metamucil) will significantly speed up your gut transit time. Totally natural, not a stimulant.

http://www.yerbaprima.com

julran · 07-04-2002, 10:01 PM

I don't know if you do your program at night or in the morn (I do mine in the morn) but it seems to help my bowel routine if I make sure to eat some breakfast and maybe drink something warm, like tea, beforehand. It just gets the whole gut system working...

One day at a time...

SCI-Nurse · 07-05-2002, 07:50 AM

julran and Stephen NYC make some excellent suggestions. Whatever your body's pattern was before you were injured, it's best to honor that and do bowel care at that time each day. Psyllium or some other form of fiber supplement is very helpful as well--it gives body to the stool and makes it easier to get out. Another possibility is an irritant laxative like senna or bisacodyl taken about eight hours before you plan to do your bowel care.

After spinal cord injury, the nerve supply to the large bowel is changed, somewhat. The upper two thirds of the large bowel, the ascending and transverse segments (as we call them in medical speak) are innervated by the vagus nerve which leaves the skull in the head and travels all through the gut. The lower third (the descending colon) is innervated from the sacral segments of the spinal cord. The problem is that the lower third is responsible for the push that forces stool out of the body. Hence we have to rely on reflexes in that part of the bowel to get the stool out. In my experience, as people with SCI age, those reflexes get weaker and take longer to work, and therefore bowel care gets longer and more tedious as people age and it eats up more of their quality time.

There are two surgical options for bowel care: colostomy and the Malone procedure. In the Malone procedure the surgeon takes the appendix and pulls it through the abdominal wall and opens a tiny stoma (it looks like a dimple and is hardly visible except when you look very closely). Then people can insert a rubber catheter and give an enema "from the top." this speeds up the process considerably. People often need to do dig stim to keep the anal sphincter open so things can flow out easily.

A colostomy is a little more disfiguring. It opens the colon onto the abdomen and leaves and small moist pinkish stoma that the poop can flow through. People have two choices--they can wear a larger bag and just let nature take its course and empty it as needed or do an "irrigation" which is to say an enema every morning to clean out the colon. They wear a smaller bag on the stoma during the day as insurance.

I know several SCI people who swear by their ostomy or Malone procedure and wouldn't dream of going back. I know others who feel they have been disfigured enough and don't want to have anything to do with either. It's an entirely personal choice.

I think it's important for a person to know what their options are, however.

RAB

07-04-2002, 10:46 AM	#1
bmjcombine Junior Member Join Date: Aug 2001 Location: Portland, Oregon Posts: 6	Bowel Programs Is there any healthy way to speed up the bowel program process? I would like to understand more about how the bowels work etc so I can better understand what might be done to speed up the process without causing any damage to the body. It sure would be nice to reduce the time spent.

07-04-2002, 03:05 PM	#2
stephen212 Senior Member Join Date: Jul 2001 Location: New York City Posts: 5,293	In a word: Psyllium Psyllium husk powder (the main ingredient in Metamucil) will significantly speed up your gut transit time. Totally natural, not a stimulant. http://www.yerbaprima.com

07-05-2002, 07:50 AM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,349	Speeding up bowel care julran and Stephen NYC make some excellent suggestions. Whatever your body's pattern was before you were injured, it's best to honor that and do bowel care at that time each day. Psyllium or some other form of fiber supplement is very helpful as well--it gives body to the stool and makes it easier to get out. Another possibility is an irritant laxative like senna or bisacodyl taken about eight hours before you plan to do your bowel care. After spinal cord injury, the nerve supply to the large bowel is changed, somewhat. The upper two thirds of the large bowel, the ascending and transverse segments (as we call them in medical speak) are innervated by the vagus nerve which leaves the skull in the head and travels all through the gut. The lower third (the descending colon) is innervated from the sacral segments of the spinal cord. The problem is that the lower third is responsible for the push that forces stool out of the body. Hence we have to rely on reflexes in that part of the bowel to get the stool out. In my experience, as people with SCI age, those reflexes get weaker and take longer to work, and therefore bowel care gets longer and more tedious as people age and it eats up more of their quality time. There are two surgical options for bowel care: colostomy and the Malone procedure. In the Malone procedure the surgeon takes the appendix and pulls it through the abdominal wall and opens a tiny stoma (it looks like a dimple and is hardly visible except when you look very closely). Then people can insert a rubber catheter and give an enema "from the top." this speeds up the process considerably. People often need to do dig stim to keep the anal sphincter open so things can flow out easily. A colostomy is a little more disfiguring. It opens the colon onto the abdomen and leaves and small moist pinkish stoma that the poop can flow through. People have two choices--they can wear a larger bag and just let nature take its course and empty it as needed or do an "irrigation" which is to say an enema every morning to clean out the colon. They wear a smaller bag on the stoma during the day as insurance. I know several SCI people who swear by their ostomy or Malone procedure and wouldn't dream of going back. I know others who feel they have been disfigured enough and don't want to have anything to do with either. It's an entirely personal choice. I think it's important for a person to know what their options are, however. RAB

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07-04-2002, 10:01 PM	#3
julran Senior Member Join Date: Mar 2002 Location: Gresham, OR Posts: 138	I don't know if you do your program at night or in the morn (I do mine in the morn) but it seems to help my bowel routine if I make sure to eat some breakfast and maybe drink something warm, like tea, beforehand. It just gets the whole gut system working... One day at a time...