Daily bowel care program

Nerves that help your bowels work smoothly can be damaged after a brain or spinal cord injury. People with multiple sclerosis, longstanding diabetes, or certain other neurologic conditions may also have problems with their bowels. Symptoms may include:

• Constipation (hard bowel movements)
• Diarrhea (loose bowel movements)
• Loss of bowel control

A daily bowel care program can help you avoid embarrassment. Work with your health care provider.

Drinking 6 to 8 glasses of water daily allows stool to pass more easily through the colon and helps relieve constipation.

Keeping active helps prevent constipation. Try to walk, if you can. If you are in a wheelchair, ask your provider about exercises.

Eat plenty of food that is high in fiber. Read labels on packages and bottles to see how much fiber the food contains.

• Eat up to 30 grams of fiber a day.
• For children, add 5 to the child's age to get the number of fiber grams they need.

Once you find a bowel routine that works, stick with it.

• Pick a regular time to sit on the toilet, such as after a meal or warm bath. You may need to sit 2 or 3 times a day.
• Be patient. It may take 15 to 45 minutes to have a bowel movement.
• Try gently rubbing your stomach to help stool move through your colon.
• When you feel the urge to have a bowel movement, use the toilet right away. Do not wait.
• Consider drinking prune juice every day, if needed.

Use K-Y jelly, petroleum jelly, or mineral oil to help lubricate your rectal opening.

You may need to insert your finger into your rectum. Your provider can show you how to gently stimulate the area to help with bowel movements. You may also need to remove some of the stool.

You can use an enema, stool softener, or laxative until the stool is smaller and it is easier for you to have a bowel movement.

• When your bowel movements have been stable for about a month, slowly decrease the use of these medicines.
• Check with your provider before using laxatives every day. Using enemas and laxatives too often can sometimes make the problem worse.

Following a regular bowel program may help prevent accidents. Learn to become aware of signs that you need to have a bowel movement, such as:

• Feeling restless or cranky
• Passing more gas
• Feeling nausea
• Sweating above the navel, if you had a spinal cord injury

If you lose control of your bowels, ask yourself these questions:

• What did I eat or drink?
• Have I been following my bowel program?

Other tips that may help include:

• Always try to be near a bedpan or toilet. Make sure you have access to a bathroom.
• Always sit on a toilet or bedpan about 20 or 30 minutes after you eat.
• Use a glycerin or Dulcolax suppository at planned times when you are near a bathroom.

Know which foods stimulate your bowel or cause diarrhea. Common examples are milk, fruit juice, raw fruits, and beans or legumes.

Make sure you are not constipated. Some people with very bad constipation leak stools or leak fluid around the stool.

Contact your provider if you notice:

• Pain in your belly that does not go away
• Blood in your stool
• You are spending a longer amount of time on bowel care
• Your belly is very bloated or distended

Incontinence - care; Dysfunctional bowel - care; Neurogenic bowel - care

Iturrino JC, Lembo AJ. Constipation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 19.

Rodriguez GM, Stiens SA. Neurogenic bowel: dysfunction and rehabilitation. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

Zainea GG. Management of fecal impaction. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 208.

Updated by: Jenifer K. Lehrer, MD, Gastroenterologist, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.