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Unclogging the Pipes

Reprinted from PN/Paraplegia News August 2015

It’s not the most pleasant or easiest subject to write about, but bowel complications in people with spinal-cord injury or disease (SCI/D) are far too common and unfortunately, neurogenic bowel gets worse over time.

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Roughly 80% of people with SCI/D experience trouble with neurogenic bowel. The problems can be extremely embarrassing, including bowel accidents, loud, foul-smelling gas, pain and discomfort, which can prevent people from working, traveling and socializing.

However, there are precautions you can take on your own to help with neurogenic bowel issues. One of the first things is making sure to understand the signs of trouble.

Symptoms

It may sound odd, but diarrhea can actually be a sign of constipation.

It’s not uncommon for individuals with SCI/D to intentionally try to constipate themselves by limiting certain foods and fluids and taking anti-diarrhea medications to avoid a bowel accident.

However, when you become severely constipated and your stools become impacted, your body will try to get rid of the stool by liquefying it, which will actually cause diarrhea and potential bowel accidents. Constipation doesn’t protect against bowel accidents; in fact, it can make them worse.

For someone with an SCI/D it may be difficult to know if you’re constipated. These are some common signs and symptoms to watch for:

-Pebble-like stools

-Pain in the abdomen

-Hard or swollen lower abdomen

-Loss of appetite

-Headaches

-Nausea

-Sweating

-Autonomic dysreflexia

-Bowel accidents

Peristalsis is the involuntary muscular contraction that moves digested food matter through the intestines so it can be eliminated. SCI/D can alter peristalsis causing longer than normal transit time.

In an able-bodied person, the transit time of eating food to when you pass it should be between 18–24 hours. However, transit time can be up to twice as long in someone with SCI/D and this can result in such problems as gas, hemorrhoids, diverticulitis, colon distention and, of course, constipation.

Regular bowel movements are important since they help remove toxins, hormone byproducts and cholesterol. Therefore, the goal in managing neurogenic bowel is to keep stools soft, well-formed and moving through the intestine as easily as possible while avoiding bowel accidents.

What and when you eat and how much fluid you drink can make a significant difference between a good bowel routine and a disastrous one.

Fiber Fill

One of the keys to maintaining a healthy bowel routine is eating enough fiber.

Fiber is critical for proper functioning of your large intestine and can help prevent and reverse constipation. It helps to absorb water, provide bulk to stools and make your stool more soft, slippery and pliable, which makes bowel evacuation easier.

There are two main types of fiber.

Soluble fiber forms a gel-like substance that helps prevent and alleviate constipation by making stool softer, moister and more pliable. Good sources of soluble fiber include: barley, beans, peas, oats, apricots, bananas, berries, figs, grapes, prunes, peaches and pears.

Insoluble fiber passes through the intestines relatively unchanged and adds bulk to stools, which can help push matter through your colon and relieve constipation. Good food sources of insoluble fiber include: seeds, whole grains and the skins of many fruits and vegetables.

How Much?

Although the type of fiber you eat is important, it’s also important to ensure you’re getting enough of it.

A 1996 Australian study from Austin Hospital and Deakin University found individuals with a SCI/D should consume between 19–30 grams of fiber a day. Any more or less can create issues such as increasing bowel transit time.

The research found that amount decreases bowel transit time, increases the amount of stool being passed during a bowel routine and creates better stool consistency to help prevent bowel accidents.

The chart below can help you get an idea of how much fiber is in what foods:

Food Amount Grams of Fiber

Brown rice: 1 cup; 2.6 grams

Brussel sprouts: 1 cup; 4 grams

Blueberries: 1 cup; 4 grams

Spinach: 1 cup; 4.2 grams

Carrots: 1 cup; 5 grams

Broccoli: 1 cup; 5 grams

Bananas: 1 large; 5 grams

Quinoa: 1 cup; 5.2 grams

Sweet potato: 1 cup; 6 grams

Prunes: 6 prunes; 6 grams

Winter squash: 1 cup; 6 grams

Apple with skin: 1 medium; 4 grams

Pear with skin: 1 medium; 4 grams

Oatmeal (not instant): 1 cup; 8.2 grams

Lentils: 1 cup; 8.4 grams

Peas: 1 cup; 9.4 grams

Baked beans: 1 cup; 13 grams

Lima beans: 1 cup; 13 grams

Chick peas: 1 cup; 14 grams

Kidney beans: 1 cup; 16 grams

Barley: 1 cup; 16 grams

Pop A Pill

If you can’t get enough fiber from your diet, you can take a fiber supplement such as:

-Whole husk psyllium

-Ground flax seeds

-Ground chia seeds

-Apple pectin

These supplements help to absorb water, and help to soften and bulk up your stool which all help to reduce constipation without the side effects associated with laxatives. You can add these to your smoothies, juice or sprinkle them on salads.

If using a fiber supplement, make sure to take it two hours apart from other supplements and medications. They can be absorbed by the fiber and eliminated from your body, thus reducing their effectiveness.

Drink Up

Increasing fiber intake also means you need to drink more liquid.

Drinking 8–10 cups of healthy fluids such as water, herbal teas and water-based smoothies are important to avoid constipation and maintain a healthy bowel routine.

You should also limit liquids such as alcohol, coffee and sodas, which can contribute to dehydration and, subsequently, constipation.

Adding more fiber to your diet should lessen a need for laxatives and stool softeners while providing a more effective bowel routine.

For more information, visit eatwelllivewellwithsci.com.

Kylie James, CNP, and Joanne Smith, CNP, are co-authors of the Paralyzed Veterans of America-supported book Eat Well, Live Well with Spinal Cord Injury.

 

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Unclogging the Pipes

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