Discussing Paralysis and Bowel Programs

Curated by
Whitney Bailey
Content via Christopher & Dana Reeve Foundation
Christopher & Dana Reeve Foundation
Curated by
Whitney Bailey

Nurse Linda highlights the management of the bowels and explains the importance of bowel programs for people with spinal cord injuries.

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“The bowel is a magnificent system that functions quite routinely. It is controlled voluntarily by the nervous system through the spinal cord sacral segments. But it is also directed by the autonomic nervous system which is not under your control but happens automatically. These two nervous system functions make the process of digestion and evacuation happen regardless of your injury level but can also lead to unfortunate incontinence if not managed. Keeping the bowel functioning with evacuation at an appropriate time is the key to a successful bowel program.”


Nurse Linda defines constipation as slow or difficulty moving and emptying the bowel. She states that constipation is common in those living with paralysis because of changes in the nervous system and immobility. Nurse Linda says exercising (or even just passive movement) your lower extremities will help mobilize your abdomen muscles which will encourage movement of the bowels.

Diet and Fluid

Diet and fluid directly affect bowel function. Nurse Linda states that eating food that contains roughage will enhance digestion of food moving through the bowels. Whole grains and vegetables contain roughage. Drinking enough fluid throughout the day will not only greatly impact your urinary system but also improves the process of waste in your bowels. The more moisture in your stool, the easier it is for it to move out of your system.

If you continue to have trouble moving your bowels, there are bulk additives that can be taken with fluid. “Be sure you take in enough water as recommended in the instructions to ensure that the bulk additive is able to move through the bowel,” says Nurse Linda.


The gastrocolic reflex is when the bowel can be stimulated to be emptied when food or fluid is put into the gut. This reflex is strongest with breakfast because the gut has been quiet while sleeping throughout the night. However, the reflex can occur with every meal.

“This does not mean that you have to perform your bowel program in the morning.  If you prefer an evening bowel program, you can trigger the gastrocolic reflex by eating a small snack in the evening or even drinking hot water. Think of people drinking coffee which stimulates a bowel movement. It is mostly the hot water that is at work stimulating the gastrocolic reflex.”

Digital Stimulation

Nurse Linda states that digital stimulation is done to open the internal and external sphincters which hold the rectum closed. The external sphincter can be seen. The internal sphincter can be felt by inserting the finger into the rectum. Nurse Linda’s advice for this process is to “be sure to use enough lubricant to create a smooth pass for your finger. Don’t be too aggressive or rough with the stimulation. The purpose is to relax the sphincters and stimulate the bowel to function which will allow the stool to pass. This is not an aggressive action. If finger function is difficult, rectal stimulators can be purchased.”

Bowel Program

Nurse Linda states that bowel programs should be performed every other day, typically 20 minutes after eating (though some people prefer an every day routine). Bowel programs should be done around the same time on the days performed. A suppository is the most common practice for a bowel program. But, make sure it is stuck against the rectal wall for best results. Gravity is a key factor in a successful bowel program, so complete your bowel program while sitting up if possible.

“In a perfect world, this will work without problems, however, as we all know, this is not always the case. Incontinences occur, the program can take longer than expected, hemorrhoids appear. There are a variety of complications that occur. Even with the best of habits, accidents happen. It takes a while to gain confidence in your bowel habits. Constipation or diarrhea can occur for no reason when following your routine diet. Aggressive digital stimulation and prolonged sitting on the toilet can produce hemorrhoids. These issues occur not because of any insufficiency on your part but just as life changes.”

Check out Nurse Linda’s full article for more details.

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