What is it?
After a spinal cord injury, your bowel cannot signal "I am full" to your brain in the normal way. Bowel control may be lost, but with a planned program you can have a predictable, accident-free routine that fits your life.
There are two main bowel patterns after SCI:
- Reflexic (UMN) bowel — injury at or above L1. The reflex arc still fires when the rectum fills. Suppositories and digital stimulation work well.
- Areflexic (LMN) bowel — injury below L1, including cauda equina. Slower-moving, prone to constipation and accidents from positional change.
How you might feel
- Constipation that lasts more than 2–3 days
- Accidents between scheduled program times
- Stomach cramping, bloating, or distension
- Sweating, headache, or AD signs (above T6) when the bowel is full
- Hemorrhoids or rectal bleeding from straining
What a good bowel program looks like
- Same time, same place every day (or every other day). The body trains to a schedule. After breakfast or dinner uses the gastrocolic reflex.
- Sit upright if possible — gravity helps.
- Trigger the reflex. Reflexic bowel: glycerin or bisacodyl suppository, then digital stimulation (gloved finger, lubricated, gentle circular motion against the rectal wall, 15–20 seconds, every 5–10 minutes). Areflexic bowel: mini-enema (Enemeez) or manual evacuation. Digital stimulation does not work well.
- Allow 30–45 minutes for completion.
- Skin check of the perianal area afterward.
💡 Tip
If your program is taking more than an hour or you are having frequent accidents, it is broken. Talk to your team — small adjustments to medicine timing, diet, or equipment usually fix it.
What helps
- Fiber: 15–25 grams per day. Adjust over weeks, not days.
- Fluids: match what your team set, usually 2 liters per day.
- Daily standing or weight-bearing if cleared.
- Activity: even small amounts help motility.
- Transanal irrigation (Peristeen, Aquaflush) — a daily or every-other-day water flush of the lower colon. Many patients report shorter program time and far fewer accidents. Discuss with your team.
💊 Medicines
- Stool softeners — docusate 100 mg twice daily.
- Stimulant laxatives — senna, bisacodyl. Adjust to keep stool soft and predictable.
- Polyethylene glycol (MiraLAX) — gentle daily option.
- Avoid mineral oil long-term (lipid pneumonia risk if aspirated).
📞 Call your doctor if
- No bowel movement in 5 days despite the program.
- Severe abdominal pain or distension.
- Bright red blood with stool more than once.
- AD signs that resolve only after manual disimpaction (your bowel is too full).
At your next clinic visit
Bring a 2-week program log: time, what you used, what came out, any accidents. Don't reinvent your program every week — change one variable at a time and watch for 1–2 weeks.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.