BOWEL MANAGEMENT

02/14/2026

The memo the bowel system tries to send the brain is also unceremoniously intercepted by spinal cord injury, resulting in complications that range from constipation to accidents. The best way to prevent both? A bowel program, and good nutrition.

Nutrition

Because of bowel issues, lack of exercise, and our body's need for fiber and protein, we should be mindful of healthy eating. Spinal cord injury survivors are more likely than the general population to have health problems related to weight gain. Being overweight can make the transfer process more difficult, too.

We also deal with changes in cholesterol and high blood sugar and we are at a higher risk of cardiovascular disease. Because we do a lot of sitting down we have lower metabolic rates and energy/calorie needs. Avoid fried and fatty foods; eat fruit and vegetables. If you’re able to participate in any physical exercise, make this part of your daily routine.

Being underweight can be an issue for quadriplegics, too. If your weight is too low, you are at a greater risk for skin breakdown. Consume enough calories and protein to help prevent pressure ulcers from forming on the bony parts of your body. Protein shakes may help.

Eating higher amounts of plant-based foods reduces your risk of several types of cancer, and avoiding meat and dairy lowers risk of developing high blood pressure and heart disease.

Bowel Program

A “bowel program” is the best way to prevent accidents without surgery. This procedure consists of using a finger or device to get your bowels moving. Once the bowels get used to this stimulation they will tend to wait for it and you can plan your bowel movements.

Bowel care may not be performed in a nursing facility, but a good rehab will definitely have a system and train you and a caregiver, if you need assistance.

Choose a convenient time, such as during your morning or evening care routine. Wearing medical gloves, you or your caregiver will usually insert a suppository. We like Enemeez mini-enemas, and the Magic Bullet (a stimulant laxative).

Give the suppository a few minutes to work. If the bowel movement does not happen, your caregiver will insert a finger or a “dil stick" device into the rectum and move it in a circular motion for several minutes.

This process is referred to as “digital stimulation” and should help the bowels to move. It’s recommended to do this for at least 20 minutes if no stool is coming and until stool stops coming. You may need to have stool removed from your rectum if it does not come out on its own.

Perform the action lying on your side (left side better for bowels) in bed. Home Health nurses can assist with bowel care.

Constipation Concerns

If you don’t have help and can’t help yourself, you’ll need to use suppositories and laxatives, eat healthy, drink a ton of water, and get used to messes. It can be dangerous, as well as inconvenient, to live without bowel care and you might opt to get a colostomy procedure done in this case.

Evacuation of the bowels is very important. Constipation is an issue many of us deal with, and it can be a serious and even fatal problem if one of your intestines gets blocked. These are called bowel obstructions, and are typically caused by fecal impaction: a large, hard mass of poop that gets stuck in your digestive tract and can’t get pushed out. In some cases surgery may be necessary.

If you’re unable to pass stool, even with relaxants and digital stimulation, and if your belly is bloated and/or hard, you may have a fecal impaction, and you need to go to the hospital. There you may be given fluids through an IV. They may also run a thin tube called a nasogastric (NG) tube through your nose and into your stomach to let out fluids and gas to ease your symptoms. A doctor may put a stent in your intestine to force the bowel open.

Most partial blockages get better on their own, but other cases may need surgery. Surgery is usually the best treatment for a totally blocked intestine when your bowel is damaged. The doctor can treat the cause of the obstruction or take out the blocked area and any damaged tissue.

Seek your doctor’s advice if you haven’t had a bowel movement in three days, if your abdomen is bloated and hard, stools are hard, rocky and pellet-like, or if usual treatments have failed to relieve your symptoms.

How do we prevent constipation?

Keep track of your bowel movements. Look out for a hard, swollen belly.
Take a prescribed stool softener like Ducolax
Eat a well-balanced high fiber diet, fruits, vegetables and drink water
Take fiber supplements
Eat flaxseed
Consume laxatives like Metamucil, Miralax, and Exlax
Drink herbal teas like Traditional Medicinal's Organic Smooth Move Tea
Utilize a bowel care routine

Colostomy Procedure

This procedure is expensive and not always covered by insurance, but many quadriplegics who are able to get this procedure report their quality of life improving. It requires less attendant care and less of your time. In one study, nearly three-quarters of the spinal cord injury survivors with colostomies reported an improved quality of life.

A colostomy is a surgically-created hole leading out of your colon. A bag is placed over the new hole, on the outside of your abdomen, to collect waste. It’s a complicated and possibly risky surgical procedure. There’s also the recovery that follows it and the training needed to manage it, and some find there can be problems with odor. The colostomy site itself can have problems, too.

Some quadriplegics get the procedure because bowel care can be time-consuming, or they cannot perform it themselves and don’t have home health nurses or a caregiver comfortable doing it.

You may get an ileostomy instead. It’s on a different part of the small intestine and stool is mostly liquid because it doesn’t travel through the colon. Talk to your specialist about options for you.

"I wish I would have gotten the colostomy sooner. It saves a lot of time and little to no mess and I don’t recall when the last time was that I’ve had an embarrassing accident either. With a bag they simply empty and wipe the rim clean. Watch some YouTube videos on colostomy how to’s. I wish I would have done it sooner.” Tiffany, C4

“Overall it is a good thing. I don't have to plan my life around bowel care and never have any accidents. Asking someone to change a pouch is so much easier than walking them through bowel care and digital stimulation. The only downside is when you need to pass gas. It just happens and could be loud. Other than that it is easypeasy. I would do it again without question." Rob, C4-5

“I've had a colostomy for 3 years and although I did have some complications and had to go back in for surgery last year it is still way better than doing bowel program like I did the 23 years before getting it. While both do have their drawbacks, I wish I had had them from the beginning of my injury.” Tiffany, C 5-6

HEALTH INFORMATION ON THIS PAGE RETRIEVED FROM CLEVELAND CLINIC