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Patient Instructions

Nerves that help your bowels work smoothly can be damaged after a brain or spinal cord injury. People with multiple sclerosis also have similar problems with their bowels. Symptoms may include loss of control, diarrhea or loose bowel movements, and constipation or hard bowel movements.

A daily bowel care program can help you avoid embarrassment and spend less time on bowel care if you work with your doctor or nurse.

Consider drinking prune juice every day, if needed. Keeping active helps to prevent constipation. Try to walk, if you can. If you are in a wheelchair, ask your doctor or nurse about exercises.

Eat plenty of food that is high in fiber. Read labels on packages and bottles.

• Up to 30 g a day
• For children, add five to the child's age to get the number of grams of fiber they need.

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

• Pick a regular time for sitting on the toilet, such as after a meal or a warm bath. You may need to do this 2 or 3 times a day.
• Be patient. It may take 15 to 45 minutes to have bowel movements.
• 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.

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

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

You may need to use an enema, stool softener, or laxative for a period of time until the stool size is smaller and it is easier to have a bowel movement.

• When things are stable for about a month, slowly decrease use of these aides.
• Always work with your doctor or nurse. Using enemas and laxatives too often can sometimes make things worse.

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

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

Questions to ask yourself if you lose control of your bowels:

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

Other tips include:

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

Be aware of foods that 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 have problems with stools leaking or fluid leaking around the stool.

Call your doctor if you notice:

• Pain in your belly that does not go away
• Blood in your stool
• Time you spend on your bowel care is getting longer
• Your belly is very bloated or distended

Incontinence - care

Updated by: George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.