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Rehabilitation Institute of Chicago: LIFE Center

Bowel System: Common Problems

Reviewed July 2014
Author: Rehabilitation Institute of Chicago - Nursing Practice Council
Listed below are common bowel problems, symptoms and management techniques.

Constipation – the inability to have a bowel movement for three or more days.
Symptoms
• hard stools
• inability to have a bowel movement in many days
• feeling bloated in the stomach area

Causes
• Insufficient fluid intake (less than one liter per day)
• Inactivity
• Poor diet – low in fiber–containing foods such as fruit, vegetables and whole grains
• Side effects of medicines – especially iron, codeine and pain medication
• Repeatedly ignoring urge to move bowels

Treatment
• Drink at least six to eight glasses of fluid each day.
• Eat a diet high in fiber.
• Ask the doctor about using a stool softener or laxative.
• If constipation persists, ask your doctor about using suppositories or an enema.
• Any person with a spinal cord injury who experiences the above symptoms along with abdominal pain that does not go away after removal of the stool should contact their physician immediately. This may be a sign of autonomic dysreflexia, a serious condition of over activity of the nervous system. Autonomic dysreflexia can happen to people who have injuries at or above T6.

Impaction – hard stool plugging the rectum
Symptoms
• Hard stools
• Bloated feeling in the stomach
• Leaking of loose or liquid stool

Causes
• Insufficient fluid intake
• Inactivity
• Poor diet
• Side effect of medications
• Chronic constipation

Treatment
Many people who experience impactions are able to remove the stool by hand. Check with your physician or health care provider to find out if this is appropriate.

Diarrhea – loose or liquid stool, usually three or more times a day.
Symptom
• Large amounts of loose or watery stool

Causes
• Illness, such as a cold or flu
• Poor diet, including too much spicy or greasy food
• Excessive use of laxatives or stool softeners

Treatment
• Do a rectal check looking for impaction.
• Check with your health care provider regarding the use of specific fiber supplements.
• Stop all laxatives and stool softeners.
• Drink plenty of fluids.

Hemorrhoids – swelling or bleeding of tissue around the rectum
Symptoms
• Red, bulging areas inside or outside the rectum
• Pain or rectal bleeding after a bowel movement

Causes
• Long history of hard stools or constipation
• Removal of stool by hand

Treatment
• Use medications ordered by doctor such as Anusol or Preparation H.
• If stool is hard, follow guidelines for constipation (above).
• Drink plenty of liquids.

Incontinence – problems controlling bowel movements
Symptoms
• Inability to start or stop bowel movements
• Lack of awareness of bowel movements

Causes
• Decreased mobility
• Inability to communicate the need to use the toilet
• Side effects of medication
• Uncontrolled diarrhea

Treatment
• Assess bowel habits to find a pattern. Some people have bowel movements every day; others have bowel movements every two or three days. Try to anticipate when a bowel movement might occur and sit on the toilet at that time.
• Sit on the toilet after eating for 30 minutes up to an hour.
• Avoid using a bed pan as much as possible; use the toilet or a commode.
• Check with your health care provider about using suppositories to regulate bowel movements.

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