Sustaining a spinal injury can change your life in a number of ways, and the impact on your bowel and bladder function can be one of the most challenging.

Losing control of your bladder or bowel function can be highly distressing and embarrassing, and it can understandably have a major impact on your confidence and self-esteem. However, it is important to remember that there are a number of potential approaches that can help you to manage your continence, including medical interventions and lifestyle changes.

In this guide, we will highlight some of the key challenges that a spinal injury can pose in terms of bowel and bladder care, and offer practical advice on how to manage effectively to ensure you can enjoy the best possible quality of life.

How spinal injuries affect your bowel and bladder functions

When the spinal cord is damaged, signals to and from the brain can be disrupted or blocked entirely, leading to a loss of movement or function below the level of the injury.

In terms of bowel and bladder control, the nerves that control these functions are located in the lower part of the spinal cord. Therefore, any injury to the spinal cord can potentially disrupt bowel and bladder function, known as ‘neurogenic’, leading to a range of symptoms and conditions, including: 

• Incontinence (the inability to control bowel or bladder movements)
• Constipation
• Bladder spasms
• Urinary tract infections
• Kidney problems

The degree to which bladder and bowel control is affected depends on the level of spinal cord injury and whether it is a complete or incomplete injury, but regardless of severity of injury, it can significantly impact an individual’s quality of life. Physical health can be affected, with recurrent infections posing a particular risk, while emotional wellbeing will also be undermined, with feelings of embarrassment or anxiety being a common problem.

Without proper management, these issues can affect a person’s independence and make them reluctant to get involved in normal activities and social situations. This is why it is so vital for anyone in this position to learn more about the various methods that may be able to help them live better.

Bowel care advice after a spinal injury

The loss of bowel control can be among the most distressing and embarrassing spinal injury-related concerns, but with an individually-tailored management approach and the right support, it is possible to control your symptoms and reduce the chances of constipation and incontinence.

When dealing with bowel problems, your doctors may recommend a number of different therapeutic approaches, depending on your specific medical history, the nature of your spinal injury and your current symptoms. These can range from medications to surgical interventions.

Medications and techniques to help a bowel management routine

Medications aim to stimulate the movement of stool through the colon and soften stool consistency. They can help prevent complications such as constipation and help achieve predictability around bowel movements.

Prior to starting, you should always discuss the use of medications with your GP and spinal consultant to ensure you’re using them safely and get the best results.

Laxatives

Laxatives help stool move through your gut and can relieve constipation. They are usually taken 8 to 12 hours before a planned bowel procedure. Types of laxatives include stool softeners, bulk-forming agents, osmotic and oral stimulants.

Rectal stimulants

Offered in the form of suppositories or liquid enemas, these are medications inserted into the rectum to lubricate the stool and initiate bowel movement. Suppositories come in a solid bullet-shaped form and dissolve within 15 minutes of insertion to allow the medication to make contact with the rectal wall and stimulate contractions.

There are different types of suppositories, so if one doesn’t work, it doesn’t mean others won’t be effective. It’s best to discuss which type might work best for you with a specialist healthcare professional.

Another effective option is an enema, a quantity of fluid inserted into the anus via a small tube or syringe. Different enemas contain different types of medications in various volumes. A low-volume enema is recommended for those with a spinal cord injury.

Transanal irrigation (TAI)

TAI is a simple procedure in which water is passed through a soft silicone cone or a catheter into the rectum. As the water fills the rectum, the rectal wall gently stretches and any stool and water is emptied from the bowel. The process takes approximately 20-35 minutes and should be performed regularly (usually every 24 or 48 hours) to achieve the best results. Transanal irrigation is usually self-administered and can reduce the amount of time you have to spend on your bowel routine.

All of these techniques will usually be accompanied by dietary changes designed to help improve bowel health; doctors may recommend increasing fluid intake and incorporating more fibre into the diet to aid digestion and promote regular bowel movements.

Anal inserts

Anal inserts are made from soft, absorbent material and are inserted into the rectum to prevent involuntary bowel movements. They can stay in situ for up to 12 hours and are helpful if you are undergoing a change in bowel routine or require the extra insurance of not having a bowel accident - if you are travelling on holiday for example.

Surgery

In cases where these management techniques are not sufficient, surgical interventions may be considered, including a colostomy to manage severe constipation or incontinence. Surgical options are typically a last resort, and are usually only considered when other treatments have been unsuccessful, although more people are opting for a colostomy as an effective and efficient way to manage their bowel in the first instance.

A colostomy can reduce faecal accidents, better enable a person to manage this aspect of their lives for themselves, and decrease the amount of time spent on a bowel routine. The procedure to reroute the large intestine/colon is usually performed via keyhole surgery, and the time spent in hospital is usually only a few days, most of which is spent learning how to manage the colostomy for yourself.

You will wear a disposable pouch adhered to the abdomen to collect waste, which will need to be emptied once or twice a day. This is a fairly simple procedure which can be performed even by those with limited hand function.

What kind of complications should I look for?

Managing your bowel after a spinal injury is an ongoing process, and you may notice some changes over time. However, if you notice any of the following complications, it may be helpful to seek the advice of a specialist healthcare professional:

• Blood in the stool or on underwear
• Change in stool colour
• Chronic diarrhoea (two or three loose stools every 24 hours over a three-week period)
• Bowel accidents more than once a week
• Poor evacuation results after two or more bowel care sessions
• Bowel care lasting more than an hour
• Difficulty in evacuation due to constipation or impaction

What causes bowel accidents?

Things can go wrong with even the most reliable of bowel routines. Although usually a temporary thing, bowel accidents can be embarrassing, inconvenient and a cause for concern.

Factors that increase the risk include:

• Change in time of bowel routine
• Rectum not being empty
• Illness
• Side effects of antibiotics
• Sudden change in diet

Recommended techniques and lifestyle changes

Alongside these treatments and products, there are several techniques and lifestyle changes that can help manage bowel function after a spinal injury:

• Establish a regular bowel routine. This involves setting specific times each day for bowel movements. The best time for this is often after a meal, as eating can stimulate the bowels. Over time, this routine can help train the bowels to empty at specific times.
• Explore abdominal massage. This involves gently massaging the abdomen in a circular motion to stimulate bowel movements. This can be particularly helpful for individuals who experience constipation.
• Maximise your physical activity, as much as your condition allows. This promotes bowel regularity, as even small amounts of movement can stimulate the bowels and aid digestion. If you have limited mobility, wheelchair exercises, stretching, or even just changing position regularly can all make a difference.

Bladder care advice after a spinal injury

Spinal injuries can damage your body’s bladder control by stopping the nerves from properly communicating with the brain, impairing the person’s ability to control the flow of urine or be aware of the fullness of their bladder. If you have been affected by these symptoms, there are various therapeutic methods that may help.

There are two different types of neurogenic bladder following spinal injury. An injury at T12 or above may result in what’s called a reflex bladder, which allows for involuntary control of the bladder and automatic emptying triggered once the bladder fills to a certain level. A reflex bladder may not empty completely, which can increase the risk of infection, and bladder contractions can also cause back pressure on the kidneys.

An injury below T12 may result in an areflexic bladder, where the impulses are interrupted so the bladder doesn’t receive the message to empty. An areflexic bladder doesn’t empty automatically, will continue to fill and small amounts or urine may leak out. The areflexic bladder needs emptied at regular intervals, usually via intermittent catheterisation.  

Establishing a good, long-term bladder management routine will help you achieve independence, improve your quality of life, protect your kidneys and reduce the risk of complications, and help you stay dry.

What kind of treatments are available?

Just as with bowel management, the first step in managing your bladder after a spinal injury is to seek medical advice. A healthcare provider can assess your symptoms, consider the specifics of your spinal injury, and suggest appropriate treatments.

Important factors to consider include your level of injury, the type of neurogenic bladder you have (reflex or areflexic), what is acceptable to you, and which treatment is least likely to cause complications such as bladder stones, infection or autonomic dysreflexia (AD).

Catheters

Catheters are thin, flexible tubes inserted into the bladder to allow urine to drain out. There are three different types of catheter you can use after a spinal injury:

• Indwelling catheter - these are inserted through the urethra and held in place by a small water-filled balloon. They can be convenient, but long-term use is best avoided as they can cause complications such as infections and bladder stones. They also need to be changed regularly (every four to six weeks), usually by a district nurse or PA.
• Intermittent catheters - often the choice for people with paraplegia, intermittent catheters are inserted into the bladder via the urethra to drain urine every few hours. If you have some hand control, you can usually learn to self-catheterise, reducing the risk of infection. Both men and women can usually self-catheterise in bed, in a wheelchair or on the toilet, but you will need privacy and access to a toilet, something that can be difficult when you are away from home.
• Suprapubic catheters - a suprapubic catheter is an indwelling catheter inserted into the bladder via a small surgical incision in the abdomen below the belly button. If you don’t have the manual dexterity to self-catheterise, a suprapubic catheter may be suitable for you. Suprapubic catheters need to be changed every six weeks or so and are similar to those used for urethral use.

Sheaths and condoms

This form of bladder management can be used by men with a reflex bladder. Urinary sheaths fit over the penis like a condom and have a tube at the end to attach to a collection bag, which can be strapped to the leg or hung beside a bed. They usually come with an adhesive coating on the inside and come in a variety of lengths and widths to ensure a good fit. Urinary sheaths are usually changed every day.

Common bladder management problems

Maintaining a healthy urinary tract system is vitally important in maintaining good overall health. The following symptoms may be a sign of infection in the bladder or kidneys:

• Concentrated, strong-smelling urine
• Blood in the urine
• Bypassing/leaking urine
• Feeling unwell with flu-like symptoms
• Sweating/goosebumps
• Pain in the abdomen or lower back
• Increased spasm
• Swollen testicles
• Raised temperature

Mild urinary tract infections can be treated by increasing your fluid intake to flush out the bacteria and ensuring your bladder is fully emptied on a frequent basis. It may also help to take vitamin C or cranberry capsules to keep your urine acidic. If your symptoms do persist, you may require a course of antibiotics to clear the infection, which you will be able to get from your GP.

Recommended techniques and lifestyle changes

The following methods and lifestyle improvements can all help you to manage your symptoms, improve bladder health, and enhance your quality of life:

• Practice bladder training - this involves establishing a regular schedule for emptying the bladder. This can help manage incontinence and prevent bladder overdistension, which can lead to kidney damage. The schedule will depend on the individual's specific needs and may involve emptying the bladder every few hours, or using a catheter at set times throughout the day.
• Stick to proper fluid management - this is crucial for bladder health. Drinking plenty of fluids can help flush bacteria out of the urinary system, reducing the risk of urinary tract infections. However, it's important to balance fluid intake with the bladder's capacity to avoid overdistension.
• Adjust your diet - certain foods and drinks can irritate the bladder and exacerbate symptoms of incontinence. As such, it may be advisable to avoid or limit caffeinated beverages, alcohol, spicy foods and acidic foods like citrus fruits.
• Pelvic floor exercises - while these exercises may not be suitable for all individuals with spinal injuries, for some, they can help strengthen the muscles that control the bladder and improve symptoms of incontinence. A physiotherapist can provide guidance on appropriate exercises.

Where can I find support for my bowel and bladder issues?

Although these tips can all be extremely helpful in managing bowel and bladder care, trying to make these kinds of lifestyle changes with a spinal injury can be a complex process, and you may require personalised advice and support. It is important to remember that you are not alone in this process, and there are resources available to help:

• Your local spinal injuries centre, which can be an excellent source of support and advice
• Your GP, who can make a referral to specialist services
• District nurses can help with bladder and bowel care 
• The Spinal Injuries Association’s (SIA’s) bowel management and bladder management resource hubs
• SIA’s SCI nurse specialists can provide practical advice and support
• SIA Healthcare, a personalised service from the SIA that delivers urology and stoma products and medication straight to your door
• The Bladder & Bowel Community, which shares information, personal stories and support tailored for all types of bladder and bowel problems

Additionally, if you have sustained a spinal injury that was someone else’s fault, you can get in touch with the legal experts at JMW Solicitors. We can help determine who was responsible for the incident - whether you are making a personal injury or medical negligence claim - and help you claim the compensation you will need to help you finance any future care and lifestyle changes you may need.

Living with a spinal injury can be challenging, but with the right support and management strategies, you can ensure your bladder and bowel symptoms are as manageable as possible, allowing you to maintain your independence and maximise your quality of life.