How does someone with a spinal cord injury cope with the changes to their bladder and bowel? - Katie Powell, OT

The changes in bowel and bladder after a spinal cord injury are often what people say are the most life-changing aspect of a spinal cord injury. Sometimes one of the resulting symptoms is that you lose control over being able to manage your bowel and bladder independently. So somebody may need other agents to help them manage their bowel and bladder. For example, they may be put on a medication that controls their bladder, so they just don’t void unexpectedly. They may be put on medications for bowels, so that their stool is softened and comes out at a consistency that is formed and not loose or too hard. Generally people are put on certain programs, such as a bowel or a bladder program, to help them regulate their bowel and bladder. If someone isn’t able to void or urinate independently, then we look at a catheterization program. There are all sorts of different types of catheters that are inserted into the bladder to allow the urine to come out. There are some that stay in the person at all times so the urine can just flow out into a bag that can then be emptied. There are people who do what’s called intermittent catheterization, where they insert a catheter into their bladder when it’s time to go to the bathroom to help it empty. In terms of bowel management, generally as a healthcare team when the person is with us on their rehab stay, we work on getting a regimented bowel program going, where the bowel is trained to go at the same time every day. So we look at does that person need a suppository, or an enema or an oral medication to help get the bowel trained to do that? Then once we have those aspects taken care of, then as an occupational therapist I’m working with generally the nurse to see if that person can manage this bowel and bladder routine by themselves, or if they’ll need help from a caregiver to do so. And so, in terms of bladder management, I’m looking at does somebody have the fine motor control or hand movement to insert a catheter? Are they able to have what’s called a “sterile technique”? We make sure that they use a clean process so they’re not at higher risk for a bladder infection? In terms of a bowel program, I’m looking at — does the person have a bowel chair, or a safe commode surface to sit on like a bathing chair, it’s a surface that’s padded that protects their skin, it’s a surface that allows them access to their bottom so that they can do the clean-up care afterwards. Can they access the buttocks to be able to insert an enema or suppository? And in some cases, sometimes after a spinal cord injury, someone may need what’s called “digital stimulation” of the bowel in order to get the bowel to excrete. Is a person able to do that stimulation themselves? Do they need a piece equipment to do so?