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Prevention

How to prevent problems and maintain a healthy bowel

Self-management tips

Ensure you stick with a routine and try to go to the toilet at the same time every day. 

Artists wooden figure sitting on a roll of toilet paper with an alarm clock
Action:
Develop a successful routine that is regular, reliable and completed within a reasonable length of time.

Ensure you stick with a routine and try to go to the toilet at the same time every day.

Artists wooden figure sitting on a roll of toilet paper with an alarm clock
Action:
Develop a successful routine that is regular, reliable and completed within a reasonable length of time.

Ensure consistency in your diet and avoid making major diet changes, take your medications and moderate your alcohol intake.

Two street signs pointing in different directions with old and new on each
Action:
Only change one thing at a time when adjusting your routine at home. Wait about 7-10 days before making another change. 

 

Ensure you have a good healthy diet with plenty of fluid and regular exercise.

Fluid is good for your bladder too, and exercise helps you to maintain a healthy bowel as well as a healthy heart.

Food with poor nutritional value or low in fibre, as well as too much alcohol, contribute to bowel problems.

food sitting in an illustrated outline of the bowel system
Actions:
Eat a balanced high-fibre diet, drink well and avoid too much alcohol.

Go around the block or do a workout in a gym.

Some spicy food, fruits and certain vegetables can cause stomach and bowel problems.

illustration of a chilli
Action:
Vegetables such as Brussels sprouts, broccoli, cabbage, asparagus and cauliflower are known to cause excess gas, so eat them in moderation.

Know how your gastrocolic reflex works to stimulate your bowel activity.

Gastrocolic reflex diagram
Action:
Having a warm drink or a light breakfast before your routine can help stimulate the bowel, helping you to complete your routine successfully. 

Look for signs of a routine that needs adjusting, including frequent bowel accidents, diarrhoea, constipation, prolonged routines, regular poor bowel results and rectal bleeding.

Artists wooden figurine sitting on a roll of toilet paper
Action:
See TOP goals to establish regular and predictable bowel emptying. 

 

Important Note

Keep a bowel diary to record the frequency (date and times) of your bowel movements. Record stool consistency, episodes of soiling or bowel accidents, fluid intake and other information such as medication use, diet and other symptoms

What does research tell you?

Changing a bowel care program should be done one element at a time and maintained for 3-5 bowel care cycles, or 7-10 days, before making more changes.

How to prevent constipation

There are a number of things you can do yourself to try to avoid or relieve constipation:

  • Drink plenty of water.
  • Eat foods containing fibre, such as high-fibre breakfast cereals, wholemeal bread, fruit and vegetables, and beans and pulses.
  • Keep as active as possible – even gentle movement can help to keep your bowels moving.
  • Try to develop a regular routine for going to the toilet and do not rush – give your bowels enough time to work.
  • If you need help from a carer, friend or family member to go to the toilet, talk to them about what kind of help you would like.
  • If you have been prescribed laxatives, take them as directed by your doctor or specialist nurse.
diagram of constipation

How to prevent haemorrhoids

Haemorrhoids or piles are swollen or inflamed veins in your bottom, due to increased pressure inside your rectum.  

Haemorrhoids can occur inside, known as internal, or outside of the anus, known as external. The best way to avoid haemorrhoids is to prevent constipation.

Take stool softeners to help stools to move with ease and drink plenty of water. Reduce your time sitting over the toilet and do not strain to empty. Be as gentle as possible when using digital stimulation or manual evacuation.

  • Do not overuse laxatives as this can worsen your haemorrhoids.
  • Ensure you have enough fibre in your diet and/or take fibre supplements.
  • Control your weight, as obesity can increase the risk of haemorrhoids.
  • Get as much exercise as possible.
Diagram of haemorrhoids

Routine follow-up and tests

In general, your general practitioner or continence nurse is the first point of contact for most bowel-related problems. You may also want to contact your community nurse or case coordinator.

It is recommended to have a routine follow-up with your GP once a year to check your bowel health; more often if you have bowel problems.

As part of a yearly review of your bowel function, particularly when experiencing problems or your bowel pattern has changed, you may require further tests. The different tests available are outlined below:

External inspection of your bottom and palpation in your rectum by your doctor with a lubricated gloved finger, looking for haemorrhoids, fissures, skin tags, blood or discharge.

illustration of digital stimulation

External inspection of your bottom and palpation in your rectum by your doctor with a lubricated gloved finger, looking for haemorrhoids, fissures, skin tags, blood or discharge.

illustration of digital stimulation

illustration of stool sample in a specimen jar
A stool sample is collected and sent to the laboratory for culture to detect infection which can be caused by parasites, viruses or bacteria.

This test is used to rule out the presence of certain bacteria, for example, Clostridium difficile (in diarrhoea associated with recent antibiotic use) or Helicobacter pylori (associated with stomach ulcers).

Tests can include a full blood count and a multi biochemical analysis to assess whether you are anaemic, possibly caused by bleeding from the bowel, and give you clues about your overall health such as blood sugar level, and kidney and liver function.

Blood tests can show whether you have an infection or inflammation somewhere in your body. Your doctor may also test your blood for a chemical sometimes produced by colon cancers, called carcinoembryonic antigen or CEA.

blood in two test tubes sitting on a table

This test uses sound waves to capture the internal organs in your abdomen and pelvis: intestines, liver, gallbladder, bile ducts, pancreas, spleen, kidneys and urinary bladder. An ultrasound can be used to show gallstones or sludge in the gallbladder as well as cysts or abnormal growths in the liver, spleen or pancreas.

Ultrasound of the bladder

There are three main imaging techniques:

  1. X-rays
  2. Computed tomography (CT) scan which takes multiple X-ray images from different angles
  3. Magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to create a detailed image on a computer.

X-ray of the bowel areaImaging techniques can help detect problems of the stomach, small bowel, colon as well as other internal organs involved in breaking down your food, such as the liver, gallbladder and pancreas. For example, a plain abdominal X-ray may be ordered to look at whether your bowels are full of stools, causing impaction, or if there is an obstruction or blockage. A CT or MRI scan of the abdomen and pelvis may be used as a way to find growths or lumps in organs such as your stomach, bowels and pancreas.

This simple, non-invasive test done after a short period of fasting is used to diagnose small intestine bacterial overgrowth and problems with the digestion or malabsorption of sugars, such as lactose, sucrose, fructose, and sorbitol.

A faecal occult blood test (FOBT) is a test to screen for bowel cancer or polyps, tiny growths on the bowel that can turn into cancer.

A FOBT involves collecting a small sample of faeces and testing it for tiny amounts of hidden, also called occult, blood in your stool.

Australian National guidelines recommendations:

  • People aged 50-74 year at average risk and without any symptoms: complete a FOBT every two years.
  • People aged 40-49 years at moderate to high risk: complete a FOBT every two years and then a colonoscopy every 5 years from 50 to 74 years of age.

People with a spinal cord injury are no more likely than anyone else in the community to develop bowel cancer. However, lack of sensation may hide symptoms from early detection while chronic rectal bleeding, either due to haemorrhoids or regular digital stimulation/manual extraction, may lead to a false positive (wrong) FOBT result.

Screening is therefore even more important. FOBT is feasible for people with a spinal cord injury to complete but a full examination of the large bowel by colonoscopy may be necessary.

A long, flexible tube is passed through your throat and oesophagus, the canal carrying food from your mouth to your stomach, down into your stomach and the first part of the small intestine, called the duodenum. This test can be used to identify inflammation of your oesophagus, called oesophagitis, which is the result of acid reflux from your stomach or ulcers in your stomach or duodenum.

This instrument allows your doctor to view any abnormalities and remove tissue samples, called a biopsy.

endoscopy equipment on sterilised table

Diagram of a colonoscopyThis is a procedure used to visually examine your lower digestive tract for screening and diagnostic reasons. A thin, flexible fibre optic tube, which transmits light and is equipped with a tiny camera, called an endoscope, is passed through the anus and manoeuvred through the large bowel and the last part of the small bowel. This instrument allows your doctor to view any abnormalities and remove tissue samples, called a biopsy.

Note: The recommended frequency of a colonoscopy for screening purposes will vary based on findings and level of risk. Level of risk depends on your family history and is related to the number of first-degree and second-degree relatives with colorectal cancer as well as their age at diagnosis (less than 55 years vs older).

Bowel preparation for colonoscopy

Adequate bowel preparation is important for not missing polyps or possible cancerous lesions. A modified bowel cleansing regime with a longer preparation time is recommended in people with a spinal cord injury to allow for slower colonic movements to pass faecal matter through the intestines. Admission to hospital prior to the procedure is often needed, particularly for people who are more dependent and need assistance with frequent toilet transfers, skin care or monitoring for autonomic dysreflexia. A colonoscopy may be arranged during an unrelated admission.

You should be on a low residue/low-fibre diet and clear fluids earlier than normal to achieve adequate cleansing for a colonoscopy. Solutions, such as Picoprep, have been shown to be safe, effective and better tolerated than polyethylene glycol electrolyte lavage solutions, such as ColonLYTELY. The latter is possibly the safest option but is often poorly tolerated by people with a spinal cord injury due to the large volume (2-4 litres) required to be consumed. Split dosing of this medication has been shown to improve tolerance and effectiveness.

 

What does research tell you?

A colonoscopy should be performed in individuals with a spinal cord injury over the age of 50, who have a major change in bowel function that cannot be resolved, or an unexplained positive faecal occult blood test (FOBT), to rule out possible colorectal cancer.

Take home messages

Artists wooden figure sitting on a roll of toilet paper with an alarm clock

DEVELOP
a regular bowel routine and don’t rush

pink toolkit with tools sticking out

TROUBLESHOOT
if you have a bowel problem

a plate of food separated by colour

EAT
a balanced diet with enough fibre

no smoking sign in pink

QUIT
smoking

woman in wheelchair playing tennis

MAINTAIN
a healthy lifestyle and exercise program

diagram of constipation

AVOID
constipation

young girl drinking a glass of water

DRINK
plenty of water

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