A spinal cord injury or other neurological conditions can disrupt the normal communication between the brain and the nerves controlling bowel movements, leading to a condition called neurogenic bowel. Managing this condition effectively often requires a multifaceted approach, with diet playing a crucial role. This article provides a detailed overview of neurogenic bowel, its management, and the importance of dietary modifications.
Understanding Neurogenic Bowel
Neurogenic bowel occurs when there is a loss of motor and sensory control of the gastrointestinal tract, anus, and rectum due to neurological conditions such as spinal cord injury, stroke, brain injury, Parkinson’s disease, multiple sclerosis, or diabetes mellitus. Rarely, it can occur after childbirth. In essence, the nerves of the body are not communicating effectively to and from the brain with the bowel. There can be a complete nerve transmission malfunction with no messages passing or just partial transmission of messages. Nerve function to the bowel is complex due to the length of this huge organ.
Types of Neurogenic Bowel
There are two primary types of neurogenic bowel, each resulting from different types of motor neuron injuries:
Reflexic (Upper Motor Neuron) Bowel: This type results from injury to motor nerves above the conus medullaris (L1 or L2). The bowel and internal rectal sphincter are hyperreflexive or spastic, causing the bowel to retain stool. Only small amounts are spontaneously released due to spasms, leading to involuntary bowel movements at erratic times.
Areflexic (Lower Motor Neuron) Bowel: This type results from injury or disease affecting lower motor neurons (LMNs). The bowel and internal rectal sphincter are flaccid, meaning tone is low to absent. Stool collects in the rectum without spontaneous evacuation, and the flaccid bowel does not respond well to stimulation. If the lower bowel becomes full of stool, the bowel will stretch to accommodate the overload. However, at times, a small amount of stool might be released as incontinence because of absence of tone in the rectal sphincters or there is no more room in the bowel, but a large amount of stool remains. The stool remains in the rectum with water constantly being removed so it becomes very dry and hard.
Read also: Causes and Treatment of Neurogenic Cough
Mixed Motor Neuron Bowel: A mixture of injury to upper motor neurons and lower motor neurons.
The Importance of Diet in Neurogenic Bowel Management
Nutrition plays a key part in the bowel management routine that can improve quality of life and independence. Adequate fiber and fluid intake, along with a well-balanced diet, can significantly impact bowel function.
Fiber: The Cornerstone of Bowel Management
Fiber is the parts of plant foods that the body can’t digest or absorb. It passes through your stomach, small intestine, large intestine, and out of your body intact (unlike protein, fats, and carbohydrates which the body breaks down and absorbs). It is crucial for managing both constipation and diarrhea, common issues in neurogenic bowel. Soluble fiber helps with constipation and diarrhea by adding bulk to dry/hard stools and loose/runny stools. Insoluble fiber helps with constipation by absorbing water into your stool which softens it and makes it easier to pass through your GI tract.
Sources of Fiber:
- Ground flax seeds (flaxmeal)
- Wheat bran
- Nuts
- Seeds
- Cauliflower
- Green beans
- Leafy greens (spinach, kale, collard)
- Potatoes with skin
- Fruits and vegetables with skin
- Whole grains
Aim for roughly 25-40g of fiber each day. It is recommended that women aim for about 25g and men aim for 38g of fiber per day. Start slowly though and increase fiber intake gradually over a few weeks to prevent any abdominal discomfort such as bloating or gas. Assess how you feel a few days after introducing fiber to your diet. If you experience some digestive discomfort, then hold back on increasing fiber intake for another few days or until your symptoms subside.
Fluids: Essential for Hydration and Bowel Function
Fluids are also crucial for the neurogenic bladder; they help flush out bacteria in the bladder, keep urine light in color, help maintain blood pressure, prevent kidney and bladder stones, and support kidney function. The general recommendation is 2-3 liters per day (equivalent to 8-12 cups or 64oz). If you want a more specific guide, it is recommended that women 19 years and older consume about 9 cups of fluids per day, and men 19 years and older should have 12 cups. Urine should be light yellow or clear.
Read also: Bowel incontinence and diet
Tips for Increasing Fluid Intake:
- Add frozen or fresh fruit, vegetables or herbs to your water to enhance the taste. Some suggestions include: lemon or lime wedges, fresh mint, cucumber slices, cinnamon sticks, strawberries, mangos, watermelon, oranges, or pineapple
- Keep a reusable water bottle with you throughout the day as a reminder to drink - keep it at your work desk, at school, when you exercise, or when you’re out. Refill it when you run out
- Take sips of water while eating meals and snacks
- Make soups more often as the liquid in them can also count towards your fluid intake
- Pair it with another habit.
*Note that caffeinated beverages, alcohol, carbonated drinks, and some other foods (such as tomato-based products, chocolate, certain acidic fruits, spicy foods) may irritate the bladder. If you think they may be impacting you, try cutting them out for about a week to see if your symptoms improve and then you can gradually (every 1-2 days) add one item at a time back into your diet.
Dietary Recommendations for Neurogenic Bowel
Eat Whole Foods: Focus on consuming whole, unprocessed foods such as raw fruits and vegetables, lean protein, and foods with plenty of natural fiber. Staying away from processed and greasy foods is very important.
Regular Eating Schedule: Be sure to eat healthy on a regular basis. Consistency in meal times can help regulate bowel movements.
Incorporate Fiber Daily: There are plenty of ways to do this. Some people prefer to eat a fiber bar or a breakfast bar with plenty of fiber (search online for recipes). There's also fiber medications available, which are taken daily. Fiber gummies are especially popular. Just make sure you eat fiber daily in order to see results. So popular it deserves as a category, psyllium husk powder is a form of fiber you can purchase from any pharmacy which is incredibly life changing for many with paralysis. Psyllium is a form of soluble fiber that is made from the husks of the Plantago ovata plant seeds.
Limit Problematic Foods: Certain foods and beverages can irritate the bladder and bowel, exacerbating symptoms. These include caffeinated beverages, alcohol, carbonated drinks, tomato-based products, chocolate, certain acidic fruits, and spicy foods.
Consider Probiotics: Taking probiotics can help regulate the bowels amazingly. They deposit good bacteria in your digestive tract. This good bacteria can help prevent diarrhea and it help form regular stool. If you begin a probiotics treatment however be patient.
Balanced Diet: A Mediterranean diet-based diet can be helpful, integrating nutritional recommendations and exercise guidelines. This includes fruits, vegetables, whole grains, lean proteins, and healthy fats
Additional Strategies for Managing Neurogenic Bowel
While diet is crucial, it's essential to incorporate other strategies for effective bowel management.
Bowel Program
Having a regular bowel program is one of the best ways to keep your bowels regular. Many people will do their bowel program either in the morning or at night, and some people will do it both morning and night. Find a rhythm that works well for your body and stick to it. An established time to perform a bowel program will ‘train’ the bowel to empty on a regular routine.
Abdominal Massage
Typically taught in rehab, rubbing the lower bowel area of your abdomen can help for many with paralysis. A simple abdominal massage is usually all it takes to get things moving in the right direction.
Medications
A medication originally prescribed for lowering cholesterol, Cholestyramine is prescribed for people with chronic diarrhea. A popular laxative taken in liquid form, Laxaclear is a generic form to Miralax, which means it is an osmotic laxative. This is also a powder solution which is added to water, and it is not taken each day but instead taken when needed. Many people take it 2 to 3 times a week. Be careful however, as it is powerful.
Magnesium
A supplement you can purchase at any pharmacy, magnesium is an element that can help regulate your bowels. Milk of magnesia is another way to take magnesium, but for most people taking a magnesium supplement is easier.
Medical Consultation
If you have tried all of the above tips and still see no results, you may have a bowel blockage. In that case, go to the doctor right away, as they will need to do a CT scan or X-ray to determine if a bowel blockage has occurred.
The Role of Healthcare Professionals
Managing neurogenic bowel often requires a team approach, involving doctors, dietitians, and other healthcare professionals. A registered dietitian can provide personalized nutrition advice, helping individuals tailor their diet to their specific needs and manage any digestive discomfort.
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