Neurogenic bowel training

§Upper motor neuron type neurogenic bowel: Although still had gastrocolic reflex and rectal defecation reflex, due to lacking central control as well as hard stool, not easily evacuate completely, and easily incontinence due to rectal defecation reflex Management:Bowel massage, digital stimulation, and suppository

§Lower motor neuron type neurogenic bowel Due to lacking rectal defecation reflex as well as flaccid rectal sphincter, the stool is difficult to be defecated and easily cumulated in the rectum Management:Digital evacuation and abdominal muscle exertion

§Fecal impaction: Most common complication in SCI patients S/S:Nausea, abdominal distension, poor appetite, difficult defecation, and small amount diarrhea Management:Oral laxative

Bowel training: §Increase water intake: cc/day §Increase dietary fiber intake §General exercise:especially abdominal muscle §Relax:private and comfortable environment §Position:upright sitting or right sidelying

§Scheduled defecation:accompanied by gastrocolic reflex, usually defecate after breakfast §Suppository:30 minutes before meal §Abdominal massage:30 minutes after meal clockwise for 15 minutes (depth 3-5 cm) §Digital manuver: UMN:Digital stimulation:Circular stimulation for 2-3 minutes (depth 2 cm) LMN:Digital evacuation §Glycerin ball:used if the above procedures failed