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what is the big secret about bowel programs

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    what is the big secret about bowel programs

    since this is my first post, let me first start by telling a little about myself. i'm a c7 injury 4 years post. i'm told i'm a complete injury, but i have recovered some function down to t1/t2, my hands function almost normal. i have been lurking here for a while. i registered, but haven't posted because i don't feel comfortable discussing personal issues with strangers, and most of my questions have been answered by searching. i'm only posting now because i'm desparate for help.

    the only bowel program i was taught in rehab was to use a supository. i was going every day for about a year after coming home. i lived with my parents during that time and the bathrooms in their house were not accessible, so a home nurse would come by every morning to help with the bowel program. she would put the supository in and i would lay in bed for about 10 minutes and then transfer to a commode chair next to my bed. i was going every day in the mornings, and i would be finished in 20-30 minutes tops. even then that didn't work very well because i still had quite a few accidents.

    i have since moved out into a small apartment alone. i quit having frequent accidents once i sarted doing my bowel program myself, but i have yet to find a bowel program that works consistantly. my apartment has an accessible bathroom with a roll in shower. i now do my bowel program by rolling over the toilet in the shower chair.

    i have tried so many thing, i can't even remember. when i first moved out on my own i stuck with my old program of using a supository every morning. i use a supository inserter and i tried inserting the supository in bed and laying for 10 minutes like before, but when i transfered to the shower chair i did not make it to the toilet in time. after that learning experience, i would roll over the toilet and insert the supository, hold it in place until it completely melted or it would fall out as stool passed by. i learned about the magic bullets from here and started using them. they do work a lot better, but with the supositories i would still have an accident either later that night or the next morning. it wouldn't be a large accident, usually just some mucus and liquid, but it is still a mess to clean up.

    i then started using just digital stimulation, and once i did that i quit having accidents and my bowel program still took me about 30 minutes every day. eventually my bowel program started taking longer and longer. it went from 30 minutes to 45 minutes to eventually about 2 hours. i then tried going to an every other day program, and that seemed to do the trick. it cut my bowel program back to about 30-45 minutes. once again that didn't last and eventually i was back to 2 hours.

    i went to see a gastro doctor, but he was unfamiliar with spinal cord injuries and just wanted to pump me full of laxitives. it was a total nightmare, i was having several accidents per day. i quit seeing this doctor and just went back to just digital stimulation. he did give me one good peice of advice, he said that when i make a change in my routine, to only make one change at a time and try to keep it up for two weeks before making another change.

    i began experimenting on my own and found that the longer i went between bowel programs the faster i would epmty out. i could skip 3, 4 or even 5 days without having accidents, but 5 days was pushing it. eventually i settled into a twice a week program, and switched to doing it at nights after dinner instead of in the morning. i kept that up until recently. my bowel program was still taking me an hour, but 1 hour twice a week was better than 1 or more hours every day or every other day.

    that worked for a while, but then once again my bowel program gradually started taking longer each time. i was creeping back up to two hours. this time i asked my spinal cord doctor for advice. he told me to try taking milk of magnesia. he said to start with 2 tablespoons 1 hour before my bowel program and adjust the time as needed. he made it sound so easy, but it turned into another bowel nightmare.

    the first night i took 2 tablespoons, waited an hour then did my usual bowel program. the milk of magnesia didn't seem to be helping at all. then about an hour into my routine the stuff kicked in. i ended up sitting on the toilet for over 3 hours that night, and then i had two bowel accident the next day.

    the next time, i took two tablespoons and this time i wated two hours. that worked ok, but it still took me an hour and 45 minutes to finish. each time i tried the milk of magnesia i waited a little longer before starting my bowel program. i even tried taking it before bed and going in the morning, but the milk of magnesia didn't seem to be making it go faster, all it seemed to do was turn my stool into liquid.

    at my follow up appointment when i told the doctor that the milk of magnesia didn't decrease the time, it only turned my stool into liquid, and he told me to increase the dosage to 4 tablespoons and try again. that was a big mistake. it didn't decrease my bowel program time, all it did was make me have several accidents later that day or the next day. the doctor said that the milk of magnesia shouldn't cause me to have accidents after doing my bowel program, but it does.

    i gave up experimenting with the milk of magnesia, and dicided to go give the supositories another try. i also switched to a three times per week bowel program. that seemed to be working, it cut my bowel program back to 30 minutes. i would sit on the toilet for a total of 45 minutes just to be sure, but 20 to 30 minutes after inserting the supository i was done. i would still have a small accident of mucus and liquid stuff either later that night or the next morning, but i kept it up for two weeks.

    after two weeks had passed, i had been getting consistant results each time, so i dicided to trust the time and after 30 minutes i got off the toilet. for two weeks, i had been finished after 30 minutes and i sat there for 45 minutes to be sure and nothing happened. but this time when i dicide to trust it and get off, i end up having a bowel accident about an hour later.

    it has now been three weeks since i started using supositories again, and i'm starting to have accidents on the off days again. nothing has changed, the only explanation i can think of is that whtever is in the supositories seems to linger in my sistem and cause me to have accidents later.

    i don't know what to do now. i've run out of ideas and no doctor has given me any advice that has helped. i'm desparate, and i can't live like this.

    the only medications i take are 80mg of baclofen for spasms and 10mg of ditripan xl. i also take one 250mg tablet of generic colace. this hasn't changed in over a year.

    i've had so many accidents recently that i have noticed a few things happen after i have an accident. first when i have an accident, i go to the toilet and use digital stimulation to make sure i empty out so i don't have another one later. when i do this, i get a lot of blood. i don't normally get blood when i do a bowel program using digital stimulation, this only happens after having an accident. second, after an accidet i seem to be dehydrated. i only drink water, but no matter how much water i drink, i hardly have any urine when i cath after an accident. the third thing i've noticed is that the spasticity in my legs completely goes away after a bowel accident. my legs become like limp noodles, and that doesn't happen after a normal bowel program. i have not noticed an increase in spasticity right before the accident either.

    because of the bowel accidents recently, i haven't been out of the apartment. i'm running out of food because i haven't been to the grocery store. lately about all i have eaten is soup because that is all i have left. could eating so much soup have anything to do with the increase in bowel accidents?

    Sorry I don't have much advice, hopfully someone does as I've been struggling with 2-4x weekly accidents for nearly 1.5 years. Taking fibrercon helped for a few weeks, maybe try that?
    Emily, C-8 sensory incomplete mom to a 8 year old and a preschooler. TEN! years post.


      I understand your circumstances

      I to was put on the magic bullet when I left the Rehab. Hospital. But since I am the Queen of Constipation, I was unknowingly only empting out partially.
      I was glued to the "loo", never leaving the house. I could sit for 5 minutes, or 5 hrs. before it would work, even then not totally empting the bowel.
      After 4 mos. of this I was put into the hospital for 4 days, totally impaction
      upper/lower bowel. My doc performed a colonoscopy, and put me on Zelnorm twice a day and Glyco-lax twice daily..then after one month, cut it back to only one each per day. After some testing and yes a few accidents, I now take one Zelnorm per day and one glyco-lax powder form every other day.

      Depending on the amount I eat, I will go to the "loo" after each meal. Sometimes have a light breakfast and nothing until after I have my lunch. Then again after my evening meal.

      No more constipation and I go on a regular basis, I have a life again with this stuff.

      Zelnorm is for men as well as women too!

      Just another option maybe and Good Luck, I know how miserable it can be.

      Your life is what you make it, and only you have that choice!


        Notsohot, I did not see anywhere in your long post anything about your diet, except in the last sentence. Do you get enough fiber in your diet? This is so critical for regulating your bowels. At least 30 gm. daily is recommended, and this is best to get from food rather than from bulk medications like Metamucil. Here is a good source of information on dietary fiber. I would recommend keeping a diet log for a couple of weeks to see if you can find a correlation between your diet and what occurs to your bowels over the next 24-72 hours also.

        Do you do bowel care within 30 minutes after a meal?

        Are the accidents you are having actually formed stool, or are they primarily mucous?

        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


          my attendant digitally stimulates every 2-3 minutes for 60 seconds, foir about 30 minutes. use emeneze mini-enema. 240mg colace twice a day. pericolace morning of bowel program. fiber one cereal for breakfast. bowel program around 4pm in bed. i have very few accidents. 27 yrs post injury. c5-6 quad.



            My secret is lots of leafy greens,V8 Juice (1ltr daily),bran muffin 2x daily,a good diet of protein,one senakot tablet the night before and a hot coffee while im sittin on the shitter.The end result is a huge formed toilet pluggin turd every second morning in a about 10min...

            And exercise,lots of exercise..
            Last edited by Shaun; 19 Jul 2005, 3:15 PM.


              I'm an active C-7 incomplete quad 21yrs post. I have raced chairs, played wheelchair rugby, swim, hand crank bike love to fish etc... Have a lot of friends over the years with similar life styles, everyone has a variation of their bowl program. It seems exercise, normal diet and consistent methods are your best chances for regularity with your program. I don't use bullets or digital stim. I found about 1 yr after using the majec bullet I was just pooping it right out. Now I go every other night, some go every 3rd day some everyday its up to what becomes consistent for you and your life style. I just transfer to the toilet and push, along with a bit of pressure using toilet paper or baby wipes (helps keep things cleaner) plus the ones I use have aloe which seems to help minimze hemmroid bleeding. (Wonder if SCI Nurse may have any input here) I usually transfer on and off the toilet around 3 times, keeping a chuck on my chair cushing for that oh I gotta go now move, I sit on the toilet for about 10-15 minutes at a time and off about the same amount of time doing this usually 3 times works good for me going some each time. Doing this before I go to bed seems to allow my system to adjust to normal over night decreasing unexpected surprises, although they do occur on occasion but not often. (also place a chuck down in bed that night just in case), Hey even able bodied get surprises, just more time to get there. Well thats just what works for me, try one thing at a time to see what works, it will very slightly from time to time, good luck


                i think all those chemicals cant be good for you, laxitives, stool softners, ect. biggest thing is water to keep u going and exercise. and i dont care what anyone says, standing frame is a huge help
                c4/5 inc funtioning c6. 28 yrs post.
                sponsored handcycle racer


                  Originally posted by SCI-Nurse
                  Notsohot, I did not see anywhere in your long post anything about your diet, except in the last sentence. Do you get enough fiber in your diet? This is so critical for regulating your bowels. At least 30 gm. daily is recommended, and this is best to get from food rather than from bulk medications like Metamucil. Here is a good source of information on dietary fiber. I would recommend keeping a diet log for a couple of weeks to see if you can find a correlation between your diet and what occurs to your bowels over the next 24-72 hours also.
                  as far as my diet goes, i don't really eat the same thing every day, but it's pretty consistant. i'm usually very weak and light headed when i wake up, so i need to eat something fast. if i'm up to it, i'll fix a bowl of cereal. otherwise i eat a banana or some type of breakfast bar type thing to get me going. lunch is usually soup or a sandwich, and dinner varies. i'll sometimes eat soup for dinner, but not if i had it for lunch.

                  i keep a lot of cans of chicken noodle soup around because i sometimes get weak and lightheaded before i actually feel hungry. it's just something quick to fix that will fill me up.

                  Originally posted by SCI-Nurse
                  Do you do bowel care within 30 minutes after a meal?
                  i used to do my bowel program first thing in the morning, after i had something to eat and sometimes coffee. i set my alarm for the same time every morning, but i sometimes will snooze for an hour or so or turn it off and go back to sleep without realizing it.

                  i switched to nights because i can keep it more consistant as to when i go. i tipically go after eating dinner, usually around 8pm. also since i take care of my bowel program at night, it's easier on me in the morning since i just have to shower and get dressed. since i never know how long my bowel program is going to take, it was pretty tough when i was doing it in the mornings.

                  Originally posted by SCI-Nurse
                  Are the accidents you are having actually formed stool, or are they primarily mucous?
                  when i use a magic bullet supository i always get the liquid and mucous in my pants. it usually happens later that night or the next morning. when i have an accident, it's usually runny stool.

                  this week has been the 4th week since i started using the magic bullets again. my bowel program has pretty much been 30-45 mintues. it is a lot easier on me using the magic bullet rather than digital stimulation. when i do my bowel program using digital stimulation, i stimulate for 5 minutes and rest for 5 minutes. i get tired after doing that for 45 minutes or more. with the magic bullet, i pretty much start going as soon as i insert the it. i have to hold it in place and let the stool pass by until it has completely melted. it takes about 10-15 minutes for it to melt and i'm going almost the whole time. then i just sit there for another 15 minutes and let things fall out. i sometimes stop going after 5-10 minutes, but i go ahead and wait for a full 15 minutes to be sure. i can sort of tell if i'm done by the way i feel. after sitting for 15 minutes i will do 5 minutes of digital stimulation, wait 5 minutes and then another 5 minutes of digital stimulation. i don't get anything else during the digital stimulation, but like i said last week, when i dicided to trust it and get off after 30 minutes, i had an accident about an hour later.

                  with just digital stimulation, i used to be finished in about 30 minutes. after about a year of that it began to start taking longer until i was approaching almost 2 hours. when using digital stimulation, the stool doesn't come out on it's own like it does with a supository. i would have to manually scoop it out once it moved down. i used to know when i was done by the way it felt 'inside.' i don't know quite how to describe it, but my anal spincter would get really tight and the inside of my recum would feel different. i would wait until i went 2 sessions of digital stimulation without getting any stool before calling it quits. then it began to lie to me. i would get those signs that i was finished, but literally right at the last minute that i was going to quit, i would start going again.

                  i need to find smething that's going to work more consistant. i don't like how later that night or the next day i pass gas and get mucous and liquid goo after using a supository. when went this past tuesday, it didn't happen that night. i got up the next morning, had breakfast, showered and got dressed. then i was bending over to pick soming up before going somewhere and it happened. i had to go change pants and ended up being late. i went last night, and when i got back in bed after my bowel program to put my pants back on i fell asleep for a couple of hours. i got up, watched a little tv and when i was going back to bed, it happened as i was bending over to take my shoes off. this time it was a little more than just moucus, there was a little bit of runny stool with it.

                  i'm all for cure research, but can't someone come up with a better way for us to have a bowel movement until then? i'm going to give the supositories anoter week before switching to digital stimulation or trying something else.

                  one last questions, are there any long term side effects of using supositories? i remember reading that long term use of laxitives aren't good for you, but what about supositories?


                    Originally posted by fuentejps
                    i think all those chemicals cant be good for you, laxitives, stool softners, ect. biggest thing is water to keep u going and exercise. and i dont care what anyone says, standing frame is a huge help
                    i don't want to have to take laxitives and chemicals just to have a bowel movement. all i drink is water, and to my understanding, stool softeners are harmless. i do have a standing frame and i stand every day. it doesn't seem to be helping me much.


                      my system includes getting a good amount of fiber (I prefer Dannon light and fit with fiber ---> ( ), drinking tons of water, and I use half a magic bullet suppository (learned that on here after having left-overs :P) every other morning.

                      I know you've already been through more trial and error than you care to....but, seriously that is all one can do to figure out what works best. what is good for another may not be most efficient for you. I'm still adjusting my routine two and a half years after the fact. 90% of what I've learned has come from this site. who better to learn from than a been-there-done-that-this-is-what-I-learned....cha know? good luck with things!

             do you make a hyper link on here? couldn't figure it out...but, I didn't try to hard.
                      "The best way to predict the future is to invent it."
                      - Alan Kay


                        I too was having problems taking a full suppository. We figured out they're too strong for my body so I know only use 3/4 of one, 1/2 if I've had an accident the previous night or the morning of. It's been working really good. Maybe that could be your next change?


                          Bowel Program

                          As a former sufferer of any and all Bowel strategies.... I hate to say it... but it was running my life. I realize the proceedure I had is not for everyone... but I cant keep it to myself either! 3 weeks ago I had a colostomy surgery. I now dont ever feel sick, toxic, bloated, aweful or have the terrible pain that came from slow on little bowel movements. Since my surgery I have way to many other things to think about.... bowels are not one of them. Sorry your having troubles, I did too... but never again. Lastly.. I cant imagine now that I know what the other side is like.... struggling and going through it... I cant imagine going back to that. Mikey.
                          Mike (Florida)

                          Cant we get 1 do over?


                            The scoop on poop

                            My program took 3 months before I could feel confident to quit wearing diapers. My program is a little bit of everything people have said on this thread. First and foremost, I'm lucky to be T 7/8 inc. I have some sensation of "going". I have a "brown" bread for toast and either eggs or raison bran cereal for breakfast. Lunch is always rye bread with turkey and swiss with tomato as a sandwich and an apple. I have a dinner consisting of lots of veggies and some meat and again an apple. I take Metamucil(Blhhhhh!!) in the morning,and 2 colalace in the morning and evening. I drink cranberry juice(obvious reason here) water and pepsi. Use standing frame as much as I can stand it each day,do exercise,range of motion every morning and night and use a suppository each night for action. This so far has been the best results for me. I know my diet is very limited(gall Bladder a problem here) and I dont drink alcohol anymore(miss my Jack Daniels). As you have a higher injury,I'm not so sure any of this would benefit you. My diet was the biggest issue to settle on before I could start "dialing" my program in. It takes 30 min. to 1.5 hrs to finish. It beats and accident any day.Good luck and I hope you get an answer soon. None of this is fun, that's for sure...John


                              what kind of things can i eat that have lots of fiber in them? i looked at the nutrition lables for the stuff i've been eating, and most of them only have 1 or 2 grams of fiber.

                              i have a question about the milk of magnesia. my doctor said to first try drinking it one hour before my bowel program and adjust to find the right time. i read a post by the sci-nurse that said it is recommended to take it 8-12 hours before the bowel program. the bottle says it usually produces a bowel movement in 1/2 to 6 hours, but that is for normal people. the directions even recommend taking it before bed time. that either means i would have to take it before bed and go back to doing my bowel program in the morning, or drink it around lunch time if i want to continue doing my bowel program at night. i did try drinking it before bed once, but i've tried so many combinations of things i don't really remember how it turned out. if i were to give the milk of magnesia another try, and i drank it during the day, would it cause an accident if it kicked in, or will it remain in my system until i do my bowel program at night?

                              one other thing i forgot to mention. when the doctor suggested i try 4 tablespoons instead of 2, i think it passed through and came out in my urine. i used the cherry flavor, and when i cathed right before my bowel program, i had cherry flavor looking milk of magnesia stuff come out right at the end. it wasn't a uti either because it didn't happen again, and i had no other symptoms of a uti. that was the last time i tried the milk of magnesia too.

                              i don't know what I did different last time, but after doing my bowel program, i did not have the discharge of mucus and liquid that I usually get.

                              i have read up on the colostomy procedure. it would be nice not to have to worry about doing a bowel program, but i don't like the sound of it. i don't want to do anything permanant to my body, and from what i've read, the longer the disconnected part of your bowels remain inactive, the less likely it is that the procedure can be reversed. it also sounds like from all the care that is required for the stoma and changing the pouch, that you spend about the same amount of time dealing with that as you would doing a bowel program. the only thing i haven't read anywhere is how long you can go between bag changes. i'm pretty active, and just the idea of having a bag of 'poop' stuck to me just doesn't sound like fun.