Bowel Management

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Anal fissure is a tear in the tissue around the anus as a result of passing hard stools or damage to the bowel lining caused by rough manual evacuation. These can be extremely painful and can cause an increase in spasm and even autonomic dysreflexia. Autonomic dysreflexia discussed in section 3.
Constipation can be caused by a change of diet and routine, low fluid intake, not eating and some drugs such as painkillers, antibiotics and depressants. If you do not empty your bowel fora longtime, the faeces become hard, dry and more difficult to move (impacted. The symptoms are headaches, feeling sick and feeling full up, not being able to empty the bowel, sweating, increase in spasm, loss of appetite, and sometimes a brown, watery discharge from the anus.

Drinking pear juice may help or try yogurt with seeds or fruit. With chronic constipation the bowel is blocked but some liquids manage to leak past the blockage, thought to be diarrhoea. This condition is often called 'overflow and should be treated right away.
Haemorrhoids (piles) are varicose veins around or just inside the anus. You maybe prone to develop these because of lack of mobility and poor circulation. They are caused or made worse by straining for long periods on the toilet and by rough manual evacuation. If the haemorrhoids are bad, it will complicate the process of bowel management, and can bring on autonomic dysreflexia, in tetraplegia or high paraplegia patients.
Haemorrhoids may also cause rectal bleeding. You should discuss these with your GP or liaison nurse. Surgery maybe necessary but there are other treatments that you can try first e.g. haemorrhoid creams.
Diarrhoea is an unformed, loose stool, which may cause unplanned bowel movements or accidents. It can cause discomfort, often in the form of abdominal cramps. Diarrhoea can also lead to skin breakdown through faecal burning of the skin by the liquid stool. You may have to stop taking any laxatives until diarrhoea clears up. You may also have to put yourself on bed rest to try and reduce any skin breakdown from sitting in wet, soiled clothing.

Managing your bowels
The science bit
Upper motor neuron or reflex bowel
Lower motor neuron or flaccid hypotonic bowel
Coffee, tea, cocoa or soft drinks
Other factors
Performing bowel care
Manual evacuation
Medication stimulant laxatives
Osmotic laxatives

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