Right place

This guideline refers to where the faeces is in the bowel, when the person is ready to go to the toilet.

If the faeces are too high in the bowel, it is unlikely to have a result at the time when sitting over the toilet. The faeces then may work itself down later, resulting in an unplanned bowel movement. Alternatively, if the faeces are too low in the bowel, there may an unplanned bowel motion prior to getting to the toilet.

The most common method for influencing Right Place is stimulating the bowel – using either food, medication and/or activity.

Food

Specific foods and regular meals can stimulate the bowel to push waste through to reach the Right Place faster. In some individuals, implementing specific, targeted dietary strategies can reduce or prevent the need for bowel medications.

Eating enough fibre is important for motility. Fibre provides bulk and gives the digestive tract muscles something to ‘grip’ onto, pushing waste through the bowel more effectively. Fibre needs fluid to work effectively though, so drinking plenty of water is vital.

Most people can readily identify foods that stimulate the bowel. These are the foods that had someone going to the toilet before their spinal cord injury and will be different for everyone.  Commonly named examples are:

• prunes
• kiwi fruit
• large serves of fruit, fruit juice or dried fruit
• sugar free chewing gum, lollies or mints
• spicy foods
• liquorice
• nuts and seeds
• alcohol and caffeine.

Eating large or frequent serves of these foods may lead to unplanned bowel movements. Alternatively, some of these foods can help to achieve a regular bowel routine if consumed in moderation.

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Medications

Medications that stimulate the bowel as are also referred to as aperients. Common aperients are Senna (Senokot) and Bisacodyl (/Dulcolax) tablets or drops. Senna or sennosides are found in many different brands and strengths over the counter and at health food shops. The table below shows some of the common medications available and the approximate compared strengths.

These medications work by stimulating peristalsis, with the best effect of the medication between 10-16 hrs after taking the medication.  The timing of these should be adjusted to suit the bowel routine time.  

An example of how to use and adjust a stimulant medication:

As a starting point if toileting at 8am, the senna dose should be given at approximately 8pm the night prior.

Will the person always need to take bowel medication?

Some people may be able to reduce or stop some of their bowel medications, whereas other people may need to continue them long term to help maintain a regular bowel routine.  This will be different for everyone and can also be influenced by diet, lifestyle, other medications, and activity.

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Activity

Gravity and sitting upright can aid in digestion. Movement – whether its moving around the house, going out to the shops or doing exercise, can aid in intestinal motility too. Any movement is better than none.