How does aging with SCI affect the bowel?

Authors: SCIRE Community Team | Reviewer: Bonnie Nybo | Published: 20 March 2018 | Updated: 23 October 2024

Watch SCIRE’s video to learn more about bowel management as you age.21

All people age, and as they do they may notice changes in how they digest certain foods or that they need to go to the bathroom more frequently, or they may not go to the bathroom as successfully. As the body ages, nerve signals to the bowel may decrease and weaken bowel contractions and cause stool to move more slowly through the bowel. As a result, more water gets reabsorbed from the stool which often leads to more constipation. Some may experience more stool leaking.

For people aging with SCI, the changes in the bowel from typical aging may combine with the effects of neurogenic bowel dysfunction to worsen problems like constipation. Generally, as people age with SCI, symptoms of constipation increase, the frequency of bowel movements decrease, and the time required to complete a bowel movement increases. Medications and antibiotics taken to treat infections can also have significant effects on bowel function. They can increase constipation, increase leaks/accidents, or make the bowels less predictable.

Bowel changes that people aging with SCI may experience:

• More severe constipation
• More leakage/accidents
• Longer time spent on bowel routines
• Greater risk of pressure injuries from sitting on the toilet for longer
• Hemorrhoids
• Rectal fissures
• Bleeding from the rectum

Other aging-related problems like pain, osteoarthritis, decreased strength and mobility, and skin issues, can affect the ability to carry out bowel routines. Bowel changes like constipation, hemorrhoids, and spending more time sitting on the toilet can trigger pain, spasticity, and autonomic dysreflexia. All these changes from aging could lead to a need to reassess bowel management strategies.

Refer to the “What bowel problems can happen after SCI?” section above for more information on bowel complications.

To manage changes to bowel function from aging with SCI, consult regularly with a health care provider about your bowel management. Strategies to manage bowel changes may include:

• Modifying your diet and fluid intake
• Medications for bowel movements like suppositories and laxatives
• Surgical procedures
• Reviewing your current medications and supplements (some medications can cause constipation or diarrhea as a side effect)
• Reviewing toilet and transfer equipment for injury to skin and joints
• Additional caregiver help

Drinking water and the types of foods you eat both play an important part in how easily stool moves through the bowel. Needing to adjust what you eat and drink as you age is common since people often feel less appetite and thirst, and your body will not be as good at maintaining water and nutrient levels.

The optimal diet and daily water intake are different for each person, but finding the right balance can make a big difference for your bowels. You might also find that adjusting when in the day you eat and drink can affect your bowel movements.

Many people with SCI change their bowel management as they age. In one study, 63% of participants changed their bowel management methods over 20 years. People who used only medication and/or straining to manage their bowels were most likely to change their methods. Use of colostomy and bowel irrigation for management increased during this time.

For some people with long bowel routines (1-2 hours spent on bowel care per day), undergoing a colostomy was able to reduce time spent on bowel care to around 10-20 minutes per day. When considering surgical options for bowel management, people with SCI find it helpful to talk to stoma nurses, SCI doctors, and peers.

There is also research looking at the potential for nerve stimulation to improve bowel function and reduce time needed for bowel management. This may be available depending on location.

Refer to the “Diet and fluids”, “Medications and suppositories”, and “Other treatments and techniques” sections above for more information.

1. Your current routine is not working anymore.
2. The time and energy you spend on bowel management is limiting time spent with family/friends or doing things you love.

• What has changed (issues, challenges, barriers)?
• When did the change start?
• What is the root cause of the change? (medical illness, injury, surgery, mobility, weakness, cognitive changes, social changes, financial changes)
• What treatments or recommendations have been tried so far?
• What has worked and what has not?
• When was the most recent review of bowel with a family doctor or physiatrist?
• Are current care team members actively involved to provide guidance and support?