10. Diet and Fluid Management in Neurogenic Bowel

Bowel management in SCI is aimed at maximizing independence, maintaining social continence, and increasing efficiency and satisfactory results (see Nugget #8). Studies have shown that dietary fibre does not have the same effect on bowel function in individuals with SCI as in those whose bowels function normally. A recommendation of 15-18 gms. of fibre per day is a general rule. Fluid intake must also be monitored to take into account the manner and frequency of bladder emptying, since neurogenic bowel and bladder often occur coincidentally. A diary of intake (diet and fluid) and output (urine and stool) may provide useful information for monitoring in primary care.

For those with an Upper Motor Neuron lesion (UMN; above T12), diet and fluid management is usually aimed at producing softer stools, whereas for those with a Lower Motor Neuron lesion (LMN; T12 or lower), slightly firmer stool is preferred to avoid incontinence. The Bristol Stool Scale describes seven types of stool:

• Type 1: Separate hard lumps, like nuts (hard to pass)
• Type 2: Sausage-shaped, but lumpy
• Type 3: Like a sausage but with cracks on its surface
• Type 4: Like a sausage or snake, smooth and soft
• Type 5: Soft blobs with clear cut edges (passed easily)
• Type 6: Fluffy pieces with ragged edges, a mushy stool
• Type 7: Watery, no solid pieces. Entirely liquid