Managing Bowel Problems in Adults with Cerebral Palsy

Bowel Issues in Adults with Cerebral Palsy and Ways to Manage Them

Cerebral palsy (CP) is a neurological disorder caused by abnormal development or damage to the developing brain. This affects body movement, muscle coordination, reflexes, posture, and balance. Bowel issues are common concerns for adults living with CP.

Many adults with cerebral palsy experience chronic constipation and other gastrointestinal problems. This results from the brain and nervous system's impaired ability to control the abdominal muscles and bowels. However, various treatments are available to relieve symptoms.

Understanding Bowel Control Issues

Healthy bowel functioning involves a complex interplay between the brain, nerves, and muscles. In cerebral palsy, these connections are disrupted, leading to problems like:

• Constipation
• Fecal impaction
• Bowel incontinence
• Abdominal pain or bloating

Muscle stiffening and tightness make it difficult to relax the pelvic floor and coordinate bowel movements. Spasticity slows food passage through the digestive tract resulting in hard, dry stools.

Nerve damage can impair normal sensations leading to an inability to recognize the urge to defecate. Mobility limitations and medication side effects add to the problem.

Risk Factors

Those at highest risk of bowel issues with CP include:

• Non-ambulatory adults
• People with moderate to severe muscle spasticity
• Those taking anticholinergic medications
• Adults with impaired cognition or communication abilities
• Individuals who are dependent on others for care

Proactive bowel maintenance is especially important for adults at higher risk. Caregiver education is also key for those assisting individuals with limited mobility or cognition.

Constipation Management Tips for Adults with CP

Constipation is the most prevalent bowel complaint in cerebral palsy. Straining from constipation can be painful and make self-care activities more challenging. Try these methods to prevent and relieve constipation:

Dietary Changes

Adjusting your diet can help maintain regularity. Tips include:

• Drink 6-8 glasses of fluids like water, juices, tea daily
• Eat high fiber foods like fruits, vegetables, whole grains
• Include probiotic foods like yogurt or kefir
• Limit dairy, red meat, processed foods, sugar

Physical Activity

Staying active within your abilities helps prevent constipation. Options to explore include:

• Regular stretching and range of motion exercises
• Supported standing with braces or assistive devices
• Physiotherapy and occupational therapy
• Swimming or aquatic therapy
• Functional electrical stimulation

Establish a Bowel Routine

Try going to the bathroom at the same time daily, such as after a meal. Allow adequate time and privacy. Using a squatting stool rather than sitting can aid elimination.

Oral Laxatives

Over-the-counter laxatives like Miralax, Colace, or stool softeners may be recommended by your doctor for stubborn constipation. Never overuse or self-prescribe laxatives.

Suppositories

Glycerin suppositories can stimulate bowels when constipation is severe. Use gently, ensuring proper insertion high into the rectum while lying on your side.

Enemas

Saline enemas involve injecting liquid into the rectum to induce bowel movements. These should be used cautiously under medical guidance for impaction.

Avoid overusing enemas or laxatives as they can disrupt normal bowel function long-term.

Bowel Incontinence Management Strategies

Some adults with CP experience bowel incontinence or accidental loss of stool. This can occur from impaired sensory signals, mobility limitations, or rectal prolapse.

Methods for managing bowel incontinence include:

• Kegel exercises to strengthen pelvic floor
• Bowel training to establish regular bathroom schedule
• Antidiarrheal medications if needed
• Protective undergarments and pads
• Cornstarch powder to reduce skin irritation
• Checking for and treating rectal prolapse

Talk to your healthcare provider if bowel incontinence persists despite lifestyle remedies. Surgery may be an option in severe cases if prolapse or other anatomical factors are involved.

Using Assistive Equipment for Bowel Care

Specialized equipment can make bowel care easier and safer for adults with limited mobility due to cerebral palsy. This may include:

• Raised toilet seat or shower commode chair
• Grab bars and rails for stability
• Bottom wiper or long-handled brush for hygiene
• URINARY CATHETERS, OSTOMY, ENEMA EQUIPMENT

An occupational therapist can recommend specific devices suited for your abilities and needs. Proper use preserves dignity while reducing dependency.

Oral Medications for Bowel Regulation

Doctors may prescribe oral medication to improve bowel regularity if lifestyle approaches are inadequate. Options include:

Stool Softener-Laxative Combinations

Products like Peri-Colace contain a stimulant laxative and a stool softener for a dual action on bowels. These provide gentle relief of constipation.

Lubiprostone

Amitiza is a chloride channel activator that draws fluid into the intestines to improve motility and soften stools.

Linaclotide

Linzess is a medication that helps regulate bowel activity by stimulating secretion of fluids and speeding up transit time.

Discuss the benefits and side effects of these medications with your doctor to determine if they may be beneficial for your situation.

Common Gastrointestinal Concerns

In addition to constipation, adults with CP often contend with other problematic digestive symptoms such as:

Reflux

Gastroesophageal reflux disease or GERD causes heartburn, nausea, and reflux of stomach contents. Staying upright during meals, eating smaller portions, and avoiding trigger foods can help.

Poor Nutrient Absorption

Digestive issues can impair absorption of nutrients from food. Ask your doctor about vitamins, supplements, or diet changes to prevent deficiencies.

Swallowing Difficulty

Dysphagia makes chewing and swallowing challenging. Adapting food textures, proper positioning during meals, and swallowing exercises can help.

Speak with a gastroenterologist if you are experiencing ongoing GI symptoms that reduce your comfort and quality of life.

When to Seek Medical Care

Contact your healthcare provider if you notice:

• No bowel movement for 3 or more days
• Hard, painful stools
• Straining or pain with elimination
• Leakage of stool between bowels movements
• Blood in stool
• Unexplained weight loss
• Worsening reflux, nausea, vomiting
• Difficulty swallowing

Sudden changes in bowel patterns, especially continued constipation with vomiting, could indicate a bowel obstruction requiring immediate medical care.

Reporting symptoms helps your doctor determine if medications, tests, or referrals to gastroenterology specialists are needed.

Ask Your Care Team About Bowel Health

Managing cerebral palsy requires a coordinated care team. This includes your primary doctor, neurologist, therapists, nurses, and caregivers.

Be proactive in discussing any bowel concerns at your appointments. Don't let embarrassment or discomfort keep you from speaking up.

Provide details on your current symptoms, habits, medications, and self-care methods. Ask questions about adding more fiber, fluids, exercise or trying medications if constipation is ongoing.

Voicing issues early prevents complications and helps maintain bowel regularity, comfort and dignity as you age with CP.

Bowel Regimen Tips for CP Caregivers

For caregivers assisting adults with cerebral palsy, be attentive to their bowel health. Watch for signs like:

• Straining or grunting during elimination
• Small, hard stools
• Infrequent bowel movements
• Abdominal distension
• Stool leakage

Help the individual adhere to a bowel routine. Offer high fiber foods with adequate fluids. Provide ample time and privacy during toileting.

Gently remind the person to avoid straining excessively. Report symptoms or concerns promptly to the care manager or doctor.

With a proactive daily regimen, many bowel problems associated with CP can be well managed. This improves health and quality of life.

Outlook for Bowel Issues with Cerebral Palsy

Bowel problems like constipation are very common in adults with CP but should not be considered inevitable or untreatable.

Using a combination of dietary adjustments, physical activity, bowel training, medications, and equipment allows many people to achieve regularity and continence.

Open communication with healthcare providers ensures bowel issues are addressed promptly before becoming complicated. This allows proactive solutions to be implemented.

While CP affects muscle coordination, working closely with your care team provides the tools and guidance to take control of your bowel health.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.