Question

Can you recommend a good diet for someone with a neurogenic bowel and bladder?

Answer

We wonder whether you are paraplegic or perhaps you are somebody with a peripheral neuropathy such as that caused by diabetes. Are your problems upper gastrointestinal tract, i.e. from the mouth, oesophagus and stomach, duodenum, gallbladder or are they from the lower bowel with problems with constipation and/or diarrhoea? If the bowel is overactive and you are suffering from possible diarrhoea and faecal leakage, if not overt incontinence, then the bowel needs to be slowed down and the amount of fibre in the diet probably requires drastic reduction. Fibre increases the bulk of faeces, and therefore if somebody is having problems in controlling their bowel, either because the faeces are too loose or because they have trouble expelling their faeces, then fibre may well make things worse.

High fibre diets are for those who have normal bowel function but want to increase the stool weight. If you bowel is underactive and there is a problem with constipation, and perhaps also faecal soiling, then the first step is to empty the bowel, and this requires medical supervision. Once the bowel is empty, a regime needs to be instigated to keep the bowel empty through regular bowel movements at a time which is convenient to the person. To find the right regime takes several attempts, because what suits one person may thoroughly upset another. Overall, it may be necessary to start with a fairly energetic regime such as enemas, but these can be reduced to perhaps merely glycerine suppositories or rectal stimulation, depending on effect. The faecal mass should be kept firm but not hard, and certainly not loose. Tablets can be taken to correct the firmness of the stool, but overall we favour local rectal measures rather than oral laxatives to control bowel movements.

Links

• Constipation and laxatives