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Jul 23

Digestive Complications In Spinal Cord Injury

In future posts I want to talk about solutions to the digestive problems suffered by people who have had a spinal cord injury or a ponytail syndrome. Reeducation of the bowel after injury is not an easy process but if we do it properly we can have a high degree of control over the intestinal habit. This is fundamental for people who suffer from it so it is not an inconvenience in their personal, family and social life. In this post I want to explain how the digestive system is altered when an injury occurs in the marrow or in the nerves that regulate it.

The digestive tract and digestion begin in the mouth with the action of saliva and progresses through the esophagus, stomach, small intestine, large intestine and ends up in the rectum and anus where we excrete waste products that are feces. This process is regulated by the autonomic nervous system (this is called because it is responsible for “automatic” functions such as sweat or heart rhythm). This nervous system is divided into two, the sympathetic and parasympathetic system. I recommend at this point stop reading and go to the post about the autonomic nervous system that I explain in a simple and fun for us to understand.

Digestive Complications In Spinal Cord InjuryThe sympathetic system leaves the part of the spinal cord that is in the dorsal area of ​​the spine and when activated reduces the digestive juices and bowel movements that make food progress (peristaltic movements). The parasympathetic system is responsible for increasing these movements and encouraging digestion. The balance between these two systems is fundamental for normal digestion.

If there is a spinal cord injury we might think that the nerve signal is no longer present and therefore the bowel should be completely paralyzed. It is not a bad approximation but it does not happen for several reasons:

– The vagus nerve. This nerve belongs to the parasympathetic system (the one that moves the intestine) and does not leave the marrow, it leaves before. It forms in the brain stem and leaves a hole in the skull and travels away from the marrow so it is never damaged with a spinal cord injury. The vagus nerve takes care of the stomach and the whole intestine except the final part, as we will see later.

– The sympathetic system that leaves the dorsal area has roots that come out of each level. This system will be affected to a greater extent the higher the injury. In addition, the spinal cord injury actually interrupts the communication of the upper and lower areas of the level of the lesion. This means that underneath the injury these nerves continue to function but are no longer regulated by the above commands.

The imbalance that occurs in the digestive system will have some consequences.

– The most frequent in the patient with spinal cord injury is having constipation, that is, it will slow down the transit and accumulate feces. The final part of the large intestine and the rectum area is regulated by an area of ​​the parasympathetic system that does travel through the medulla. This is sometimes associated with paralysis of the abdominal muscles that makes expulsion difficult and makes it easier for the abdomen to spread.

– Evacuation of feces is made more difficult by the involvement of the final part of the bowel that pushes the stool. To this is added paralysis of the abdominal muscles and, occasionally, a hypertonic anal sphincter that does not relax properly. All this can make the act of deposition take a long time.

– The sensitivity will be altered and the person will not notice when the rectal ampulla is filled. In addition to making it difficult to evacuate, the frustration component of not knowing when to do the belly is added. It is undoubtedly one of the main problems of adaptation that entails having a spinal cord injury, due to the uncertainty of stool output.

– In low lesions, it may happen that the sphincter is very hypotonic, that is to say, it is very loose and that the anus is opened very easily. This facilitates stool incontinence.

– The slowing down of the whole process of digestion leads to bacteria producing a lot of gas. This causes greater abdominal distension or meteorism that adds more discomfort, apart from the often uncontrolled expulsion of these gases with the logical discomfort for social life.

Here we have exposed the problems, in future posts we will talk about the solutions.

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