Question

You are providing care for a paraplegic patient with a recent spinal cord injury resulting in permanent paralysis from the midthoracic (T5/T6) region downward which includes all lumbosacral nerves. The patient is unable to initiate or control bowel function, but states, "I am going to get bowel training later and should regain control of my bowels." Which is the CORRECT response to this patient given his neurologic injury.

1. Ability to control the sphincter muscles may return

2. Neural control of the large intestine is likely lost

3. Bowel stimulants will aid in self-management

4. Strong abdominal muscles can replace peristalsis

Answer 1

The patient with a midthoracic spinal cord injury is unlikely to regain autonomous neural control of the large intestine; thus, the use of bowel stimulants and training are key components in bowel management after such an injury.

Step-by-step explanation:

In response to the patient's expectation of bowel training and regaining control of bowel functions, the correct response for a patient with a spinal cord injury resulting in paralysis from the midthoracic (T5/T6) region downward would be:

• Neural control of the large intestine is likely lost due to the injury.

Unfortunately, with the injury described as being in the midthoracic region, the innervation that controls bowel motility and function is likely affected. This means that the automatic neural control of the large intestine, which is crucial for initiating bowel movements, has been disrupted. The ability to control the sphincter muscles may not return since the nerves controlling these muscles are damaged. However, bowel training programs often include the use of scheduled times for attempting to have a bowel movement, diet management, and sometimes the use of bowel stimulants or other medications.

While strong abdominal muscles can help with some aspects of bowel management, they cannot replace the natural peristalsis of the intestines. Therefore, the final process of bowel management in patients with spinal cord injury is usually a combination of dietary management, medication, and timed bowel routines, which might include manual methods or the use of bowel stimulants as part of the bowel management program.