Paraplegia and Constipation
A common problem
The muscles that line the gastrointestinal wall are known as smooth muscle, in contrast to the striated muscles which one consciously controls, like those in the biceps of the arm or the quadraceps of the leg. Smooth muscle is involuntary, meaning that its movement is guided by autonomous processes. One cannot stop the continuous contraction nor speed it up by conscious thought.
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The contraction of smooth muscle in the gastrointestinal wall is what keeps the contents moving from one end to another. Some evidence exists that shows physical activity, which involves voluntary or striated muscles, can aid in the movement of food. Perhaps in light of this evidence, it is not surprising to find that spinal cord injuries, such as in tetraplegic or paraplegic patients, are major causes of constipation and require constipation medication or constipation treatments. The type of constipation in such patients was usually confined to low frequency, long transit time constipation.
Two causes of constipation trouble
There are two kinds of problems that lead to chronic constipation in victims of spinal cord injuries. The first kind is directly related to the injury. According to a recent study of victims of spinal cord injuries, the severity of the injury is correlated to the severity of constipation. It is thought that two things happen to muscular movement in paraplegic and tetraplegic patients. Control of the anal spincter is impaired, which makes the final step of evacuation difficult.
In addition, the nerve signals being sent to the smooth muscles is also changed, causing what physcians call "insufficient innervation". The other kind of problem is related to intake of medications. Anticholinergic drugs , which may aid in various ailments related to lung, heart and intestine function, can cause constipation. Patients with tetraplegia and paraplegia, like the general population, also use antidepressants, some types of which such as the tricyclics cause chronic constipation.
Causes of constipation and incontinence
Patients with paraplegia or tetraplegia also experience other difficulties concerning the gastrointestinal tract that require constipation medication. Although hard or difficult to pass feces is no more a problem than what the general population experiences, such patients had problems with fecal incontinence. This is the phenomenon where the body's signal for defecation comes very late or not at all, which can result in release of fecal contents before the patient is ready. Abdominal pain was also frequently reported, which interestingly was relieved by a bowel movement.
A normal course of treatment
Constipation treatments for patients with paraplegia or tetraplegia will likely follow a normal course of action with more emphasis on management of difficulties specifically correlated to spinal cord injuries. At the very least, a high dose insoluble fiber regiment is recommended by physicians as well as the use of a best laxative or constipation medication like Amitiza for controlling the chronic constipation.
Sources:
De Looze et al, Constipation and other chronic gastrointestinal problems in spinal cord injury patients Spinal Cord (1998) 36, 63-66