The person suffering from a ponytail syndrome, among other problems, may have difficulty making bowel movements normally and having fecal incontinence. This has social consequences because of the uncertainty it generates in the person. Fear of being deposed in public and seeing yourself in embarrassing situations can limit the life of the sufferer. In an earlier post we described how the digestive system worked in spinal cord injuries. There you can find interesting information related to this topic.
Let’s see what happens in the bowel in a patient with ponytail syndrome and then talk about how to solve it.
– The patient may have lack of sensitivity in the anal area. This causes that we do not notice if they are leaving the feces until they have already left. This logically generates insecurity in those who suffer it.
– Lack of sensation in the rectum. Not noticing that the blister is filled rectal we cannot know that we feel like going to the bathroom. These forces us to plan when we should do belly because our body is not going to warn us.
– The sphincter may be hypotonic. When this happens it is easier for the faeces to escape by making an effort, for example.
– Most often there is constipation. This is due to a slowing of the transit in the end part of the large intestine and the lack of adequate contraction in the rectum. In a way it can be a help to avoid fecal incontinence. As the stool is more compact, it is more difficult to exit through the anus.
In short, what a patient wants with sequels of this type is not to “poop on” and, above all, to control when it is going to do belly. Having this controlled improves self-esteem and social life. So what should we do?
– In general, it must be said that incontinence is infrequent if the rectal ampulla is emptied daily or every other day. There are several ways to perform the evacuation:
In smaller lesions it is possible that we go to the bathroom normally as before the injury, although with certain difficulties and alterations of the sensitivity (sometimes).
If not, the simplest way is to put on a disposable glove and add lubricant to a finger. Introduce the finger in the anus and with gentle gestures we push the walls of the sphincter to relax it. Then we completely insert the finger and drag the stool out helping the evacuation. This maneuver is usually simple since the sphincter is usually weaker due to the injury.
Medications such as micralax or glycerin suppositories may be used, although they are often insufficient. They are substances that are not very potent and do not always achieve complete evacuation. There are stronger medications such as bisacodyl suppositories (Dulcolaxo) that can be effective and achieve complete evacuation. Sometimes, if the sphincter is very hypotonic, the suppositories can easily escape and not act correctly. Another complaint of some patients is the long time that it takes them in the service to get the evacuation since the suppositories are put.
There are anal irrigation systems that can help. The one that I know and I have verified its effectiveness is the Peristeen system of the brand Coloplast . The link that I have left leads you to the page where they have a very illustrative video of how they work. Basically it is a device that allows us to introduce water into the rectum and the end part of the large intestine. This distends the intestinal walls and stimulates its contraction and the expulsion of the feces. In addition the water can help to drag the fecal content. If the sphincter is very hypotonic you may have some difficulties with the system. With training it works very well and gets the complete evacuation in a short time in most cases.
– Constipation that causes the ponytail syndrome helps patients not to have incontinence. In this sense we do not mind being somewhat constipated but we must have some considerations.
If we are evacuated by making the pushing effort with the abs we are at high risk of developing major hemorrhoids. It must be taken into account that this is the tendency that an injured person has because he wants to go to the bathroom in the same way as before. Ignoring the problem leads to these behaviors. If you manage to evacuate without undue effort, there is no problem, but we must avoid pushing too much. If we see that the efforts are great, we must consider another way to evacuate.
If constipation is excessive it can also become a problem. In these cases our doctor can recommend us an oral laxative. Osmotic laxatives can help soften stools and ease their way out. On regular occasions taking these laxatives is enough. People who do the manual evacuation (with the glove as we talked about earlier) do not usually like these laxatives because they make the stool pasteier and more difficult to remove.
– There is a third important general point which is food. Eating habits are important. Taking the right food and above all being very consistent will help us to predict the behavior of our gut. We will talk more about food in future posts but, in general, we must eat food with high fiber content and the adequate amount of water to help the progress of food through the digestive tract.
In summary, we should eat properly and perform a complete evacuation of the rectal ampulla every one to two days. This is the best way for us to live peacefully knowing that we will not make a deposition without wanting to. It is preferable to be a bit constipated to have adequate control so we should moderate the use of laxatives. In most cases a regulation can be achieved without laxatives. Excessive effort to evacuate can be harmful and we must find a suitable method of evacuation for us.