• Chapter 5: Taking care of your body
• Eat well for good health
• Keep your body moving
• Preventing common health problems
• Passing urine and stool
• Treating and preventing urinary infections
• Bowel control
• Monthly bleeding
• Discharge from the vagina
• Pressure sores
• Sudden high blood pressure with pounding headache (dysreflexia)
• Managing pain
• Working for change

Try to pass stool at the same time every day or every other day. Do it even if you have had an accidental bowel movement at another time. Eventually, your body will adjust to the schedule and the stool will come out more easily at a regular time. This is called a bowel program.

Suppositories such as bisacodyl or glycerin can be used. These bullet-shaped pills put into the anus will stimulate the bowel and cause it to push out stool.

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If you cannot use the muscles in your lower body to pass stool, you can help the stool come out with a finger. You can also use this method if you have difficulty passing stool (constipation) or have hard stools.

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Stool usually comes out easier when you are sitting, so try to remove the stool when you are sitting on a toilet or pot. If you cannot sit, try to do it lying on your left side. Ask someone to help you if necessary. Be careful not to get any stool in your vagina or urine hole. Harmful germs in the stool can cause an infection.

How to remove stool:

1. Cover your hand with a clean plastic or rubber glove, or a plastic bag. Put vegetable or mineral oil on your pointing finger or on whatever finger works best.
2. Put your oiled finger into the anus about 2 cm (1 inch).
3. Gently move the finger in circles for about 1 minute, until the muscle relaxes and the stool pushes out.
4. If the stool does not come out by itself, remove as much as you can with your finger. Be gentle, so you do not scratch or cut the skin inside the anus.
5. Clean the anus and the skin around it well, and wash your hands.

Some women can remove stool while sitting in a wheelchair. To do this, make a hole in the ground or have a container to put the stool into. Then move forward on the seat, and turn sideways as far as you can. Use a looped strap or a belt to pull one leg over and up, so that you can reach your anus with your hand. You can loop the other end of the strap around your chair, to keep your leg in place.

Constipation (difficulty passing stool)

Women with cerebral palsy and spinal cord injury often have constipation or hard stools that can take several days to come out. This can cause serious problems, such as when the stool forms a hard ball in the rectum (impaction), or dysreflexia.

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To prevent constipation:

• drink at least 8 glasses of liquid every day. Water is best, if you have it.
• try to eat plenty of fruits, vegetables, and foods with fiber—such as whole grains and cassava (manioc), beans, or other root foods that are high in fiber.
• keep your body moving and exercise as much as possible.
• keep a regular bowel program.
• add a little vegetable oil to your food each day.
• massage your belly.
• eat ripe papaya or mango, or green bananas.
• mix one spoonful of psyllium husks (isabgol, the crushed seeds of the Plantago ovata plant) with a glass of water, 2 times a day.

If you have not passed stool for 4 days or more, you can take a mild laxative, such as milk of magnesia. But do not do this if you have any pain in your stomach. And do not take laxatives often. Inserts that contain glycerin (Dulcolax is one brand) can also be used to relieve constipation.

Painful swellings around the anus (hemorrhoids)

Hemorrhoids are swollen veins around the anus. They often itch, burn, or bleed. Constipation makes them worse. Women who use wheelchairs, women who sit often, and women with cerebral palsy are more likely to have problems with hemorrhoids as they grow older. If you remove stool with your hand, watch for bleeding. This is a common sign of hemorrhoids.

What to do if you have hemorrhoids

• Sit in a basin or pan of cool water to relieve the pain.
• Follow the advice on this page for preventing constipation.
• Soak some clean cloth in witch hazel (a liquid plant medicine) and put it on the painful area.
• Kneel with your buttocks in the air. This can help relieve the pain.

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