Life on Wheels (29 page)

Suppositories. There are two types: bisacodyl (Dulcolax

) suppositories, which work by stimulating the nerve endings in the rectum, causing the bowel to contract, and glycerin suppositories, which draw water into the stool to stimulate evacuation. Overuse of suppositories or laxatives can cause deterioration of the tissue in the colon.

Mini-enema. Softens, lubricates, and draws water into the stool.

A program that relies on the aid of suppositories or enemas can take from 30 to 60 minutes to complete. In a 1997 study of 100 people with SCIs, 23% of them took more than 45 minutes with their bowel program.
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Some of that time might be spent lying down waiting for the treatments to have their effect. You will develop a sense of when you would need to be on the toilet, though a protective bed pad is always a good precaution.

If you have sufficient balance to sit on a toilet or commode chair, gravity can help you along. Many people with high quadriplegia are unable to be stable sitting on a toilet or commode for a bowel program, so it must be performed by an assistant while you are lying down.

If you can contract your anal sphincter on your own, that is certainly more attractive than having to put on a glove and dig, or sit waiting for a suppository to act. If you have some manual control of the anal sphincter, beware of the inclination to push continuously to force the feces out. It seems reasonable to think that, since the muscle is weakened, you have to make up for it with more effort, but such a strategy is exhausting and stressful. The rectum actually works somewhat on its own. If you can make a contraction, you will achieve more effect by alternately pushing down and relaxing. Alternately pushing and relaxing allows the natural reflex of these muscles to work with you, and you will find that stool will evacuate more easily.

Take care not to irritate the delicate lining of the rectum, which can cause bleeding or development of hemorrhoids. Emphasize this with any PA who aids you with your program.

Now that we’ve reviewed the risks specifically associated with being a wheelchair user, and certain disabilities, now let’s discuss the best ways to avoid these potential pitfalls—by being as healthy as possible. Health and disability are not mutually exclusive concepts. “Impairment” is not the same as “illness.” You can be very healthy in the context of your disability. The place to start is by keeping in shape.

If you use your body, you will live longer and more happily. It is especially important for chair riders to exercise to the degree possible. An inactive, sedentary lifestyle is an invitation to a variety of undesirable results:

Weak muscles

Cardiovascular loss

Osteoporosis Weight gain

Our overall health relies on blood being able to flow efficiently, carrying the vital nutrients and metabolic components we need throughout the body. The pumping of the heart does not do this job alone, but relies on the movement and contraction of our muscles to assist in moving blood through the miles of arteries and veins in our bodies.

This is especially true in the legs, where veins that return blood to the heart employ a system of valves to prevent blood from flowing back down toward our feet. It is the contraction of our leg muscles that assists the hydraulic flow of blood up against gravity and back to the heart. If we are not using our legs, then our heart is working harder, so we need our heart to be healthy. Any physical activity that is available to us contributes to the health of our circulation.

You don’t have to be a bodybuilder to maintain strength. Muscle strength is as much a matter of softness and elasticity as it is of bulk. Flexible muscles can travel further when they contract, which translates to additional strength.

Whatever muscles you have voluntary control of can be exercised and kept at an optimal level of mass and elasticity. You can do this without an extreme amount of exertion. It is a myth that, to exercise a muscle, you have to strain it to exhaustion. A regular routine of gentle and slow repetitions with little weight will maintain muscle tone, at least, and gradually build strength, at best. Exercising moderately two or three times a week will take you a long way toward attaining the strength, stamina, and general health you desire.

For people with limited hand strength and ability to grasp, a quad cuff, such as the one shown in Figure 2-1 from Preston Sammons (www.prestonsammons.com), will allow you to use exercise machines and free weights.

Aerobic exercise has a number of important benefits:

It makes the heart stronger and improves circulatory efficiency. The heart is, after all, a muscle, too.

It helps reduce blood pressure and heart rate.

It helps control your weight.