Bowel Cancer and Disabilities

Cancer screening for people with disabilities, both physical and intellectual, can be a lot more challenging than for able-bodied people who may find themselves at higher risk if they are diagnosed too late.

Bowel Cancer Foundation Trust has partnered with Parafed Auckland to help bring more awareness to the disability community focusing on the prevention of bowel cancer specifically for wheelchair users who face daily challenges around bowel health.

Below highlights the importance of good food and exercise to avoid complications associated with bowel health.

How paralysis impacts the digestive and bowel systems

Paralysis disrupts the bowel system and causes complications ranging from constipation to accidents. If you are living with or impacted by paralysis, it is important to understand the digestive tract and how to manage bowel complications to preserve health and quality of life.

After food is swallowed, it moves through the oesophagus to the stomach, which is basically a storage bag, and then on to the intestines or bowels. The absorption of nutrients occurs in the small intestines, the duodenum, the jejunum and the ileum. Next is the colon, which encircles the abdomen, starting on the right with the ascending colon, passing across the top with the transverse colon, and down the “s”-shaped sigmoid colon to the rectum, which opens at the anus.

Messages relayed via the spinal cord produce voluntary relaxation of the pelvic floor and anal sphincter muscles, allowing the defecation process to occur.

Effects of paralysis on the bowel system

Simply put, paralysis disrupts the bowel system. There are two main types of neurogenic bowel dysfunction, depending on the level of injury: an injury above the conus medullaris (at L1) results in upper motor neuron (UMN) bowel syndrome; a lower motor neuron (LMN) bowel syndrome occurs in injuries below L1.

In a UMN or hyperreflexic bowel, voluntary control of the external anal sphincter is affected; the sphincter remains tight, which promotes constipation and retention of stool. This complication has been linked to episodes of autonomic dysreflexia. UMN connections between the spinal cord and the colon remain intact, thus reflex coordination and stool propulsion remain intact. Stool evacuation in people with UMN bowel occurs by means of reflex activity caused by a stimulus introduced into the rectum, such as a suppository or digital stimulation.

LMN or flaccid bowel is marked by loss of stool movement (peristalsis) and slow stool propulsion. The result is constipation and a higher risk of incontinence due to lack of a functional anal sphincter. To minimize the risk of hemorrhoids, use stool softeners, minimal straining during bowel efforts, and minimal physical trauma during stimulation.

Bowel programmes

Special bowel programmes are required by wheelchair users impacted by paralysis to ensure a healthy bowel, with a focus on nutrition and fitness to ensure they remain healthy and strong. It is generally not necessary to have a bowel movement every day. Every other day is okay. Bowels move more readily after a meal.

The best way to prevent bowel accidents is to follow a schedule and teach the bowel when to have a movement.

Constipation:

There are several bowel programmes for people in wheelchairs to prevent constipation or manage faecal incontinence. A referral to a Continence Nurse is required for an assessment and treatment plan to be put in place for the individual patient's needs and lifestyle.

There is a list on the Continence NZ website of all the Continence Nurses in the country for adults and children. A referral is required from a GP or other Health Professional, although some Nurses do take self-referrals.

If only lower bowel stimulation is required, digital stimulation and anal sweeps are used first to promote bowel emptying. Suppositories and enemas are a last resort. A bowel assessment is required to have the most appropriate one prescribed.

Many spinal injury patients use natural suppositories such as glycerine, having the least long-term side effects.

Continence NZ assures us there is no evidence that the chemicals in other suppositories can cause cancer and that the only long-term side effect reported on is sloughing or shedding of the surface tissue inside the rectum.

Continence NZ prefer to treat constipation naturally, using conservative measures with diet, fluids, apple/prune and bran mix, kiwi crush, Ispaghulla husk, Alpine Tea, the gastro colic reflex and the correct toileting position before using laxatives.

The Peristeem bowel irrigation system available, popular with spinal injury patients as this fully empties the lower bowel for up to three days.

Symptoms of bowel cancer for wheelchair users

The best way to protect yourself and your loved ones against bowel cancer are to be aware of the symptoms. In the early stages, there may be no obvious signs or symptoms to bowel cancer but in most cases, the following will be a good indicator:

  • Blood in the stools and/or bleeding from the rectum
  • A change in bowel habit lasting longer than 6 weeks (e.g. loose stools, diarrhoea or constipation)
  • Stomach pain (often severe)
  • Lumps or a mass in the abdomen
  • Weight loss
  • Weakness and tiredness (symptoms of anaemia)

If you are experiencing a number of these it is a good idea to get checked out by your doctor immediately.

Inflammatory bowel disease such as Crohn's disease and ulcerative colitis can also mimic all the symptoms of bowel cancer listed above.

Using a wheelchair has no bearing on the screening, diagnosis or treatment of bowel cancer which are the same for everybody.

However, pain intensity may change, dependent on degree of sensation at the torso.

Dependent on your transfer method to and from the toilet, it may be beneficial to make a habit of checking your poo, or having a carer or family member check your poo, to identify any blood or mucus which could suggest further investigation is required via your GP.

Risk Factors

Chronic constipation and obesity are associated with bowel cancer but are not causative risk factors on their own. The other main risk factors for bowel cancer are high alcohol intake, a poor diet low in fresh fruit and vegetables, high intake of red and processed meats and genetic factors.

Bowel cancer screening for wheelchair users


The screening tests are three consecutive faecal samples for occult blood (FOB's) and blood tests. If blood is found in the stool samples they would be referred to a colorectal specialist who would do further screening tests such an ultrasound scan, a sigmoidoscopy/ colonoscopy.

The only time diagnosis is delayed is if people ignore the signs and do not report this to their Doctor.

The screening consists of a stool sample which can be taken from an incontinence pad if the patient cannot sit on the toilet. Most physical disabilities can be accommodated for if the patient needs to have a colonoscopy, the hospitals are used to managing patients with different physical needs and have equipment such as hoists to help.

Some patients may need to be admitted for the bowel clear out as this may be difficult to manage at home, as happens with frail elderly patients.

The National Bowel Screening Programme which started in 2017, is slowly being rolled out across NZ for men and women without symptoms aged 60-74. However, if there is a strong family history such as parents and siblings dying from bowel cancer, or someone known to have multiple bowel polyps Patients may be put on a surveillance list and may be offered routine screening in the form of a colonoscopy every two years.

If a patient thinks their disability prevents them from screening they should talk to their GP about how to overcome this.

Access to screening:

Screening may prove more difficult in some geographical areas far away from one of the main hospitals, where waitlists may be longer or access to specialist's restricted.

In such cases, extra travel may be involved in the main city hospital or waiting for a clinic which may only be held once a month. All hospitals have equipment such as hoists and staff trained to deal with any type of disability for transferring or lifting patients.

Nutrition and Exercise

Nutrition should be carefully managed, as the quality of a persons food can significantly effect how the body performs its processes.

Wheelchair users are recommended to increase the amount of fibre in their diet (wholegrains, fruit and vegetables) to prevent constipation. Individuals that are overweight, increase the probability of chronic disease such as Type 2 Diabetes.

Weight can be managed by eliminating sugar and highly process foods. Exercise is highly recommended for all people. There are many gyms and sports centres who cater to these needs such as Parafed Auckland who encourage individuals of all abilities to get fit.

Parafed Auckland provides sport and recreation opportunities to all Aucklanders with different abilities that want to get involved through a range of programmes and events.

The coaches within Parafed Auckland encourage regular exercise and healthy lifestyle habits.

How medication can affect the bowel

Some medications commonly used by people with paralysis can affect the bowel. For example, anticholinergic medications (for bladder care) may result in constipation or even bowel obstruction. Additionally, there are several medications that can lead to constipation like antidepressant drugs, such as amitryptyline; narcotic pain medications; and some drugs used for the treatment of spasticity, such as dantrolene sodium.

Parafed Auckland

Parafed Auckland – Para Sport & Recreation is New Zealand’s oldest and largest disability sports organisation. They lead a network of 15 sports clubs and activity providers catering for 300+ members. They are the lead organisation for all physical disability sport in Auckland, providing pathways and opportunities for beginners, all the way through to Paralympic Champions!

Parafed Auckland provides sport and recreation opportunities to all Aucklanders with different abilities that want to get involved through a range of programmes and events.

The coaches within Parafed Auckland encourage regular exercise and healthy lifestyle habits.

The staff pride themselves on being able to find sport and recreation opportunities and hobbies for anyone.

They offer a wide variety of programmes and events throughout the year.

To learn more click here.

Charity Achievements

Key milestones reached by Bowel Cancer Foundation Trust

$1.1million

Dollars distributed in the last 12 months to fund research and provide equity of care and better patient outcomes

195

Bowel cancer survivors rehabilitated after gruelling treatment helping to reduce cancer re-occurrence

109+

Bowel screening kits provided to Kiwi’s who do not qualify for free public screening to detect bowel cancer early

7+

Years we've been making a difference for bowel cancer patients in New Zealand