Bowel Management in Spinal Cord Injury: Difference between revisions

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Neurogenic bowel dysfunction is characterized by alteration in normal bowel function due to the lack of nervous control.<ref>Stiens SA, Bergman SB, Goetz LL. Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Archives of physical medicine and rehabilitation. 1997 Mar 1;78(3):S86-102.</ref> <ref name=":0">Deng Y, Dong Y, Liu Y, Zhang Q, Guan X, Chen X, Li M, Xu L, Yang C. A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury. Medicine. 2018 Oct;97(41).</ref>The clinical symptoms of neurogenic bowel may vary. Some clinical symptoms are bloating, constipation, abdominal pain, incontinence.<ref name=":0" />
Neurogenic bowel dysfunction is characterized by alteration in normal bowel function due to the lack of nervous control.<ref>Stiens SA, Bergman SB, Goetz LL. Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Archives of physical medicine and rehabilitation. 1997 Mar 1;78(3):S86-102.</ref> <ref name=":0">Deng Y, Dong Y, Liu Y, Zhang Q, Guan X, Chen X, Li M, Xu L, Yang C. A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury. Medicine. 2018 Oct;97(41).</ref>The clinical symptoms of neurogenic bowel may vary. Some clinical symptoms are bloating, constipation, abdominal pain, incontinence.<ref name=":0" />


The symptoms of neurogenic bladder in [[Spinal cord injury|Spinal Cord Injury]](SCI) can be broadly divided into two headings:
* Upper Motor Neuron (UMN) bowel syndrome
* Lower Motor Neuron (LMN) bowel syndrome
Upper Motor Neuron (UMN) Bowel Syndrome, occurring in a spinal cord injury above the conus medullaris results in a hyperreflexic bowel, characterised by increased colonic wall and anal tones, with disrupted voluntary external anal sphincter control. Typically associated with constipation and fecal retention at least in part due to external anal sphincter activity. <ref name=":10" /><ref name=":12">Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118252/ Neurogenic Bowel Management after Spinal Cord Injury: A Systematic Review of the Evidence.] Spinal Cord. 2010 Oct;48(10):718.</ref>
Upper Motor Neuron (UMN) Bowel Syndrome, occurring in a spinal cord injury above the conus medullaris results in a hyperreflexic bowel, characterised by increased colonic wall and anal tones, with disrupted voluntary external anal sphincter control. Typically associated with constipation and fecal retention at least in part due to external anal sphincter activity. <ref name=":10" /><ref name=":12">Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118252/ Neurogenic Bowel Management after Spinal Cord Injury: A Systematic Review of the Evidence.] Spinal Cord. 2010 Oct;48(10):718.</ref>


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Introduction[edit | edit source]

Neurogenic bowel dysfunction is characterized by alteration in normal bowel function due to the lack of nervous control.[1] [2]The clinical symptoms of neurogenic bowel may vary. Some clinical symptoms are bloating, constipation, abdominal pain, incontinence.[2]

The symptoms of neurogenic bladder in Spinal Cord Injury(SCI) can be broadly divided into two headings:

  • Upper Motor Neuron (UMN) bowel syndrome
  • Lower Motor Neuron (LMN) bowel syndrome

Upper Motor Neuron (UMN) Bowel Syndrome, occurring in a spinal cord injury above the conus medullaris results in a hyperreflexic bowel, characterised by increased colonic wall and anal tones, with disrupted voluntary external anal sphincter control. Typically associated with constipation and fecal retention at least in part due to external anal sphincter activity. [3][4]

Lower Motor Neuron (LMN) Bowel Syndrome, occurring in a spinal cord injury at the injury at the conus medullaris or cauda equina results in an areflexic bowel, characterised by loss of spinal cord-mediated peristalsis and slow stool propulsion with an atonic external anal sphincter. Typically associated with constipation and a significant risk of incontinence due to flaccid paralysis of the external anal sphincter and reduced motor control of levator ani. [3][4]

The three main implications of disruption to motor, sensory and autonomic pathways post spinal cord injury on bowel function are an inability to:

  1. feel when the bowel is full
  2. voluntarily control muscles to defecate
  3. voluntarily contract muscles to prevent defecating

Successful bowel management is multi-dimensional and needs to be specific to each individual requiring careful assessment for accurate diagnoses and prescription of treatments for bowel management following spinal cord injury, recognising that completeness of injury also has a significant impact on bowel function.Key strategies for bowel management include a high-fibre diet although further research to examine the optimal level, adequate fluid intake and a regular routine for bowel evacuation, which may incorporate digital stimulation or manual evacuation. Transanal irrigation is also now seen as a promising technique to reduce constipation and fecal incontinence. Prokinetic agents such as cisapride, prucalopride, metoclopramide, neostigmine, and fampridine are supported by strong evidence for the treatment of chronic constipation in individuals with a spinal cord injury in those where conservative management is not effective. [3][5][4]

Bowel Management Options Considerations for Appropriate Bowel Management Options
High Fibre Diet Presence or Absence of Bowel Reflexes
  • Complete Lesions below the conus medullaris have loss of bowel reflexes,
  • Complete Lesions above the conus medullaris do not have loss of bowel reflexes

Hand Function

Patients’ Preference

Other Complex Factors

Adequate Fluid Intake
Regular Bowel Emptying Routine
Digital Stimulation Bowel Reflexes
Medication
  • Oral e.g. Bowel Softeners
  • Rectal e.g. Enemas
[6]
[7]

References[edit | edit source]

  1. ↑ Stiens SA, Bergman SB, Goetz LL. Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Archives of physical medicine and rehabilitation. 1997 Mar 1;78(3):S86-102.
  2. ↑ 2.0 2.1 Deng Y, Dong Y, Liu Y, Zhang Q, Guan X, Chen X, Li M, Xu L, Yang C. A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury. Medicine. 2018 Oct;97(41).
  3. ↑ 3.0 3.1 3.2 Cite error: Invalid <ref> tag; no text was provided for refs named :10
  4. ↑ 4.0 4.1 4.2 Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic Bowel Management after Spinal Cord Injury: A Systematic Review of the Evidence. Spinal Cord. 2010 Oct;48(10):718.
  5. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named :7
  6. ↑ SCIUcourses. Bowel 1.3 - Neurogenic Bowel. Available from: https://youtu.be/AYQo1R-sFHk[last accessed 30/10/18]
  7. ↑ SCIUcourses. Bowel 2.1 - The Perfect Program. Available from: https://youtu.be/2K7DByoxias[last accessed 30/10/18]
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