INTRODUCTION: Almost all people with spinal cord injury/disease (SCI/D) suffer from neurogenic bowel dysfunction (NBD), with a considerable impact on quality of life. The Association of the Scientific Medical Societies in Germany (AWMF e.V.) guideline for NBD in SCI/D aims to provide practice-oriented support for the care of patients with NBD resulting from congenital or aquired SCI/D. The guideline describes the diagnosis and bowel management of NBD in people with SCI/D. Thus, treatment processes in acute medical care and rehabilitation as well as for lifelong aftercare are presented. METHODS: The present guideline was developed under the leadership of the German-speaking Medical Society for Paraplegiology in a multiprofessional interdisciplinary guideline team. To exceed the level of expert recommendations, consensus was reached within the framework of a structured nominal group process in defined steps under neutral moderation considering the criteria of the German guideline development instrument (DELBI). RESULTS: Individual bowel management must be developed on the basis of an adequate diagnosis and considering the different lesion types. Due to the multifactorial influenceability of the intestine and the individual neurological deficit, a simple to-do checklist is not effective. Various and complex bowel management programmes are the basis of the treatment of NBD. CONCLUSIONS: Guidelines can only be successful in so far as they are applied in everyday life. Of course, the selection and application of the measures described must always take into consideration the individual situation of the person concerned, and the correct application is always a prerequisite for success.

Study design: A descriptive, cross-sectional, multicentre design was used. Objective: To analyse bowel management in patients with spinal cord injury (SCI) especially the occurrence of unplanned bowel evacuations and duration of planned bowel evacuation. Setting: In total, 29 rehabilitation facilities for SCI patients in Austria, Germany, the Netherlands and Switzerland, with a total of 837 hospitalized SCI patients. Method: Data were collected by nurses within 1 week in November 2001 using a quantitative questionnaire containing 14 questions. For data analysis, a w 2 -test was used for differences in the outcome of bowel evacuation procedures associated with different interventions. Stepwise multiple logistic regression was used to analyse the relationship between the outcome of bowel management and the interventions as well as intervening factors. Results: More unplanned bowel evacuations were associated with usage of oral laxatives (n ¼ 444, Po0.001) as well as bowel evacuation every day (n ¼ 270, Po0.05) or every second day (n ¼ 368, Po0.05). The outcome of less unplanned bowel evacuations was associated with manual removal of stool combined with digital stimulation (n ¼ 35, Po0.05) and spontaneous bowel evacuations (n ¼ 104, Po0.001). Short duration of bowel evacuation (o60 min) was associated with manual removal of stool (n ¼ 64, Po0.05), the sitting position at defecation (n ¼ 494, Po0.001) and low frequency of bowel evacuation (X3 days) (n ¼ 638, Po0.05). Duration 460 min was associated with the use of oral laxatives (n ¼ 444, Po0.001) and complete loss of sensory function (n ¼ 349, Po0.05). Stool of hard consistency was associated with the manual removal of stool (n ¼ 64, Po0.001), the manual removal of stool in combination with digital stimulation (n ¼ 53, Po0.001) and the sitting position at defecation (n ¼ 494, Po0.05). Stool of soft consistency (n ¼ 341) was associated with the complete motor lesion (n ¼ 443, Po0.05). Conclusion: Manual removal of stool was combined with low risk of unplanned bowel evacuations and short duration of evacuation time. These results are useful to improve the outcomes of bowel management in SCI patients.Spinal Cord (2005) 43, 724-730.

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As a considerable heterogeneity in the procedure of intermittent catheterization (IC) was identified by a questionnaire survey conducted in hospitals and institutions for the treatment of patients with spinal cord injury in 2010, it became necessary to standardize the IC procedure (i.e. self‐catheterization and assisted catheterization). These guidelines were developed within a structured consensus process (e.g. several consensus conferences and nominal group process) by members of the working group on neuro‐urology and the working group on nursing of the German‐speaking Medical Society of Paraplegia and were published as guidelines of the German Society of Urology (DGU). The guidelines developer group was a multiprofessional group. Firstly, the indications for IC are presented and concepts such as sterile, aseptic and hygienic catheterization are defined. The materials necessary for the IC are presented in detail. The disinfection and catheterization techniques are described and a detailed explanation of the potential complications and their management is given. Finally, the legal aspects and issues of eligibility of catheter materials are discussed. The purpose of this consensus is to contribute to the standardization of IC. It should remove uncertainty and offer assistance to users (i.e. patients, staff and care providers). A particular focus is placed on practical instructions for carrying out the IC. The intention is to support the realization of IC in various settings (e.g. hospital, rehabilitation, long‐term care institutions and home‐based care). A wide implementation of the guidelines should lead to a reduction of the risks and complications of IC.

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