A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia

Abstract

Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.

Creation and validation of a new tool for the monitoring efficacy of neurogenic bowel dysfunction treatment on response: the MENTOR tool

“…An initial survey of the literature identified that the evolution of newer therapeutic options for NBD (prokinetic agents, TAI) has not been reflected in change of treatment for participants. This is especially revealing since 40% were dissatisfied with their bowel function [13]. This result has good concordance with our sample where 35% of individuals with SCI were dissatisfied or very dissatisfied with their bowel function.…”

“…In addition, there is the burden of excessive time spent on toileting and increased frequency of urinary tract infections that accompanies sub-optimal bowel management [11]. For individuals with chronic conditions in the community, the prevalence of NBD may be as high as 98% [12] and 40% report being dissatisfied with their current bowel management [13]. Moreover, a survey of 287 community-dwelling individuals with SCI identified that 70% had not had a change of any aspect of their bowel management in the preceding 5 years [13].…”

“…For individuals with chronic conditions in the community, the prevalence of NBD may be as high as 98% [12] and 40% report being dissatisfied with their current bowel management [13]. Moreover, a survey of 287 community-dwelling individuals with SCI identified that 70% had not had a change of any aspect of their bowel management in the preceding 5 years [13]. This may have an impact on the fact that hospitalisations are twice as common in people with NBD symptoms compared with those individuals with SCI with wellregulated bowel function [14].…”

“…A minority of this population may consider surgical procedures like the antegrade continence enema or a colostomy [19,20], or experimental neuromodulation therapies [21]. However, it is clear that management of NBD is not systematically undertaken [13,17].…”

Conceitos, manifestações clínicas e cuidados imediatos na disreflexia autonômica

“…Estudiosos 21 ressaltam que existem incidências iguais tanto para a bradicardia quanto para a taquicardia. Outros pesquisadores 8,11 acrescentam que além das manifestações citadas anteriormente, identificam-se pele fria e pálida abaixo do nível da LM, trombose venosa Comumente os fatores etiológicos que podem desencadear a DA são as lesões traumáticas que incluem a LM, e, causas não traumáticas que se referem a neoplasias, patologia de origem vascular como problema arteriovenoso e má formação, patologias degenerativas como a siringomielia, patologias inflamatórias incluindo a mielite transversa e encefalomielite 11 .nível da lesão que irão desencadear uma reação do SNAP causando uma ação vasodilatadora para gerar a diminuição da frequência cardíaca 12 .Vale mencionar que alguns pacientes de DA não sabiam a respeito de sua condição clínica, apesar de referir seus sinais e sintomas, mostrando a importância de ter melhorias na educação nesses indivíduos sobre sua patologia com objetivo de identificar sua sintomatologia e como saber procurar assistência para sua condição15 .Vale mencionar alguns pontos de importância desses pacientes, como a educação para que os mesmo possa se ajudar em seu processo saúde e doença, o uso da toxina botulínica, que além de minimizar a espasticidade também auxilia os profissionais de saúde em suas condutas, e não menos importante às intervenções do trato urinário que segundo os estudos encontrados são um dos maiores causadores da DA.Contudo, observou-se que há uma grande escassez de estudos referente o tema, e que se fazem necessárias mais pesquisas para disseminar mais essa desordem e fazer com que seja mais conhecida perante os profissionais de saúde com objetivo de aperfeiçoar os cuidados aos portadores de DA. Eldahan KC, Rabchevsky AG.…”