Bowel Care for Individuals with Spinal Cord Injury: Comparison of Four Approaches

Amir, Imran; Sharma, Rajesh; Bauman, William A.; Korsten, Mark A.

doi:10.1080/10790268.1998.11719506

Cited by 26 publications

(12 citation statements)

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“…Bisacodyl (dulcolax) and glycerin are the most common active ingredients in these suppositories. Five studies (aggregate N ¼ 69) [19][20][21][22][23] examined the effect of suppositories on bowel management in SCI including one RCT and two controlled trials, which were not randomized ( Table 2). There is Level 1 evidence (from one good-quality RCT, however, with few subjects), 19 in addition to lower levels of evidence, [20][21][22] to support polyethylene glycol-based suppositories for bowel management.…”

Section: Resultsmentioning

confidence: 99%

“…The total bowel care time with the polyethylene glycol-based suppository is significantly less compared with hydrogenated vegetable oil-based bisacodyl suppositories. [21][22][23] Dietary fiber. There is Level 4 evidence (from one case series; N ¼ 11) 24 that high fiber diets may cause colonic transit time to increase, rather than decrease ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

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Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results: A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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“…The majority of interventional bowel-related studies in this population report very small samples and this may reflect generally low recruitment rates. 20 Among those that attended for the previous anorectal physiology study but who declined inclusion in this trial, a number of issues regarding BM research were identified. Many felt that they lacked time because of work, educational, family or carer commitments, BM had to fit into an often tight schedule.…”

Section: Discussionmentioning

confidence: 99%

“…There was an acceptance of the status quo; they had learned how to cope with their altered bowel function and BM as they now conducted it, possibly using reappraisal strategies. 20 Individuals indicated that allowing the research to impinge on their everyday life was unacceptable. These views underline how integral BM is to everyday life and illustrate why recruitment is so problematic.…”

Section: Discussionmentioning

confidence: 99%

The need for manual evacuation and oral laxatives in the management of neurogenic bowel dysfunction after spinal cord injury: a randomized controlled trial of a stepwise protocol

Coggrave

Norton

2009

Spinal Cord

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Study design: Randomised controlled trial. Objectives: High-quality evidence for interventions in bowel management (BM) after spinal cord injury (SCI) is lacking and BM programs are developed empirically. This randomized, controlled trial compared usual care with a stepwise protocol based on earlier published work to examine whether systematic use of less invasive interventions could reduce the need for oral laxatives and invasive interventions such as manual evacuation, and improve BM outcomes in individuals with chronic SCI. Setting: United Kingdom. Methods: In all, 68 individuals were recruited (35 in intervention group), median age 47 years (range 24-73 years), median duration of injury 16 years (range 1-47 years). Bowel diaries were maintained for a maximum of 6 weeks while the intervention group followed a stepwise protocol designed to test interventions singly and in combination. Measures of quality of life and preferences for different bowel care interventions were recorded. Results: The stepwise protocol did not improve BM outcomes; fecal incontinence was more frequent (P ¼ 0.04); the need for oral laxatives and invasive interventions was not reduced (P ¼ 0.4). Bowel care took consistently longer in the intervention group. Conclusions: The study findings support the need for manual evacuation in BM and provide evidence of acceptability of the technique to SCI individuals. For some individuals oral laxatives are an essential part of management. The results are in contrast with previous studies in younger samples with shorter duration of injury.

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“…Use of suppositories has been shown to decrease duration of time spent on bowel care and the need for nursing/ caregiver assistance, specifically for PEG-based suppositories. 158,159,160,161,162 There is at least one good quality RCT study by House and Stiens that showed effective response to PEG-based bisacodyl suppositories for bowel management. 158 There are other studies with lower levels of evidence that support this finding.…”

Section: Glycerin Suppositorymentioning

confidence: 99%

Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury

Johns

Krogh

Rodriguez

et al. 2021

Topics in Spinal Cord Injury Rehabilitation

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Since nearly everyone who experiences a spinal cord injury (SCI) experiences neurogenic bowel dysfunction (NBD), the information contained in this clinical practice guideline (CPG) is of great relevance both to the community of persons with SCI and to the clinicians who help them manage the secondary conditions of SCI, of which controlled NBD remains a major determinant of quality of life (QOL). This CPG, similar to its predecessor version, is anticipated to be one of the most important CPGs of the Consortium for Spinal Cord Medicine regarding potential impact on the care of persons with SCI. The scope of this most recent update has been expanded to include a review of the different types of oral and rectally administered medications, of procedures such as transanal irrigation, and of surgical options.During the development and peer review of this CPG, we were fortunate to have the representation of an international team of various stakeholders, including the subspecialties affected by these recommendations, ranging from experts in gastroenterology, gastrointestinal surgery, and nutrition to rehabilitation professionals, including physiatrists, nurses, psychologists, and occupational and physical therapists. We hope that this wide-ranging representation translates into uniform quality practice through the widespread use of this CPG to guide NBD in all settings, which can only result in the best outcomes and QOL for those who experience SCI.On behalf of the consortium steering committee, I want first to acknowledge the leadership of the Chair, Jeffery Johns, MD, in guiding this panel through the development process. Next, I would like to acknowledge the panel members themselves for keeping to task, as well as the many reviewers who provided valuable feedback from all areas and are to be commended. All of these people, including the panel Chair, have volunteered their time to help produce this superb document. In addition, I wish to acknowledge the ongoing support of the Paralyzed Veterans of America, especially President David Zurfluh, Executive Director Carl Blake, and Director of Research and Education Cheryl Vines, as well as the rest of the leadership team, without whose support these guidelines would not exist.Finally, we thank the Craig H. Neilsen Foundation and Executive Director Kym Eisner for their commitment to improving the QOL for those living with SCIs and for their generous financial support of this CPG.

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Bowel Care for Individuals with Spinal Cord Injury: Comparison of Four Approaches

Cited by 26 publications

References 0 publications

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

The need for manual evacuation and oral laxatives in the management of neurogenic bowel dysfunction after spinal cord injury: a randomized controlled trial of a stepwise protocol

Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury

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