Bowel dysfunction following spinal cord injury

Lynch, A. C.; Antony, Ajay; Dobbs, B. R.; Frizelle, F. A.

doi:10.1038/sj.sc.3101119

Cited by 147 publications

(118 citation statements)

References 40 publications

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“…13 A previous study found that patients with higher tetraplegia had the highest prevalence of bowel problems compared with patients with lower paraplegia. 14 Lynch et al 15 also reported that the level of the spinal cord lesion determines the effect on colonic motility, and cervical injuries can result in more remarkable constipation, abdominal distention and discomfort. From the results of our study, we can clearly see that cervical and thoracic level of injury carry a higher risk of severe NBD than lumbar level injury (OR ¼ 10.5 and 7.1, respectively) and the severity of bowel dysfunction is strongly associated with the level of cord injury.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Liu

Huang

et al. 2010

Spinal Cord

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Study design: Cross-sectional study. Objective: To analyze the predictors of severe neurogenic bowel dysfunction (NBD) in persons with spinal cord injury (SCI). Setting: The Kaohsiung Medical University Hospital, Taiwan. Methods: Two questionnairesFthe NBD score and the Beck Depression Inventory second editionFwere sent to 232 persons with SCI by mail. The demographic factors and injury-related factors were recorded to evaluate any relationships with severe NBD. The associations between the severity of NBD and psychological condition were also measured. Results: In all, 39.4% of the respondents suffered from severe NBD. Multiple logistic regression analysis showed that those with a cervical injury (odds ratios (OR) ¼ 10.5, 95% confidence interval (CI) 1.6-67.7) or a thoracic injury (OR ¼ 7.1, 95% CI 1.2-40.3) had a higher risk of severe NBD than those with a lumbar injury. Persons with American Spinal Injury Association (ASIA) A had a 12.8-fold higher risk of severe NBD than persons with ASIA D (OR ¼ 12.8, 95% CI 3.3-50.1). Longer duration of injury (X10 years) was another risk factor of severe NBD. Moderate-to-severe depression was associated with reduced bowel function. Conclusions: This study showed that high level of cord lesion, completeness of cord injury and longer duration of injury (X10 years) could predict the severity of NBD in patients with SCI.

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Section: Discussionmentioning

confidence: 99%

“…The total score ranges from 0 to 63, with higher scores indicating a greater level of a depressive mood. The total score can be further categorized into four grades: normal (0-13); mild depression (14)(15)(16)(17)(18)(19); moderate depression (20-28); and severe depression (29-63).…”

Section: Methodsmentioning

confidence: 99%

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Liu

Huang

et al. 2010

Spinal Cord

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“…Moderately invasive, use of rectal stimulant/ osmotic laxative, can result in prolonged reflex rectal activity leading to incontinence, abdominal cramping, irritation of rectal mucosa, can result in soiling because of retention of melted suppositories. 6 Manual evacuation Mechanical removal of stool from the bowel using a digit.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…[3][4][5] Neurogenic bowel dysfunction can result in considerable morbidity, such as autonomic dysreflexia, impaction, hemorrhoids, abdominal pain, rectal bleeding, rectal prolapse, anal fissure, bloating, nausea, constipation and prolonged evacuation. 1,3,4,6,7 Bowel management programs are based on regular routine, dietary manipulation, laxatives, digital and pharmacological rectal stimulation, manual evacuation of stool and assistive interventions such as abdominal massage. There is little evidence to support these interventions individually or in combination.…”

Section: Introductionmentioning

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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“…8,15 In rehabilitation centres, nurses care for the bowel management of patients with SCI and initiate a bowel management program. 21 The aim of such programs is to eliminate faecal incontinence or other complications 3,19 and to evacuate stool at a regular, predictable time 14,19 within 60 min. 7 The interventions include the manual removal of stool 11,15,17,19,22 for patients with an areflexic bowel as well as techniques like digital stimulation 11,15,22 and suppositories 11,15,22 for patients with a reflexic bowel to initiate reflex peristalsis, 14 frequency, 14 timing of bowel evacuation, 11,22 and the usage of oral laxatives.…”

Section: Introductionmentioning

confidence: 99%

Bowel management in patients with spinal cord injury – a multicentre study of the German speaking society of paraplegia (DMGP)

et al. 2005

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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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Bowel dysfunction following spinal cord injury

Cited by 147 publications

References 40 publications

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

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

Bowel management in patients with spinal cord injury – a multicentre study of the German speaking society of paraplegia (DMGP)

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