Colonic transit time and anorectal manometric anomalies in 19 patients with complete transection of the spinal cord

Beuret-Blanquart, F.; Wéber, Jacques; Gouverneur, J.P.; Demangeon, S.; Denis, Philippe

doi:10.1016/0165-1838(90)90251-d

Cited by 91 publications

(77 citation statements)

References 23 publications

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“…[1][2][3][4] Colonic transit times are often prolonged, [5][6][7][8] and anorectal sensibility and voluntary control of the external anal sphincter is reduced or lost. 5,9,10 The severity of colorectal and anal sphincter dysfunction depends on the completeness of SCI 3 and constipation-related symptoms become significantly more severe with time since injury. 1,11 To facilitate a comparison of symptoms, treatment modalities, and outcomes between patients, various centers and countries it would be advantageous to collect data on bowel symptoms after SCI in the form of common international data sets.…”

Section: Introductionmentioning

confidence: 99%

International bowel function basic spinal cord injury data set

et al. 2008

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Study design: International expert working group. Objective: To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research. Setting: Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). Methods: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCoS Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Council and ASIA Board received the data set for final review and approval. Results: The International Bowel Function Basic SCI Data Set includes the following 12 items: date of data collection, gastrointestinal or anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, awareness of the need to defecate, defecation method and bowel care procedures, average time required for defecation, frequency of defecation, frequency of fecal incontinence, need to wear pad or plug, medication affecting bowel function/constipating agents, oral laxatives and perianal problems. Conclusion: An International Bowel Function Basic SCI Data Set has been developed.

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Section: Introductionmentioning

confidence: 99%

International bowel function basic spinal cord injury data set

et al. 2008

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“…The gastrocolonic re¯ex is absent after SCI 4 and depending on the neurological level of the lesion, two kinds of motility alteration may ensue: an increase in non-peristaltic contractions of the sigmoid colon and/or a decrease of the peristaltic contractions. 5 In SCI there is loss of the conscious urge to defaecate with inability to trigger the defaecatory act; in addition, once rectal distension activates the defaecatory re¯ex, the timely inhibition of the anal canal is opposed by the dyssynergic contraction of the external anal sphincter and of the other pelvic muscles. 5,6 The aim of this study was to assess if a therapeutic protocol which combines the means to accelerate large bowel transit and to trigger the defaecatory act, can increase the frequency and optimise the timing of bowel movements, and thus decrease the necessity for the use of oral laxatives and/or enemas in SCI patients.…”

Section: Introductionmentioning

confidence: 99%

Sequential treatment of chronic constipation in paraplegic subjects

et al. 1997

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Chronic constipation is the main gastrointestinal complaint of spinal cord injury (SCI) patients, and has a signi®cant e ect on patients' lives, concerning nursing dependence, morbidity and complications. Many therapies have been proposed to treat chronic severe constipation, most of them with limited e ect or being unpredictable in their e ect or being expensive or very radical. Ten spinal cord injury patients have been submitted to a therapeutic protocol based on a high residue diet, a standardised water intake, and on the use of a sequential schedule of evacuating stimuli. After four weeks of treatment the patients showed an increased frequency of bowel movements per week, a decreased total gastrointestinal transit time, and a decreased need for oral and rectal laxatives. This treatment seems to be e ective in modifying patients' bowel habits, and therefore could be considered as a standardised protocol for the management of severe constipation in those who are paraplegic.

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“…Functional classi®cation Frankel grade A and B may be associated in part due to the probability of the gut being more severely a ected in individuals with complete cord transection, 10,23 and the greater degree of immobility. 5,22 Range of motion exercises prior to the bowel program may help to facilitate evacuation in these individuals. 22,60 Polypharmacy may increase the risk of constipation, especially in older individuals, 34 and constipation as a drug side-e ect may be substantially under-reported in patients with SCI.…”

Section: Discussionmentioning

confidence: 99%

“…5,22 Range of motion exercises prior to the bowel program may help to facilitate evacuation in these individuals. 22,60 Polypharmacy may increase the risk of constipation, especially in older individuals, 34 and constipation as a drug side-e ect may be substantially under-reported in patients with SCI. Benzodiazepines have not previously been shown to increase the risk of constipation in non-injured subjects 33,37 and this study ®nding may be confounded by increased administration to individuals who are Frankel grade A or B.…”

Section: Discussionmentioning

confidence: 99%

“…3,8,9,23,25 However, individual patients with comparable neurological levels of injury may show markedly di erent patterns of constipation. 2,22 In particular, as individuals age with cervicothoracic cord injury, the colon may become progressively more compliant and¯accid, predisposing them to worsening constipation symptoms. 5 There are limited data examining di culty with evacuation in relation to neurological level of SCI, time elapsed since injury, 3 and other factors such as age, functional impairment, medications, and comorbidity.…”

Section: Introductionmentioning

confidence: 99%

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Constipation-related symptoms and bowel program concerning individuals with spinal cord injury

Harari

Sarkarati²,

Gurwitz

et al. 1997

Spinal Cord

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Purpose. To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of di culty with evacuation. Patients and Methods. This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n=197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n=161, 82%) regarding bowelrelated symptoms and treatment over the previous 1 month period. The study de®nition of di culty with evacuation was spending more than 1 h per episode of bowel evacuation. Results. Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with di culty with evacuation (n=66) were compared with those who spent less than 1 h on evacuation (n=95). Factors associated with di culty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. Conclusion. Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable laxative use. Our ®ndings suggest that di culty with evacuation can be predicted on the basis of a patient's clinical pro®le.

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Colonic transit time and anorectal manometric anomalies in 19 patients with complete transection of the spinal cord

Cited by 91 publications

References 23 publications

International bowel function basic spinal cord injury data set

International bowel function basic spinal cord injury data set

Sequential treatment of chronic constipation in paraplegic subjects

Constipation-related symptoms and bowel program concerning individuals with spinal cord injury

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