Constipation associated with chronic spinal cord injury: the effect of pelvic parasympathetic stimulation by the Brindley stimulator

Binnie, N. R.; Smith, A. N.; Creasey, Graham; Edmond, P.

doi:10.1038/sc.1991.63

Cited by 76 publications

(40 citation statements)

References 9 publications

(1 reference statement)

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“…[51][52][53][54][55][56][57][58][59] There is Level 2 evidence (from one prospective, non-randomizedcontrolled trial) 51 that supports the use of sacral anterior root stimulation to reduce severe constipation in complete injuries. Binnie et al 51 had found that an implanted Brindley stimulator did not reduce oro-cecal time for individuals with Figure 2 Schematic diagram of the enema continence catheter. A catheter is inserted into the rectum and a balloon is inflated to hold the catheter in place during the administration of an enema.…”

Section: Resultsmentioning

confidence: 99%

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%

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

et al. 2010

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“…Bladder control can be successfully achieved by using Brindley's anterior root stimulator implant. Because most of these patients had concomitant bowel dysfunction, its effect on bowel function as defecation has been documented by Varma et al [12] , in 1986, MacDonagh et al [13] , in 1990, Binnie et al [14] , in 1991, Chia et al [15] , in 1996 and Creasey et al [11] , in 2001. The mechanism of improvement in bowel function is attributed to the activation of contraction of the terminal colon and rectum, resulting in the movement of feces caudally into the anal canal.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors [12][13][14][15] have reported the clinical and manometric results of the implanted neuroprosthesis. However, experimental studies concerning electrically stimulated defecation are fen [15] .…”

Section: Introductionmentioning

confidence: 99%

Sacral anterior root stimulated defecation in spinal cord injuries: An experimental study in canine model

Chang

Yu²,

Diao³

et al. 2005

WJG

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AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter, and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries. METHODS:Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots. RESULTS:For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure), S1 (11.3 kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa, 31.6%) and S1 (14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter. For both rectum and sphincter, the right sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device.CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.

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“…Anecdotally, the subject related that his satisfaction with using stimulation correlated not with the decreased time required to defecate, but with the greater quantity of fecal material he felt he passed. With the Finetech-Brindley implanted stimulator, it has been reported that sacral nerve stimulation provided both an improvement in the frequency of defecation 19 and a decreased time for bowel evacuation. 20 In our study, the high-lowfrequency stimulation paradigm appeared to provide added benefit over a low-frequency only pattern in that the average defecation time was further reduced by 20%.…”

Section: Stimulation For Bladder and Bowel Managementmentioning

confidence: 99%

Implantable FES system for upright mobility and bladder and bowel function for individuals with spinal cord injury

et al. 2005

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Study design: Postintervention. Objectives: To determine the effectiveness of the Praxis multifunctional implantable functional electrical stimulation (FES) system (Neopraxis Pty. Ltd, Lane Cove, NSW, Australia) to provide standing and stepping ability and bladder and bowel management for individuals with motor complete thoracic level spinal cord injuries (SCI). Setting: Pediatric orthopedic hospital specializing in SCI. Subjects: Three males, ages 17 and 21 years, with motor-complete thoracic level SCI and intact lower motor neurons to the muscles targeted for stimulation. Methods: Each subject was successfully implanted with the Praxis FES system. All three subjects received electrodes for upright mobility and the first two subjects received additional electrodes for stimulated bladder and bowel management. Following training, subjects were evaluated in their ability to use FES for nine mobility activities. Acute and chronic experiments of the effect of stimulation on bowel and bladder function were also performed. Results: All three subjects could independently stand up from the wheelchair and could walk at least 6 m using a swing through gait pattern. Two subjects were able to independently perform swing through gait for 6 min and one subject was able to independently ascend and descend stairs. Suppression of reflex bladder contractions by neuromodulation (subject 1) and stimulated contractions of the rectum (subject 2) were observed in acute experiments. When stimulation was applied over the course of several weeks, a positive effect on bowel function was measured. Stimulated bladder contractions were not achieved. Conclusion: The feasibility of using the Praxis FES system for upright mobility and aiding aspects of bladder and bowel function was demonstrated with three subjects with thoracic level SCI.

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Constipation associated with chronic spinal cord injury: the effect of pelvic parasympathetic stimulation by the Brindley stimulator

Abstract: SummaryTen subjects with severe constipation due to complete spinal cord injury (SCI) had pro longed oro-anal transit time (p Show more

Cited by 76 publications

References 9 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

Sacral anterior root stimulated defecation in spinal cord injuries: An experimental study in canine model

Implantable FES system for upright mobility and bladder and bowel function for individuals with spinal cord injury

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