Guideline for the management of neurogenic bowel dysfunction in spinal cord injury/disease

Abstract

INTRODUCTION: Almost all people with spinal cord injury/disease (SCI/D) suffer from neurogenic bowel dysfunction (NBD), with a considerable impact on quality of life. The Association of the Scientific Medical Societies in Germany (AWMF e.V.) guideline for NBD in SCI/D aims to provide practice-oriented support for the care of patients with NBD resulting from congenital or aquired SCI/D. The guideline describes the diagnosis and bowel management of NBD in people with SCI/D. Thus, treatment processes in acute medical care and rehabilitation as well as for lifelong aftercare are presented. METHODS: The present guideline was developed under the leadership of the German-speaking Medical Society for Paraplegiology in a multiprofessional interdisciplinary guideline team. To exceed the level of expert recommendations, consensus was reached within the framework of a structured nominal group process in defined steps under neutral moderation considering the criteria of the German guideline development instrument (DELBI). RESULTS: Individual bowel management must be developed on the basis of an adequate diagnosis and considering the different lesion types. Due to the multifactorial influenceability of the intestine and the individual neurological deficit, a simple to-do checklist is not effective. Various and complex bowel management programmes are the basis of the treatment of NBD. CONCLUSIONS: Guidelines can only be successful in so far as they are applied in everyday life. Of course, the selection and application of the measures described must always take into consideration the individual situation of the person concerned, and the correct application is always a prerequisite for success.

Neurogenic Bowel and Management after Spinal Cord Injury: A Narrative Review

“…As many as 60% of individuals in one study reported adverse effects on life activities, altering their lifestyle due to irregular bowel movements associated with problems of recurrent abdominal discomfort, constipation, and/or fecal incontinence requiring treatment [ 4 ]. To facilitate education for all, the PVA Clinical Practice Guidelines for neurogenic bowels have recently been updated by the Consortium for Spinal Cord Medicine [ 11 ] and have affirmed/complemented the recent neurogenic bowel guidelines put forward by the Association of the Scientific Medical Societies in Germany [ 12 ].…”

“…People with neurogenic bowel will need thorough evaluation beginning with a comprehensive medical history. This should include past medical history, allergies, medications, family history, social environment/resources, and a thorough review of systems, including neurologic diagnoses and functional impairments that might contribute to GI symptoms, bowel, and defecation problems [ 11 , 12 , 37 ]. It is important to determine the duration, severity, and progression of any GI problems, as well as the current bowel care program for emptying [ 11 , 37 ].…”

“…The physical examination is integral in the assessment and management of NB [ 11 , 12 ]. Basic assessment for constitutional signs of malnutrition and dehydration, including loss of weight, pale skin, dry mucous membranes, poor skin turgor, orthostatic hypotension, and tachycardia is necessary.…”

“…The most fundamental and relevant information for the neurogenic bowel is derived from history and physical examinations [ 11 , 12 ]. Further testing is warranted when GI problems are acute, progressive, when causality is unclear, when history is not reliable, or when conservative management has been unsuccessful and surgical options are being entertained.…”

“…The simplest radiologic test is an abdominal X-ray for the evaluation of fecal loading, impaction, megacolon, intestinal obstruction, or perforation [ 49 , 51 , 52 ]. If more information is necessary, an abdominal CT scan can delineate gastric, small intestinal, colonic, or pelvic structural or anatomical abnormalities [ 11 , 12 ]. CT is mainly utilized to identify small or large intestinal obstruction, and can establish the cause, site, and extent of an obstruction.…”