Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

Abstract

Study design: Postal survey. Objectives: To describe bowel management in community-dwelling spinal cord-injured (SCI) individuals and to explore associations between age, injury, dependency, problems, interventions and satisfaction. Setting: Outpatients of a single SCI unit, in the United Kingdom. Methods: Postal questionnaire to all outpatients with SCI for at least 1 year, of any level or density, aged 18 years or more. Results: Response rate was 48.6% (n ¼ 1334). Median age was 52 years, median duration of injury 18 years. The most common intervention was digital evacuation (56%). Up to 30 min was spent on each bowel care episode by 58% of respondents; 31-60 min by 22%; 14% spent over 60 min. Reported problems included constipation (39%), haemorrhoids (36%) and abdominal distension (31%). Reduced satisfaction with bowel function was associated with longer duration of each bowel care episode, faecal incontinence, greater number of interventions used and more problems reported (all Pp0.001); 130 (9.7%) had undergone any type of surgical bowel intervention. Impact of bowel dysfunction on the respondent's life was rated as significantly greater than other aspects of SCI (Pp0.001). Conclusions: Managing SCI bowel function in the community is complex, time consuming and remains conservative. Despite potential for bias from a low response, for this large group of responders, bowel dysfunction impacted most on life compared with other SCI-related impairments. The study findings demand further exploration of bowel management to reduce impact, minimize side effects and increase the choice of management strategies available.

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

“…The results of our study are compatible with another study that reported significant associations between AD and manual evacuation. 13 Manual removal of stool is the only method used by many patients with SCI especially those with complete lesion, 8 because of the lack of non-invasive and efficient bowel management methods for defecation. Furthermore, it has been reported that manual removal of stool is associated with low risk of unplanned bowel evacuation and short duration of evacuation time.…”

“…11,12 Recently, Coggrave et al used postal questionnaire to investigate the management of neurogenic bowel dysfunction in the community after SCI. 13 They received responses from 1334 persons with SCI (response rate: 48.6%) and reported that AD was a frequent complication of bowel care in 9.5% of those with injuries above T7. 13 Furthermore, significant associations were noted between AD and certain interventions such as manual evacuation in persons with cervical SCI, laxatives (stimulant) and chemical rectal stimulants.…”

“…13 They received responses from 1334 persons with SCI (response rate: 48.6%) and reported that AD was a frequent complication of bowel care in 9.5% of those with injuries above T7. 13 Furthermore, significant associations were noted between AD and certain interventions such as manual evacuation in persons with cervical SCI, laxatives (stimulant) and chemical rectal stimulants. 13 Prevention of AD is the best approach.…”

“…13 Furthermore, significant associations were noted between AD and certain interventions such as manual evacuation in persons with cervical SCI, laxatives (stimulant) and chemical rectal stimulants. 13 Prevention of AD is the best approach. 14 Therefore, patients with SCI should be advised to follow proper bowel and bladder management methods.…”

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

“…When BM is ineffective, bowel dysfunction may dominate day-to-day life, severely curtailing community reintegration and reducing quality of life. [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.…”