Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

Abstract

In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia) and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation) were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80%) of the 55 patients before bowel program. Constipation (56%, 31/55) and incontinence (42%, 23/55) were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55) and after (73%, 40/55) bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

Gut Microbiota in male patients with chronic traumatic complete spinal cord injury

“…R Yasmeen had reported that 43 of 50 adult patients with SCI in Pakistan gave a history of occasional or regular fecal incontinence (38). The prevalence of NBD in SCI patients was 80% in previous study, 97.3% of motor complete SCI patients had chronic NBD complaints in their study (10), which was similar with patients had a constipation in our study. The patients in our study had to spend much time on defecation in their long course of SCI to deal with NBD.…”

“…Among them, neurogenic bowel dysfunction (NBD) is a major physical and psychological problem in patients with SCI, which can seriously affect the quality life of patients. The two main manifestations of NBD are constipation and fecal incontinence, with the prevalence of constipation in these patients reported to be 40–58%, and fecal incontinence from 2 to 61% (8,9,10,11). Because of these problems, patients with chronic SCI tend to spend more time in the toilet while evacuating their bowels, use suppositories, laxatives and supplemental dietary fiber more frequently to improve bowel evacuation and require manual removal of feces much more frequently when compared with their matched control population (12,13,14,15).…”

Effect of quantitative assessment‐based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury

“…The injury of nerves that control rectal defecation reflex results in the disappearance of defecation reflex. Prolonged stay of stool in rectum and water absorption led to the occurrence of dry stool (Ozisler, Koklu, Ozel, & Unsal-Delialioglu, 2015). Due to the bowel dysfunction, patient diet is limited and they cannot participate in normal work and life.…”

Chronic abdominal pain in long-term spinal cord injury: a follow-up study

“…6,8 The effect of a bowel program on different neurogenic bowel symptoms including abdominal pain supports the relation between abdominal pain and constipation. 13 However, it is possible that neuropathic pain contributes to abdominal pain in some of the patients.…”

“…8 Abdominal pain is not associated with completeness or the level of SCI, 5,7 and the underlying mechanisms are likely to vary among SCI individuals and may be related to both visceral and neuropathic pain mechanisms. [6][7][8][9][10][11][12][13] Abdominal pain has a late onset after SCI, and although it is relatively uncommon in the first 5 years, 2,4-5 it has been reported in 22% at 10 years and in up to 34% of SCI individuals at 20 years after SCI. [5][6] However, little is known about the time course of abdominal pain once it has developed.…”