Sequential treatment of chronic constipation in paraplegic subjects

Badiali, Danilo; Bracci, F.; Castellano, V.; Corazziari, Enrico; Fuoco, U.; Habib, F. I.; Scivoletto, Giorgio

doi:10.1038/sj.sc.3100355

Cited by 33 publications

(28 citation statements)

References 16 publications

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“…12,13 However, the samples in these previous studies were younger and injured for a shorter time. Increasing age and duration of injury are associated with increased use of medicated rectal stimulants, manual evacuation and oral laxatives; 3 response to less invasive BM techniques may be reduced as time since injury increases.…”

Section: Discussionmentioning

confidence: 92%

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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

Coggrave

Norton

2009

Spinal Cord

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Study design: Randomised controlled trial. Objectives: High-quality evidence for interventions in bowel management (BM) after spinal cord injury (SCI) is lacking and BM programs are developed empirically. This randomized, controlled trial compared usual care with a stepwise protocol based on earlier published work to examine whether systematic use of less invasive interventions could reduce the need for oral laxatives and invasive interventions such as manual evacuation, and improve BM outcomes in individuals with chronic SCI. Setting: United Kingdom. Methods: In all, 68 individuals were recruited (35 in intervention group), median age 47 years (range 24-73 years), median duration of injury 16 years (range 1-47 years). Bowel diaries were maintained for a maximum of 6 weeks while the intervention group followed a stepwise protocol designed to test interventions singly and in combination. Measures of quality of life and preferences for different bowel care interventions were recorded. Results: The stepwise protocol did not improve BM outcomes; fecal incontinence was more frequent (P ¼ 0.04); the need for oral laxatives and invasive interventions was not reduced (P ¼ 0.4). Bowel care took consistently longer in the intervention group. Conclusions: The study findings support the need for manual evacuation in BM and provide evidence of acceptability of the technique to SCI individuals. For some individuals oral laxatives are an essential part of management. The results are in contrast with previous studies in younger samples with shorter duration of injury.

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Section: Discussionmentioning

confidence: 92%

“…12,13 was developed. Interventions were ordered from the least to most invasive to allow assessment of both effect of each intervention and effects of combined interventions, while ensuring effective BM.…”

Section: Intervention Groupmentioning

confidence: 99%

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

Coggrave

Norton

2009

Spinal Cord

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“…There is Level 4 evidence (from three pre-post studies; aggregate N ¼ 65) [16][17][18] that multifaceted bowel management programs reduce GI transit time, incidences of difficult evaluations, and duration of time required for bowel management ( 18 recently modified the bowel management program originally proposed by Badiali et al 16 by including an additional step of manual evacuation and found a significant decrease in the number of bowel movement episodes requiring laxatives (from 62.8 to 23.1%). These authors also reported a significant decrease in the mean duration of bowel management episodes with the introduction of this protocol.…”

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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“…Dicult Intestinal Evacuation (DIE) 2,27 is de®ned when two or more of the following are present: (a) Defecatory frequency of less than three times a week; 7 (b) Hard stools. These cause urgency, dicult bowel evacuation, and sensation of incomplete evacuation; 7,10 (c) Prolonged intestinal management time, more than 45 min.…”

Section: Methodsmentioning

confidence: 99%

Clinical evaluation and management of neurogenic bowel after spinal cord injury

Correa

Rotter

2000

Spinal Cord

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Objectives: To assess the state of the neurological bowel in spinal cord injured (SCI) patients, design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome. Setting: Out-patient in a Rehabilitation Service. Subjects: Thirty-eight SCI patients, 12 (32%) with complete lesions of more than 5 years duration. Design: Observational, longitudinal and prospective. Pre and post intervention. Method: Pre and post SCI intestinal function was evaluated clinically prior to beginning program. The presence of GI symptoms were studied. Laboratory work-up included colonic transit time (CTT), anorectal manometry and recto-colonoscopy. An intestinal program was designed, in order to achieve an eective and ecient evacuation in a predictable and socially acceptable time, to avoid short and long term complications and eliminate inadequate intestinal evacuation habits. Outcome measures: Pre and post SCI diculty in intestinal evacuation (DIE) was increased (from 2.6% to 26.3%). The most frequent GI symptom was abdominal distention (53%). Colonic inertia was present in 49% of CTT, internal anal sphincter pressure was normal or increased in 77% and rectoanal inhibitory re¯ex was present in 88%. With the intestinal program, the incidence of DIE was reduced to 8.8%, manual extraction (ME) was reduced from 53% to 37%. Excellent and good results were obtained in 56% of the patients. Conclusion: The proposed intestinal program is eective in the rehabilitation of SCI patients with neurogenic bowel. It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future. Spinal Cord (2000) 38, 301 ± 308

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Sequential treatment of chronic constipation in paraplegic subjects

Cited by 33 publications

References 16 publications

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

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

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

Clinical evaluation and management of neurogenic bowel after spinal cord injury

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