Anorectal Stimulation Causes Increased Colonic Motor Activity in Subjects With Spinal Cord Injury

Abstract

Background: Difficulty with evacuation (DWE) is a major problem after spinal cord injury (SCI). Stimulation of the anal canal and lower rectum, accomplished using a gloved finger (so-called digital rectal stimulation or DRS) is often used as an adjunct to laxatives and enemas to facilitate bowel evacuation. However, the basis for the efficacy of DRS is not known. This study assessed the effect of DRS on colonic motility.Methods: Six subjects with SCI were studied several hours after a bowel care session. Colonic motility was assessed using a manometric catheter (affixed endoscopically to the splenic flexure) at baseline, during DRS, and after DRS. In addition, evacuation of barium oatmeal paste (with the consistency of stool and introduced into the rectum and descending colon) was assessed simultaneously using fluoroscopic techniques.Results: The mean number (6 SEM) of peristaltic waves per minute increased from 0 at baseline to 1.9 (60.5/min) during DRS and 1.5 (60.3/min) during the period immediately after cessation of DRS (P , 0.05). The mean amplitude (6SEM) of the peristaltic contractions was 43.4 (62.2) mmHg. The frequency of contractions, as well as amplitude of contractions, during or immediately after DRS was not significantly different. These manometric changes in response to DRS were accompanied by expulsion of barium oatmeal paste in every subject by the fifth DRS.Conclusions: DRS causes left-sided colonic activity in subjects with SCI. At least in part, an anorectal colonic reflex that results in enhanced contractions of the descending colon and rectum may contribute to bowel evacuation in individuals with SCI. Spinal Cord Med. 2007;30:31-35 J

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

“…There is Level 4 evidence (from one pre-post study; N ¼ 6) ( Table 4) that digital rectal stimulation increases motility in the left colon by activating preserved anorectal colonic reflexes. 25 Abdominal massage. There is Level 4 evidence (from one pre-post study; N ¼ 24) that abdominal massage significantly shortened total colonic transit time, reduced abdominal distension, and increased frequency of bowel movements per week (Table 5).…”

“…One study 25 showed that digital rectal stimulation increases peristaltic waves in the left colon, thus increasing motility in this segment. Gastrocolonic and anorectal reflexes can be successfully incorporated into a bowel routine for individuals with SCI.…”

Self care in neurogenic intestine in subjects with spinal cord injury: an integrative review

“…A adoção de hábitos saudáveis com relação à dieta devem ser indicados (2,9,11,(16)(17)(18) . Pode-se orientar a construção de refeições balanceadas, com cardápio rico em fibras.…”

“…Os sinais da impactação fecal são a ausência de eliminação de fezes por vários dias ou quando há eliminação de apenas exudatos fluidos de fezes (14) . As intervenções indicadas para o Risco de constipação também se aplicam ao diagnóstico de Constipação, sendo pertinente apontar outras intervenções de enfermagem, como por exemplo, a administração de medicamentos (2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Em alguns casos, sob prescrição médica, cabe ao enfermeiro a administração de laxantes orais ou supositórios, sendo esses indicados após tentativas terapêuticas não farmacológicas sem Vasconcelos (2,11,16,18) .…”

“…No tocante à orientação nutricional (2,9,11,(16)(17)(18) , deve-se encorajar o consumo de alimentos ricos em fibras para aumentar o bolo fecal, sendo evitadas bebidas alcoólicas e cafeína. No concernente à administração de medicamentos, podem-se indicar substâncias que possam reduzir a frequência da incontinência e modificar a consistência das fezes produzidas.…”