Bowel management in patients with spinal cord injury – a multicentre study of the German speaking society of paraplegia (DMGP)

Abstract

Study design: A descriptive, cross-sectional, multicentre design was used. Objective: To analyse bowel management in patients with spinal cord injury (SCI) especially the occurrence of unplanned bowel evacuations and duration of planned bowel evacuation. Setting: In total, 29 rehabilitation facilities for SCI patients in Austria, Germany, the Netherlands and Switzerland, with a total of 837 hospitalized SCI patients. Method: Data were collected by nurses within 1 week in November 2001 using a quantitative questionnaire containing 14 questions. For data analysis, a w 2 -test was used for differences in the outcome of bowel evacuation procedures associated with different interventions. Stepwise multiple logistic regression was used to analyse the relationship between the outcome of bowel management and the interventions as well as intervening factors. Results: More unplanned bowel evacuations were associated with usage of oral laxatives (n ¼ 444, Po0.001) as well as bowel evacuation every day (n ¼ 270, Po0.05) or every second day (n ¼ 368, Po0.05). The outcome of less unplanned bowel evacuations was associated with manual removal of stool combined with digital stimulation (n ¼ 35, Po0.05) and spontaneous bowel evacuations (n ¼ 104, Po0.001). Short duration of bowel evacuation (o60 min) was associated with manual removal of stool (n ¼ 64, Po0.05), the sitting position at defecation (n ¼ 494, Po0.001) and low frequency of bowel evacuation (X3 days) (n ¼ 638, Po0.05). Duration 460 min was associated with the use of oral laxatives (n ¼ 444, Po0.001) and complete loss of sensory function (n ¼ 349, Po0.05). Stool of hard consistency was associated with the manual removal of stool (n ¼ 64, Po0.001), the manual removal of stool in combination with digital stimulation (n ¼ 53, Po0.001) and the sitting position at defecation (n ¼ 494, Po0.05). Stool of soft consistency (n ¼ 341) was associated with the complete motor lesion (n ¼ 443, Po0.05). Conclusion: Manual removal of stool was combined with low risk of unplanned bowel evacuations and short duration of evacuation time. These results are useful to improve the outcomes of bowel management in SCI patients.Spinal Cord (2005) 43, 724-730.

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

“…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. 24 In this study, 29.8% of the patients used manual removal of stool. The use of this method by patients with SCI at or above the T6 level should require topical anesthesia to prevent AD reactions.…”

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

“…16 Limited understanding of the need for this intervention has resulted in difficulties for SCI individuals when nursed in general hospitals, 17 and the community. However, manual evacuation is associated with shorter duration of bowel care 3,8 and it is the most common intervention among UK communitybased SCI individuals. 3 It is acceptable to SCI individuals because it is an effective intervention.…”

“…Development of an individual program depends on the experience of the health-care practitioner and trial and error. Use of manual evacuation of stool is reported in 8-68% [1][2][3]8,9 but there is little evidence of the need for and acceptability of the procedure. 10 Anecdotally it is regarded as invasive and may be unacceptable to patients, carers and staff.…”

“…Oral laxative use is reported in 39-60% of SCI individuals. 1,3,9,8,11 Studies examining dosage and side effects in the neurogenic population are lacking and anecdotally there is much anxiety regarding long-term use of stimulant laxatives.…”

Sensation of defecation in patients with spinal cord injury

“…10 There are also patients with SCI who are able to initiate defecation when they sense an urge. The size of this group was found to be 12% of 837 patients in one study 11 and 20% of 171 patients in another. 10 There are also patients with SCI who perceive sensations of bowel activities associated with symptoms of an autonomic dysreflexia, visceral pain, non-painful sensations and phantom phenomena.…”