Bowel Management in Spinal Cord Injury Patients

Abstract

Spinal cord injuries are common in the United States, affecting approximately 12,000 people per year. Most of these patients lack normal bowel function. The pattern of dysfunction varies with the spinal level involved. Most patients use a bowel management program, and elements of successful programs are discussed. Surgical treatment, when indicated, could include sacral nerve stimulation, Malone antegrade continence enema, and colostomy.

Update on critical care for acute spinal cord injury in the setting of polytrauma

“…Hughes defined the following 3 different neuropathological patterns of bowel dysfunction: Pattern A, injury above T-7, when voluntary control of abdominal muscles was absent but spinal sacral reflexes were preserved; Pattern B, injury below T-7 with voluntary control of abdominal muscles and preserved sacral reflexes; and Pattern C, injury below T-7 with voluntary control of abdominal muscles and absent sacral reflexes. 40 First-line therapy involves timed dietary intake and, if needed, rectal stimulation. Pharmacological management with prokinetic laxatives is also an option, and for patients whose condition is refractory, surgical management via colostomy.…”

Pharmacodynamic evaluation of Lys5, MeLeu9, Nle10-NKA(4–10) prokinetic effects on bladder and colon activity in acute spinal cord transected and spinally intact rats

“…For bowel, injuries above the sacral level result in poor colonic motility and tightening of the sphincters and pelvic floor muscles, which leads to constipation. Injuries involving the sacral cord result in weak sphincters and pelvic floor muscles, which leads to stool incontinence (Fajardo et al 2003; Hughes 2014). The current standard therapy for urinary retention consists primarily of clean intermittent catheterization.…”

“…These include urinary tract infections, bleeding, strictures, and stones, which pose a significant health risk to the individual and account for high costs of healthcare (Cardenas et al 2004; Gregory et al 1984; Singh et al 2011; Yilmaz et al 2014). Voiding of stools are managed by digital rectal stimulation with digital removal of stools, or with enemas, all of which are time consuming and greatly reduce the quality of life of affected individuals and caregivers (Hughes 2014). Therefore, efficient and effective pharmacological treatments to elicit bladder and bowel emptying after SCI are imperative.…”

Neural pathways for colorectal control, relevance to spinal cord injury and treatment: a narrative review

“…A possible reason that SCI above about T5-7 causes greater problems is that these individuals either cannot, or have reduced ability to, voluntarily contract abdominal muscles. For lesions below T7, patients can increase intra-abdominal pressure by contracting the abdominal wall [44]. Although this assists in activating colorectal propulsion, there is still dyssynergia, with the external anal sphincter commonly contracting when the intra-abdominal pressure is increased [44].…”

“…Conservative management includes mechanical means of aiding emptying (abdominal massage, digital rectal stimulation, manual evacuation, trans-anal irrigation), use of chemical agents (oral laxatives, stool softeners, colonic stimulants, bulk forming agents, bisacodyl suppositories), changes in diet (high dietary fibre) and pharmacological agents, notably anticholinesterases [51][52][53]. Most people with SCI develop a bowel routine using more than one conservative management procedure [44,52].…”