Constipation-related symptoms and bowel program concerning individuals with spinal cord injury

Abstract

Purpose. To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of di culty with evacuation. Patients and Methods. This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n=197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n=161, 82%) regarding bowelrelated symptoms and treatment over the previous 1 month period. The study de®nition of di culty with evacuation was spending more than 1 h per episode of bowel evacuation. Results. Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with di culty with evacuation (n=66) were compared with those who spent less than 1 h on evacuation (n=95). Factors associated with di culty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. Conclusion. Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable laxative use. Our ®ndings suggest that di culty with evacuation can be predicted on the basis of a patient's clinical pro®le.

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

“…Laxative use is associated with FI and difficulty with evacuation, and regular use may lead to an increased need for laxatives over time, 2,7 hence long-term use is often discouraged. However, no studies have elucidated a causal relationship and the direction of the association is open to debate, that is, are laxatives used more by individuals with these problems or do they cause them?…”

“…[3][4][5] Neurogenic bowel dysfunction can result in considerable morbidity, such as autonomic dysreflexia, impaction, hemorrhoids, abdominal pain, rectal bleeding, rectal prolapse, anal fissure, bloating, nausea, constipation and prolonged evacuation. 1,3,4,6,7 Bowel management programs are based on regular routine, dietary manipulation, laxatives, digital and pharmacological rectal stimulation, manual evacuation of stool and assistive interventions such as abdominal massage. There is little evidence to support these interventions individually or in combination.…”

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

“…The influence of oral laxatives on increased duration of bowel management procedure was already identified in other studies. 16,22 Their regular use leads also to more difficulties in bowel evacuation 9 and to an increased consumption over the course of time. 26 The high incidence of unplanned bowel evacuation and the prolonged duration of bowel evacuation might be due to the softer consistency of the stool, which seems to lower the reflex activity and make it harder to empty the rectum.…”

“…1 The neurological lesion interfering with the cortical interrelationships and the postulated pontine defecation centre causes a dysfunction of peristaltic movement and defecation. 2 Clinically relevant signs and symptoms as well as complications reported in the literature are prolonged colonic transit time, 2-4 faecal impaction, 2,[5][6][7] abdominal distension, 2,8,9 colonic dilatation, 2,8,9 and megacolon. 10 Concerning everyday life, patients with SCI suffer from partial or complete loss of ability to consciously feel stool in the rectum or to initiate or delay defecation.…”

“…7 The interventions include the manual removal of stool 11,15,17,19,22 for patients with an areflexic bowel as well as techniques like digital stimulation 11,15,22 and suppositories 11,15,22 for patients with a reflexic bowel to initiate reflex peristalsis, 14 frequency, 14 timing of bowel evacuation, 11,22 and the usage of oral laxatives. 9,11,14,15,18,22 Objective…”