Neurogenic bowel dysfunction after spinal cord injury: Clinical evaluation and rehabilitative management

Stiens, Steven A.; Bergman, Susan Biener; Goetz, Lance L.

doi:10.1016/s0003-9993(97)90416-0

Cited by 234 publications

(179 citation statements)

References 92 publications

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“…The basic di erences are the presence of spinal cord-mediated re¯ex peristalsis and the integrity of the pudendal nerve. 15 During the management of neurogenic bowel in patients with SCI, we noticed signi®cant di erences in bowel care patterns between the two types of neurogenic bowel, which would thus require di erent bowel care programs based on their clinical differences. However, to the best of our knowledge, there have been few reports comparing bowel care pattern between the two groups and little data collected on the clinical characteristics of patients with LMNB.…”

Section: Introductionmentioning

confidence: 90%

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel

et al. 2001

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Study design: A face-to-face interview survey. Objective: To compare bowel care patterns in spinal cord injury (SCI) patients based on type of neurogenic bowel. Setting: Department of Physical Medicine and Rehabilitation of a tertiary university hospital in Suwon, Korea. Methods: Among chronic SCI patients, 22 patients with upper motor neuron bowel (UMNB) and 20 patients with lower motor neuron bowel (LMNB) participated in an interview survey for the evaluation of bowel care patterns. Results:The patients with LMNB demonstrated increased frequency of defecation, increased frequency of fecal incontinence, increased use of oral medications for bowel care, increased required time for defecation and more diet modi®cation than those with UMNB (P50.05). However, there was no signi®cant di erence in the subjective di culty of bowel care. Among several available bowel care methods, suppositories were used most frequently by the UMNB group, whereas the Valsalva maneuver was the most frequently used method by the LMNB group. Conclusions: Patients with LMNB tend to su er more di culties in management of their neurogenic bowel than those with UMNB. Therefore, more intensive and aggressive bowel care programs should be provided for SCI patients with LMNB.

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Section: Introductionmentioning

confidence: 90%

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel

et al. 2001

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“…Baseline demographic information on each subject included: age, years since SCI, SCI level, bulbocavernous re¯ex, anocutaneous re¯ex, anal tone, and phasic re¯exes of the lower extremities. 1 The two types of bisacodyl suppositories used in the study di ered only in the base used for dispersion of the active ingredient. The HVB suppositories utilized contained 10 mg bisacodyl USP in a hydrogenated vegetable oil base (UDL Lab, Rockford, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Each bowel care procedure was performed by a sta nurse with the consistent technique and data collection. 1 All subjects were positioned side-lying with the left side down and knees¯exed. At the beginning of each bowel care session, either a PGB or a HVB bisacodyl suppository was inserted and positioned against the mucosal surface of the rectum at a ®nger length from the anus.…”

Section: Methodsmentioning

confidence: 99%

“…Both the upper motor neuron (UMN) and lower motor neuron (LMN) patterns of bowel dysfunction are characterized by fecal retention and uniformly require a comprehensive plan of management (bowel program) that consists of diet, oral medications and a scheduled evacuation procedure (bowel care) to avoid impaction and incontinence. 1,2 Classically, bowel care has been a time consuming process that has been detrimental to quality of life. 3 Many people with SCI rank neurogenic bowel dysfunction as a major life limiting problem.…”

Section: Introductionmentioning

confidence: 99%

“…1,10 For independent bowel care after SCI typically, 10 mg suppositories are used due to ease of insertion with dexterity de®cits and improved anal retention without voluntary external anal sphincter constriction. The most common suppository preparation includes bisacodyl powder dispersed within a hydrogenated vegetable oil base (HVB).…”

Section: Introductionmentioning

confidence: 99%

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Polyethylene glycol versus vegetable oil based bisacodyl suppositories to initiate side-lying bowel care: A clinical trial in persons with spinal cord injury

1998

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Introduction: Neurogenic bowel dysfunction resulting from spinal cord injury (SCI) frequently requires bowel care (BC) with stimulant suppositories for initiation of e ective defecation. The excessive time required for BC and bowel complications have limited quality of life after SCI. Objective: To test the hypothesis that: the time required for bowel care with bisacodyl suppositories can be reduced by substituting a polyethylene glycol base (PGB) for the traditional hydrogenated vegetable oil base (HVB) in the suppository. Setting: Inpatient SCI medicine unit. Subjects: Fourteen persons with SCI with chronic stable paralysis from upper motor neuron SCI for greater than one year with a stable HVB bisacodyl suppository initiated BC. Design: Crossover Controlled. Method: Subjects received HVB bisacodyl suppositories for six sequential BC sessions and then were crossed over to PGB bisacodyl suppositories for six more BCs. Outcome measures: BC event times were utilized to derive BC intervals: suppository insertion to ®rst¯atus=Time to¯atus, ®rst¯atus until the beginning of stool¯ow=Flatus to stool¯ow, begin stool¯ow until end stool¯ow=Defecation period, end stool¯ow until end of clean up=Clean up, and suppository insertion until end clean up=Total bowel care time. Results: The data included two groups of BC sessions: HVB (n=84) and PGB (n=81). Mean times in minutes and P values from t tests for paired samples yielded: Time to¯atus: (HVB 31, PGB 12.8 P50.002), Defecation period: (HVB 58, PGB 32, P50.0005), Clean up: (HVB 1.9, PGB 3.2 P=0.165), Total bowel care time: (HVB 102, PGB 51.2 P50.0005). Conclusion: This analysis suggests that PGB based bisacodyl suppositories may stimulate re¯ex defecation sooner and shorten the Total BC Time as compared with HVB bisacodyl suppositories.

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Physical Medicine and Rehabilitation

Young¹

1997

JAMA

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Neurogenic bowel dysfunction after spinal cord injury: Clinical evaluation and rehabilitative management

Cited by 234 publications

References 92 publications

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel

Polyethylene glycol versus vegetable oil based bisacodyl suppositories to initiate side-lying bowel care: A clinical trial in persons with spinal cord injury

Physical Medicine and Rehabilitation

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