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

Abstract

Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results: A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

Funcionamento intestinal e a relação com a independência funcional de indivíduos com lesão medular

“…As complicações gastrintestinais, decorrentes do intestino neurogênico, podem ser classificadas em agudas ou crônicas, ou de acordo com o nível de comprometimento medular, cervical, torácica e lombar. 6,7 O intestino reflexivo ou espástico resulta de lesão medular cervical ou torácica alta, em que ocorre a interrupção das mensagens entre cérebro e intestino, porém, a medula coordena os reflexos de eliminação fecal. Nesse caso, apesar de o paciente não sentir a necessidade de eliminar as fezes, a peristalse está presente e há resposta frente ao estímulo dígito-anal ou químico.…”

“…Na fase crônica, a principal complicação é a impactação fecal, podendo modificar o estilo e a qualidade de vida. 6,7 O indivíduo com LME pode apresentar fases alternadas de constipação e incontinência fecal, antes de fazer o treinamento para a regulação intestinal, já que o componente muscular voluntário inibe o esvaziamento intestinal. 6 Para atender às complicações intestinais de indivíduos com LME, foram construídas diretrizes com enfoque na prevenção de complicações, onde o enfermeiro expert tem papel preponderante na avaliação dos sinais e sintomas apresentados pelos pacientes e na proposição de plano de cuidados, envolvendo os familiares/ cuidadores na dinâmica da assistência.…”

TEMA 15-2015: Beneficios de la colostomía en la calidad de vida del paciente con lesión medular crónica y ventajas de su realización por vía laparoscópica

“…9/10 tuvo cuidado intestinal más fácil, y 6 tuvieron una mayor independencia. (10) Safadi y colaboradores compararon además los resultados de los pacientes con colostomía en el lado derecho versus colostomía en el lado izquierdo versus ileostomía. Observaron que cuando se compara con otros tipos de ostomía, los pacientes que se sometieron a colostomía en el lado derecho tienden a tener más síntomas persistentes de alteración de la motilidad colonica, incluyendo hinchazón abdominal y dolor.…”

Medication before and after a spinal cord lesion

“…Still people with SCL are at high risk of developing disturbances related to the urinary tract, 5,6 and bowel, [7][8][9] together with several other physical and psychological challenges.…”