Actionable Nuggets for SCI (3rd ed., 2016)
Conduct an annual assessment of bowel function in patients with SCI.
Neurogenic bowel dysfunction is rated as one of the most significant factors affecting quality of life for people with SCI. Bowel management is a huge factor in the daily routines of people with spinal cord injuries, and has profound effects on functional, psychological and social life. Bowel function typically deteriorates over time in the SCI population, resulting in increased time for evacuation, more constipation and more bowel incontinence.
Evidence-based Best Practice:
Neurogenic bowel dysfunction affects 95% of individuals with spinal cord injury (SCI). Ongoing monitoring of bowel function in primary care is required to ensure safety, effectiveness, and predictability, as well as to meet the goals of the individual with a SCI – continence, reasonable evacuation time, regularity.
There are two types of bowel dysfunction associated with SCI:
- An Upper Motor Neuron (UMN) lesion (above T12) typically produces a hyper-reflexive bowel; that is, spastic paralysis of the colonic wall and anal sphincters. It may also be associated with proximal impaction of stool and autonomic dysreflexia (see Nugget #13);
- A Lower Motor Neuron (LMN) lesion (T12 and below) produces an areflexive bowel (flaccid paralysis of the external sphincter and levator ani), and impaction of stool in the rectum.
Annual assessment of neurogenic bowel in primary care is essential to detect changes in bowel functioning and bowel management. The assessment should include abdominal palpation, rectal exam, assessment of anal sphincter tone, and inspection for perianal lesions. For patients over 50 years of age, fecal occult blood testing should be conducted to screen for colon cancer bi-annually (see Nugget #11). For those with UMN lesions, the ano-cutaneous reflex should also be elicited by stroking of the skin around the anus. This test, sometimes referred to as the anal wink, ensures that reflex sphincter functioning remains intact.
Both conditions result in constipation, difficulty with evacuation and fecal incontinence.
Pan, Y., Liu, B., Li, R., Zhang, Z., & Lu, L. (2014). Bowel Dysfunction in Spinal Cord Injury: Current Perspectives. Cell Biochemistry and Biophysics, 69(3), 385–388. http://doi.org/10.1007/s12013-014-9842-6
Additional References (chronological listing):
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Park, H. J., Noh, S. E., Kim, G. D., & Joo, M. C. (2013). Plain abdominal radiograph as an evaluation method of bowel dysfunction in patients with spinal cord injury. Annals of Rehabilitation Medicine, 37(4), 547–555. http://doi.org/10.5535/arm.2013.37.4.547
Krassioukov, A., Eng, J.J., & Venables, B. (2012). Neurogenic bowel following spinal cord injury. In Eng, J.J., Teasell, R.W., Miller, W.C., Wolfe, D.L., Townson, A.F., Hseich, J.T.C., et al. editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0. Vancouver, p 1-39.
Pardee, C., Bricker, D., Rundquist, J., MacRae, C., & Tebben, C. (2012). Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life. Rehabilitation Nursing, 37(3), 128–135. http://doi.org/10.1002/RNJ.00024
Coggrave, M., & Norton, C. (2010). 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. Spinal Cord, 48, 504-510.
Coggrave, M., Norton, C., & Wilson-Barnett, J. (2009). Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom. Spinal Cord, 47(4), 323-30.http://dx.doi.org/10.1038/sc.2008.137
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Goetz, L.L., Nelson, A.L., Guihan, M., Bosshart, H.T., Harrow, J., Gerhart, K.D., Krasnicka, B., et al. (2005). Provider adherence to implementation of clinical practice guidelines for neurogenic bowel in adults with spinal cord injury. The Journal of Spinal Cord Medicine, 28(5), 394-406.
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