Actionable Nuggets for SCI (2nd ed., 2013)
Conduct an annual assessment of bowel function in patients with SCI.
Neurogenic bowel dysfunction has been repeatedly rated as the most significant factor affecting the 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 of functional, social and psychological 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). 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 colon and anal sphincters. It may also be associated with proximal colonic impaction 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 the rectum.
Both conditions result in constipation, difficulty with evacuation and fecal incontinence.
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 (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.
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