Actionable Nuggets for SCI (3rd ed., 2016)
A step-wise approach to bowel management is recommended, with involvement of SCI specialists as needed.
The effectiveness of bowel management in patients with spinal cord injury (SCI) may be assessed in primary care in terms of constipation, incontinence or delayed evacuations, despite adherence to a consistent bowel care routine. If these problems persist, overall re-design of the bowel program may be required.
Evidence-based Best Practice:
A highly individualized, multi-faceted approach to bowel management is required to optimize continence, stool consistency and bowel emptying. A bowel management program is usually designed for an individual with SCI during rehabilitation, and differs depending on the details of bowel functioning and hand functioning. Bowel care may need to be modified periodically as bowel function changes with age and duration post-injury, or as personal circumstances change. Furthermore, new methods of bowel management have been shown to be effective for some patients, such as trans-anal irrigation and sacral nerve root stimulation.
A step-wise approach to bowel management in spinal cord injury includes the following:
- First line treatment involves conservative management, such as diet and fluid management (see Nugget # 10), regular scheduling, manual techniques, suppositories, irrigation, and abdominal massage.
- When conservative techniques are inadequately effective, pharmacological measures may be considered as second level treatments; e.g., over-the-counter medications (laxatives and stool-softeners) and prescription medications (prokinetic agents such as metoclopramide). Transanal irrigation may also be beneficial for many individuals.
- Finally surgical intervention may be indicated, such as colostomy, anterograde catheterization, implanted electrical sacral nerve stimulation.
Adriaansen, J. J., Van Asbeck, F. W., Van Kuppevelt, D., Snoek, G. J., & Post, M. W. (2015). Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least 10 years. Archives of Physical Medicine and Rehabilitation, 96(8), 1546-1547. http://doi.org/10.1016/j.apmr.2015.01.011
Additional References (chronological listing):
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