A Primary Care Provider’s Guide to Neurogenic Bowel Dysfunction in Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2020 · DOI: 10.46292/sci2603-172 · Published: July 1, 2020

Spinal Cord Injury Healthcare Gastroenterology

Simple Explanation

Spinal cord injury (SCI) affects the gastrointestinal (GI) tract in several ways, most notably by causing impairment of colonic motility and sphincter dysfunction. Characterizing the severity of NBD, its impact on an individual’s QOL, and which interventions have been successful or ineffective is integral to the routine care of people living with SCI. Treatment of NBD is generally multimodal and includes attention to diet, pharmacologic and mechanical stimulation, and possibly surgery.

Study Duration

Not specified

Participants

115-371 individuals with SCI

Evidence Level

Not specified

Key Findings

1
People with SCI consistently rank neurogenic bowel dysfunction (NBD) as an important health concern.
2
Bowel incontinence can increase the risk for skin breakdown and lead to social isolation.
3
People with UMN bowel dysfunction rely on a combination of pharmacologic and digital stimulation for evacuation.

Research Summary

SCI may significantly impact the gastrointestinal (GI) tract, causing dysmotility and sphincter dysfunction that may diminish the quality of life (QOL) and opportunities for social integration for individuals with SCI. Successful treatment of NBD requires a multimodal approach that may include dietary modifications, pharmacological agents, mechanical or electrical stimulation, and possibly surgery. Management of NBD after SCI can be challenging. However, it also offers us the opportunity to substantially improve the QOL of individuals living with injuries.

Practical Implications

Assessment of Bowel Program

Regularly assess all aspects of the client's bowel program, including medication, diet, interventions, and frequency.

Impact on Quality of Life

Assess the impact of bowel complications like incontinence and autonomic dysreflexia on quality of life.

Education for Patients and Caregivers

Provide comprehensive education to both patients and caregivers, focusing on anatomy, bowel program details, medication use, and complication management.

Study Limitations

1
The pathophysiology of NBD is not completely understood
2
Clinical severity is not necessarily predicted by level or completeness of SCI
3
Neuromodulation and electrical stimulation treatments are not yet widely accepted

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