Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2019.1696077 · Published: July 1, 2021

Spinal Cord Injury Gastroenterology Rehabilitation

Simple Explanation

This review examines the use of digital rectal stimulation (DRS) for bowel management in adults with spinal cord injury (SCI) and upper motor neuron neurogenic bowel (UMN-NB). DRS involves physical stimulation of the rectal wall to promote bowel evacuation. The review assesses existing research articles and practice guidelines to determine the evidence supporting DRS as an effective intervention. It considers factors like cost-effectiveness and the impact on the patient's quality of life. The study concludes that there's insufficient evidence to strongly favor any single intervention for UMN-NB. However, DRS remains an important educational tool for promoting bowel evacuation, and further research is needed using standardized methods.

Study Duration

Not specified

Participants

Eleven articles were included in the systematic review.

Evidence Level

Level I to II studies with quality ratings A-C

Key Findings

1
There is moderate evidence supporting the use of DRS in persons with SCI and UMN-NB.
2
DRS has a demonstrated physiologic effect, inducing contractions that can completely evacuate the bowel.
3
Combining DRS with other treatments like electrical stimulation or oral agents can improve colonic transit times and reduce incontinence.

Research Summary

This systematic review evaluates the evidence for digital rectal stimulation (DRS) as an intervention for managing upper motor neuron neurogenic bowel (UMN-NB) in adults with spinal cord injury (SCI). The review analyzed research articles and practice guidelines. The review found moderate evidence supporting DRS, demonstrating its physiologic effect and potential to improve outcomes when combined with other treatments. However, the evidence is insufficient to strongly promote any single intervention. The study suggests that DRS should remain an emphasized educational tool for home management of UMN-NB in persons with SCI. Future research should focus on standardized, validated tools to evaluate management techniques.

Practical Implications

Educational Emphasis

DRS education should remain a primary focus for newly injured individuals with UMN-NB to promote daily bowel evacuation.

Combined Therapies

Consider adding transanal irrigation when DRS alone is insufficient, given evidence supporting its ability to improve bowel-related QOL.

Future Research

Future research should focus on standardized, validated tools to evaluate UMN-NB management techniques.

Study Limitations

1
Insufficient evidence to promote any one intervention over another.
2
Lack of control of confounding factors in studies including DRS with other interventions.
3
Need for further research to establish the benefit of DRS over the potential risk of damage to the rectal mucosa.

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