Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers

Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2021.1883385 · Published: January 1, 2021

Spinal Cord Injury Gastroenterology Rehabilitation

Simple Explanation

This clinical practice guideline (CPG) addresses neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI), a major determinant of quality of life. The guideline provides recommendations for assessment, basic bowel management, adaptive equipment, diet, medications, and surgical options. It emphasizes holistic, individually tailored management, focusing on reflexic and areflexic NBD pathophysiology.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Clinical Practice Guideline

Key Findings

1
A basic bowel management (BBM) program should be used for both reflexic and areflexic NBD.
2
Transanal irrigation (TAI) is recommended for individuals with NBD who have insufficient results with BBM.
3
MACE procedures and colostomy can be used for severe NBD when other modalities fail, after thorough education and shared decision-making.

Research Summary

This clinical practice guideline (CPG) focuses on the management of neurogenic bowel dysfunction (NBD) in adults after spinal cord injury (SCI). The CPG offers recommendations on assessment, basic bowel management, adaptive equipment, diet, medications, surgical interventions and education. It highlights the importance of a holistic and individualized approach to NBD management, considering reflexic and areflexic bowel dysfunction.

Practical Implications

Standardized Assessment

Implement systematic and comprehensive evaluations of bowel function at the onset of SCI and annually.

Individualized Bowel Programs

Tailor bowel management programs to address the specific needs and type of NBD (reflexic or areflexic) for each individual.

Education and Support

Provide comprehensive education for individuals with SCI, caregivers, and healthcare providers to improve knowledge and compliance with bowel management strategies.

Study Limitations

1
Limited evidence for specific oral medications for bowel management.
2
Lack of well-designed placebo-controlled studies for functional electrical stimulation.
3
Studies on the relationship between physical activity and bowel outcomes in SCI is sparse.

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