Bowel function and continence are issues of central importance to persons with spinal cord injury (SCI), their families, community supports, and health care providers. Dunn  found that bowel incontinence was the greatest source of social discomfort following SCI. Recovery of bowel and bladder function has also been rated as more important than walking by individuals with SCI .
A common syndrome following SCI is neurogenic bowel dysfunction, which is defined as colonic dysfunctions due to lack of central nervous control. Neurogenic bowel adversely affects day-to-day activities and lifestyle in ~ 40 – 60% of individuals following SCI [3, 4]. Furthermore, up to 25% of individuals with long-term SCI will require hospitalization for gastrointestinal complications [4, 5]. The failure of conservative measures to treat chronic bowel problems in some patients requires treatments such as anterior sacral root stimulation [6, 7]antegrade colonic lavage , and stoma formation [5, 9].
In general, incontinence and neurogenic bowel dysfunction have been found to be major barriers to participation in community activities and therefore adversely impact quality of life [10, 11].
SCI BOWEL RESOURCES
Clinical Guidelines for the Management of Neurogenic Bowel Dysfunction can be found on the website of the Royal College of Nursing as a downlable PDF.
Spinal Cord Essentials – is a patient education initiative which aims help people through rehabilitation following SCI. Below are downloable PDFs of the bowel care handouts.
1. Dunn M. Social discomfort in the patient with spinal cord injury. Arch Phys Med Rehabil 1977;58:257-60.
2. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004;21:1371-83.
3. Glickman S, Kamm MA. Bowel dysfunction in spinal-cord-injury patients. Lancet 1996;347:1651-3.
4. Kirk PM, King RB, Temple R, Bourjaily J, Thomas P. Long-term follow-up of bowel management after spinal cord injury. Sci Nursing 1997;14::56-63.
5. Stone JM, Nino-Murcia M, Wolfe VA, Perkash I. Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Am J Gastroenterol 1990;85:1114-9.
6. Macdonagh RP, Sun WM, Smallwood R, Forster D, Read NW. Control of defaecation in patients with spinal cord injury by stimulation of sacral anterior nerve roots. BMJ 1990;300:1494-7.
7. Chia YW, Lee TK, Kour NW, Tung KH, Tan ES. Microchip implants on the anterior sacral nerve roots in patients with spinal trauma. Does it improve bowel function? Dis Colon Rectum 1996;39:690-4.
8. Malone PS, Ransley PG, Kiely EM. Preliminary report of the antegrade continence enema. Lancet, 1990. 336: p. 1217-8.
9. Kelly SR, Shashidharan M, Borwell B, Tromans AM, Finnis D, Grundy DJ. The role of the intestinal stoma in patients with spinal cord injury. Spinal Cord 1999;37:211-4.
10. Correa GI, Rotter KP. Clinical evaluation and management of neurogenic bowel after spinal cord injury. Spinal Cord 2000;38:301-8.
11. Longo WE, Woolsey RM, Vernava AM, Virgo KS, McKirgan L, Johnson FE. Cisapride for constipation in spinal cord injured patients: a preliminary report. J Spinal Cord Med 1995;18:240-4.
Page last updated May 11, 2013