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World Journal of Urology

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01-10-2018 | Topic Paper

Neurogenic bowel management for the adult spinal cord injury patient

Authors: John T. Stoffel, F. Van der Aa, D. Wittmann, S. Yande, S. Elliott

Published in: World Journal of Urology | Issue 10/2018

Abstract

Background

Bowel function can be markedly changed after a spinal cord injury (SCI). These changes, and the care associated with managing the changes, can greatly impact a person's quality of life over a lifetime.

Purpose

The purpose of the SIU-ICUD workgroup was to identify, assess, and summarize evidence and expert opinion-based themes and recommendations regarding bowel function and management in SCI populations.

Methods

As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury, a workgroup was formed and comprehensive literature search of English language manuscripts regarding bowel physiology and management plans for the SCI patient. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs).

Results

Neurogenic bowel symptoms are highly prevalent in the SCI population. Patients with injuries above the conus medullaris have increased bowel motility and poor anorectal sphincter relaxation. Patients with injuries below the conus are more likely to have an areflexic colon and low sphincter tone. Conservative management strategies include diet modification and anorectal stimulation. There are few evidence-based pharmacologic interventions, which improve fecal transit time. Intestinal ostomy can be an effective treatment for reducing hours spent per week on bowel management and colostomy may be easier to manage than ileostomy due to solid vs liquid stool.

Conclusions

By understanding physiology and treatment options, patients and care teams can work together to achieve goals and maximize quality of life after injury.

Trivedi PM, Kumar L, Emmanuel AV (2016) Altered colorectal compliance and anorectal physiology in upper and lower motor neurone spinal injury may explain bowel symptom pattern. Am J Gastroenterol 111(4):552–560CrossRefPubMed

Valles M, Mearin F (2009) Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury. Dis Colon Rectum 52(9):1589–1597CrossRefPubMed

Liu CW, Huang CC, Yang YH, Chen SC, Weng MC, Huang MH (2009) Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury. J Rehabil Med 41(1):35–40CrossRefPubMed

Stone JM, Nino-Murcia M, Wolfe VA, Perkash I (1990) Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis. Am J Gastroenterol 85(9):1114–1119PubMed

Ng C, Prott G, Rutkowski S, Li Y, Hansen R, Kellow J et al (2005) Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors. Dis Colon Rectum 48(8):1562–1568CrossRefPubMed

Tate DG, Forchheimer M, Rodriguez G, Chiodo A, Cameron AP, Meade M et al (2016) Risk factors associated with neurogenic bowel complications and dysfunction in spinal cord injury. Arch Phys Med Rehabil 97(10):1679–1686CrossRefPubMed

Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT (2015) The severity of bowel dysfunction in patients with neurogenic bladder. J Urol 194(5):1336–1341CrossRefPubMed

Lynch AC, Wong C, Anthony A, Dobbs BR, Frizelle FA (2000) Bowel dysfunction following spinal cord injury: a description of bowel function in a spinal cord-injured population and comparison with age and gender matched controls. Spinal Cord 38(12):717–723CrossRefPubMed

Pagliacci MC, Franceschini M, Di Clemente B, Agosti M, Spizzichino L (2007) A multicentre follow-up of clinical aspects of traumatic spinal cord injury. Spinal Cord 45(6):404–410CrossRefPubMed

10.

Krogh K, Perkash I, Stiens SA, Biering-Sorensen F (2009) International bowel function extended spinal cord injury data set. Spinal Cord 47(3):235–241CrossRefPubMed

11.

Juul T, Bazzocchi G, Coggrave M, Johannesen IL, Hansen RB, Thiyagarajan C et al (2011) Reliability of the international spinal cord injury bowel function basic and extended data sets. Spinal Cord 49(8):886–891CrossRefPubMed

12.

Tulsky DS, Kisala PA (2015) The spinal cord injury-quality of life (SCI-QOL) measurement system: development, psychometrics, and item bank calibration. J Spinal Cord Med 38(3):251–256CrossRefPubMedPubMedCentral

13.

Patel DP, Elliott SP, Stoffel JT, Brant WO, Hotaling JM, Myers JB (2016) Patient reported outcomes measures in neurogenic bladder and bowel: a systematic review of the current literature. Neurourol Urodyn 35(1):8–14CrossRefPubMed

14.

Cameron KJ, Nyulasi IB, Collier GR, Brown DJ (1996) Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Spinal Cord 34(5):277–283CrossRefPubMed

15.

Badiali D, Bracci F, Castellano V, Corazziari E, Fuoco U, Habib FI et al (1997) Sequential treatment of chronic constipation in paraplegic subjects. Spinal Cord 35(2):116–120CrossRefPubMed

16.

Ozisler Z, Koklu K, Ozel S, Unsal-Delialioglu S (2015) Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regen Res 10(7):1153–1158CrossRefPubMedPubMedCentral

17.

Korsten MA, Singal AK, Monga A, Chaparala G, Khan AM, Palmon R et al (2007) Anorectal stimulation causes increased colonic motor activity in subjects with spinal cord injury. J Spinal Cord Med 30(1):31–35CrossRefPubMedPubMedCentral

18.

Coggrave M, Norton C, Cody JD (2014) Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev (1):CD002115. https://doi.org/10.1002/14651858.CD002115.pub5

19.

Christensen P, Bazzocchi G, Coggrave M, Abel R, Hulting C, Krogh K et al (2008) Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury. J Spinal Cord Med 31(5):560–567CrossRefPubMedPubMedCentral

20.

Emmanuel A, Kumar G, Christensen P, Mealing S, Storling ZM, Andersen F et al (2016) Long-term cost-effectiveness of transanal irrigation in patients with neurogenic bowel dysfunction. PLoS One 11(8):e0159394CrossRefPubMedPubMedCentral

21.

Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S (2010) Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord 48(10):718–733CrossRefPubMedPubMedCentral

22.

Rosman AS, Chaparala G, Monga A, Spungen AM, Bauman WA, Korsten MA (2008) Intramuscular neostigmine and glycopyrrolate safely accelerated bowel evacuation in patients with spinal cord injury and defecatory disorders. Dig Dis Sci 53(10):2710–2713CrossRefPubMed

23.

Van Kerrebroeck PE, Koldewijn EL, Rosier PF, Wijkstra H, Debruyne FM (1996) Results of the treatment of neurogenic bladder dysfunction in spinal cord injury by sacral posterior root rhizotomy and anterior sacral root stimulation. J Urol 155(4):1378–1381CrossRefPubMed

24.

Lombardi G, Del Popolo G, Cecconi F, Surrenti E, Macchiarella A (2010) Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord 48(2):154–159CrossRefPubMed

25.

Chen G, Liao L (2014) Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease. Spinal Cord 53(3):204CrossRef

26.

Hwang M, Zebracki K, Vogel LC (2016) Long-term outcomes and longitudinal changes of neurogenic bowel management in adults with pediatric-onset spinal cord injury. Arch Phys Med Rehabil 98(2):241–248CrossRefPubMed

27.

Branagan G, Tromans A, Finnis D (2003) Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury. Spinal Cord 41(12):680–683CrossRefPubMed

28.

Munck J, Simoens C, Thill V, Smets D, Debergh N, Fievet F et al (2008) Intestinal stoma in patients with spinal cord injury: a retrospective study of 23 patients. Hepatogastroenterology 55(88):2125–2129PubMed

29.

Coggrave MJ, Ingram RM, Gardner BP, Norton CS (2012) The impact of stoma for bowel management after spinal cord injury. Spinal Cord 50(11):848–852CrossRefPubMed

30.

Hocevar B, Gray M (2008) Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury. J Wound Ostomy Cont Nurs 35(2):159–166CrossRef

31.

Safadi BY, Rosito O, Nino-Murcia M, Wolfe VA, Perkash I (2003) Which stoma works better for colonic dysmotility in the spinal cord injured patient? Am J Surg 186(5):437–442CrossRefPubMed

32.

Gerharz EW, Vik V, Webb G, Leaver R, Shah PJ, Woodhouse CR (1997) The value of the MACE (Malone antegrade colonic enema) procedure in adult patients. J Am Coll Surg 185(6):544–547CrossRefPubMed

33.

Poirier M, Abcarian H, Nelson R (2007) Malone antegrade continent enema: an alternative to resection in severe defecation disorders. Dis Colon Rectum 50(1):22–28CrossRefPubMed

34.

Santiago-Lastra Y, Mathis MR, Andraska E, Thompson AL, Malaeb BS, Cameron AP et al (2018) Extended case duration and hypotension are associated with higher-grade postoperative complications after urinary diversion for non-oncological disease. Urology 111:189–196CrossRefPubMed

35.

Reyblat P, Chan KG, Josephson DY, Stein JP, Freeman JA, Grossfeld GD et al (2009) Comparison of extraperitoneal and intraperitoneal augmentation enterocystoplasty for neurogenic bladder in spinal cord injury patients. World J Urol 27(1):63–68CrossRefPubMed

36.

Krebs J, Bartel P, Pannek J (2016) Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction. Neurourol Urodyn 35(2):260–266CrossRefPubMed

37.

Romo PGB, Santiago-Lastra Y, Myers JB, Pathak P, Elliott SP, Cotter KA, Stoffel JT, The Neurogenic Bladder Research Group (2018) Multi-institutional outcomes for simultaneous and staged urinary and fecal diversions in patients without cancer. Urology. https://doi.org/10.1016/j.urology.2017.11.057 CrossRefPubMed

Title: Neurogenic bowel management for the adult spinal cord injury patient
Authors: John T. Stoffel
F. Van der Aa
D. Wittmann
S. Yande
S. Elliott
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2018
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2388-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Neurogenic bowel management for the adult spinal cord injury patient

Abstract

Background

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

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