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E - Bowel Continence

Bowel Continence | Body Structure and Function K Smith, MD; C Balioussis, PhD; C Craven, MD; and the E-Scan Investigative Team Bowel continence, in the context of individuals with spinal cord injury (SCI), can be interpreted as efficient and effective bowel evacuation, occurring at socially appropriate times, and without adverse effects on health or quality of life. Neurogenic Bowel Dysfunction (NBD) care is based on an overall bowel program, which outlines the full treatment plan. The goal of the bowel program is to eliminate impaction or incontinence, resulting in efficient and timely bowel evacuation, at a socially appropriate time, and to prevent secondary complications.1 Individuals after SCI require an effective bowel program and bowel care to achieve continence, and to avoid the two most common patterns of bowel dysfunction: constipation or incontinence. A bowel program typically includes adequate fluid intake, diet, oral and rectal medications (to avoid adverse effects on bowel function, or to facilitate bowel function), activity levels, personal assistance and equipment required for scheduled bowel care. Bowel care is the regular routine followed to ensure emptying of stool, from the left colon and rectum. In a non-injured population, normal stool frequencies range from three times a week, to three times a day. Again, in a non-injured population, constipation is defined by the Rome III criteria, which includes stool frequency of less than three times per week, hard dry stools, sensation of incomplete evacuation, straining and sensation of anorectal obstruction.2 Fecal incontinence is defined as the continuous or recurrent uncontrolled passage of fecal material (more than 10 ml), for at least one month, in an individual over age three.3 Figure 1.0 Schematic of nervous inervation of the bowel. Reproduced from Bergman.4 © 2000 John Wiley & Sons Ltd. Reprinted with permision. Spinal Cord Parasympathetic and Somatic Sympathetic Midbrain Medulla Spinal Cord Stomach Thoracolumbar Sympathe��c Ou��low Tract Celiac Ganglion Superior Mesenteric Ganglion Inferior Mesenteric Ganglion Duodenum Colon Internal Anal Sphincter External Anal Sphincter IAS Small Bowel Vagus Nerve - Parasympathe��c Pelvic Nerve - Parasympathe��c Pudendal Nerve - Soma��c EAS IAS EAS C1 2345678 T1 23456789 10 11 12 L1 2345 S1 2345 C1 2345678 T1 23456789 10 11 12 L1 2345 S1 2345 BOWEL CONTINENCE | BODY STRUCTURE AND FNUCTION 61


E - Bowel Continence
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