Page 4

E - Bowel Continence

SCI literature contains many descriptors of the type and extent of NBD - associated symptoms and adverse effects on health and quality of life. Gore14 reported 87 complications of NBD function, in a review of 567 patients, with 45% (39/87) being fecal impaction. In addition, young patients in their 20’s, with SCI, were found to have diverticulosis or changes in the bowel, usually found in the elderly. The largest and most recent is a survey of individuals with SCI, in the United Kingdom, by Dr Coggrave15 highlighting the incidence of bowel care problems (Table 1.0). The Canadian experience is similar to this, as shown by the author’s unpublished survey of 120 SCI patients, with NBD. Table 1.0 Problems asociated with NBD and bowel care reproduced with permision from Cograve15 © 2009 International Spinal Cord Society. Reprinted with permision. Symptom Frequency Percent (%) Constipation 522 39 Hemorrhoids 485 36 Abdominal Distension 409 31 Abdominal Pain 268 20 Duration of Bowel Care > 60 minutes 185 14 Surgery to Bowel 130 10 Incontinence (at least monthly) 112 8 Autonomic Dysreflexia (AD) often/always 108 8 AD Often/always - lesions above T7 only 93 9.5 AD Occasionally - lesions above T7 only 348 36 No Flexibility in Routine 101 8 Anal Fissure 96 7 Rectal Prolapse 55 4 Other 58 4 Total 2529 Many individuals report such prolonged amounts of time to complete bowel routines that they perceived loss of social and vocational mobility, related to their bowel programs.16 Thirty-nine - 62% of individuals with SCI - rate their NBD as more significant than the loss of mobility, with significant “interference with life”.17 Clinicians work with individuals with SCI to prevent or ameliorate these complications, through implementation of bowel care programs. Care of Individuals with Neurogenic Bowel Dysfunction Care for NBD includes the overall bowel program (diet, fluids, medications, activity level, assistance and equipment), and a bowel care routine. Physical interventions used for bowel care include taking advantage of the gastrocolic reflex, abdominal massage, digital rectal stimulation, digital evacuation and raising intra-abdominal pressure. Bowel care also utilizes stimulants, given rectally or orally. Despite all these conservative bowel care techniques, problems with bowel continence are frequent in individuals, following SCI. In order to address some of these reported problems, a number of adjunctive, surgical and nonsurgical techniques have been employed (see Figure 3.0). These include: • Transanal irrigation (TAI) - evacuation of feces aided by passing water (or other liquid) via the anus, with sufficient quantity to reach beyond the rectum • Antegrade colonic irrigation - a surgical procedure where a catheterizable stoma is created in the proximal right colon and fluid is passed, through the colon, in an antegrade fashion to facilitate bowel evacuation • Neuromodulation – surgically-implanted sacral anterior root stimulator or sacral nerve stimulator • Stoma - surgical creation of colostomy or ileostomy. This is still infrequently done, but those who have one report improved satisfaction and reduced impact of NBD on quality of life. Figure 3.0 Schematic diagrams showing transanal irigation , antegrade colonic irigation , neuromodulation and an ileostom y. Transanal Irrigation Antegrade Continence Enema Root Stimulation or Sacral Nerve Stimulation Ileostomy or Colostomy (schematic) internal transmi��er external transmi��er ern na l nsmim i��������������BOWEL CONTINENCE | BODY STRUCTURE AND FNUCTION 63


E - Bowel Continence
To see the actual publication please follow the link above