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E - Bowel Continence

The current clinical practice, suggested by Cograve (created originaly by Christensen, Bazzochi, Cograve, et al.18), and supported by a decision analysis published by Furlan.19 Figure 4.0 Current Clinical Practice Paradigm for NEUROGENIC BOWEL DYSFUNCTION Used with permision from M. Cograve. Original source: Christensen P, Bazzochi G, Cograve M, et al.18 Neuromodulation Percutaneus endoscopic colostomy Antegrade colonic irrigation Transanal irrigation Conservative bowel management Rethinking NBD Practice Where does TAI fit in the current spectrum of bowel care procedures? Current evidence suggests using standard neurogenic bowel care procedures, based on the published Paralyzed Veterans of America guidelines. When the conservative measures recommended in the guideline are ineffective, before the availability of TAI, research reported by Furlan19 would have suggested that individuals proceed with surgery called the Malone procedure (Appendicostomies), as the next logical treatment option. Christensen, Krogh and Coggrave suggest TAI should be introduced and evaluated, prior to considering any surgical intervention. How do we prevent the morbidity asociated with ineffective bowel care? Using the above paradigm, clinicians hope to eliminate the morbidity associated with NBD care. However, there is substantial regional disparity in practice and funding models across the provinces that Stoma often limit access to the newer NBD interventions. Multicentre studies of efficacy and effectiveness of these interventions are required to determine if the goal of reduced morbidity is being achieved. In addition to the above treatment paradigm for management of NBD, there are two clinical scenarios, in which transanal irrigation has been reported to be clinically helpful: 1) In the acute rehabilitation setting, for select individuals having problems with conservative bowel management, but before all conservative treatments have been exhausted. 2) In the acute or chronic setting, to assist individuals with bowel preparation and cleanout, prior to colonoscopy.20 This strategy avoids the use of large quantities of laxatives and potential for incontinence from unpredictable bowel movements, and reduces the potential for skin breakdown secondary to prolonged periods of time on the commode. There are published reports of the benefit of pulsed anal irrigation being used successfully in this clinical scenario, as well. 64 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


E - Bowel Continence
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