Clinical evaluation and management of neurogenic bowel after spinal cord injury.
OBJECTIVE
To assess the state of the neurological bowel in spinal cord injured (SCI) patients, design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome.


METHODS
Out-patient in a Rehabilitation Service.


METHODS
Thirty-eight SCI patients, 12 (32%) with complete lesions of more than 5 years duration.


METHODS
Observational, longitudinal and prospective. Pre and post intervention.


METHODS
Pre and post SCI intestinal function was evaluated clinically prior to beginning program. The presence of GI symptoms were studied. Laboratory work-up included colonic transit time (CTT), anorectal manometry and recto-colonoscopy. An intestinal program was designed, in order to achieve an effective and efficient evacuation in a predictable and socially acceptable time, to avoid short and long term complications and eliminate inadequate intestinal evacuation habits.


METHODS
Pre and post SCI difficulty in intestinal evacuation (DIE) was increased (from 2.6% to 26.3%). The most frequent GI symptom was abdominal distention (53%). Colonic inertia was present in 49% of CTT, internal anal sphincter pressure was normal or increased in 77% and rectoanal inhibitory reflex was present in 88%. With the intestinal program, the incidence of DIE was reduced to 8.8%, manual extraction (ME) was reduced from 53% to 37%. Excellent and good results were obtained in 56% of the patients.


CONCLUSIONS
The proposed intestinal program is effective in the rehabilitation of SCI patients with neurogenic bowel. It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future Spinal Cord (2000) 38, 301 - 308.
Correa
G I
GI
Hospital del Trabajador de Santiago, Asociación Chilena de Seguridad, Chile.
Rotter
K P
KP
D000328:Adult; D020117:Cisapride / Q000627:therapeutic use; D003108:Colonic Diseases / Q000209:etiology / Q000503:physiopathology; D004043:Dietary Fiber / Q000627:therapeutic use; D004143:Dioctyl Sulfosuccinic Acid / Q000627:therapeutic use; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005772:Gastrointestinal Transit; D005990:Glycerol / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000534:rehabilitation / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013488:Suppositories; D013501:Surface-Active Agents / Q000627:therapeutic use; D016896:Treatment Outcome
D004043:Dietary Fiber; D005765:Gastrointestinal Agents; D013488:Suppositories; D013501:Surface-Active Agents; D004143:Dioctyl Sulfosuccinic Acid; D005990:Glycerol; D020117:Cisapride