The WOCN Toolkit for Spinal Cord Injury; Utilization of Bladder and Bowel Clinical Practice Guidelines to Support Community Reintegration

There are approximately 250,000 Americans currently living with spinal cord injury (SCI) and an estimated 11,000 new injuries occur annually. Damage to nerve pathways following SCI can result in sensory and/or motor dysfunction leading to reflex urinary incontinence (UI), detrusor sphincter dyssynergia, or neurogenic detrusor areflexia (overflow UI).  This resulting voiding dysfunction can cause upper and lower tract complications.  The goals of bladder management then following SCI are; 1) preserve upper tract function, 2) minimize lower tract complications, and 3) establish a program compatible with a person’s lifestyle.

GI changes following SCI include increased colorectal transit time, loss of colonic compliance, and changes in sphincter tone and pelvic floor musculature. This often leads to symptoms of constipation, fecal incontinence, and autonomic dysreflexia. Uncontrolled bowel evacuation is the most common complaint and is the greatest source of social discomfort. Bowel dysfunction has been reported to affect life activities in up to 61% of people with SCI.  This suggests a need to incorporate quality of life into the development of interventions and as a program outcome.

The Consortium for Spinal Cord Medicine has published 2 clinical practice guidelines that may be of use to the WOCN in helping to establish bladder and bowel care.  Bladder Management for Adults with Spinal Cord Injury:  A Clinical Practice Guideline for Health-Care Providers provides recommendations for intermittent and indwelling catheterization, reflex voiding, medications, and surgical procedures such as stents, bladder augmentation and urinary diversion.  Neurogenic Bowel Management provides recommendations on designing a bowel program, medications, nutrition, surgical and non surgical therapies, managing complications, and education. 

One of the biggest challenges for many patients with SCI is the establishment of a bladder and bowel program that achieves continence or containment, and that supports community reintegration.  The WOCN now has the tools at hand to facilitate this integration.