Breaking the Boundaries of Neurogenic Bowel Management in Spinal Cord Injury

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 two very different types of bowel dysfunction.  Reflex, or upper motor neuron bowel, or Areflexic, or lower motor neuron bowel dysfunction. 

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.

Therefore, the interdisciplinary team must work with the spinal cord injured patient to establish a bowel program that achieves continence or containment, and that supports community reintegration. The WOC nurse with an understanding of continence issues can be an essential part of this team.

This poster will review the essential components of a bowel program including; 

–        Anatomy

–        Process of defecation

–        Effect of SCI on bowel function

–        Description and goals of a bowel program

–        Safe and effective use of medications

–        The role of therapy with adaptive equipment related to expected level of function

–        Prevention and treatment of common bowel problems

–        When and how to make medication or schedule changes

–        Management of emergencies

–        Long term implications of neurogenic bowel dysfunction