Bowel Care for Patients with a Spinal Cord Lesion

1. Indications

1.1 Background

Neuropathic bowel is a common problem and often seriously debilitating ¹. More than one third of surveyed subjects with a spinal cord injury rated bladder and bowel dysfunction as having the most significant effect on their lives after injury, and many rank bowel dysfunction as one of their major life limiting problems ².

Problems with defecation is manifested by prolonged oro-anal transit time, diminished faecal water content and a reduced frequency of defecation. This can result in faecal incontinence and/or chronic constipation owing to loss of anorectal sensation and inhibitory regulations of the anorectum and the left colon, and by lack of ability to voluntary contract the external sphincter ^3,4. Consequently, bowel dysfunction can have severe implications for patients’ reintegration into society ³.

1.2 Aim/purpose

The aim of this policy is to achieve effective bowel management for patients with a spinal cord lesion. Effective bowel management:

is tailored to the needs of the individual, and promotes the eventual reintegration of the patient into the community ⁵
maintains short and long-term gastrointestinal health ⁵
achieves regular predictable complete emptying of the bowel within a reasonable time period, at a socially acceptable time and place ⁵
uses the minimum chemical interventions ⁵
minimizes the incidence of faecal incontinence and chronic constipation ⁵
reduces the incidence of bowel related autonomic dysreflexia ⁵