Bowel rehabilitation of individuals with spinal cord injury: video production / Rehabilitación intestinal de individuos con lesión medular: producción de vídeo / Reabilitação intestinal de indivíduos com lesão medular: produção de vídeo

ABSTRACT Objective: produce and validate an educational video about bowel emptying maneuvers for training of individuals with neurogenic bowel in bowel rehabilitation process. Method: this is a methodological study developed in four stages: script/storyboard production, validation, educational video production and pilot study, which was conducted from January 2013 to July 2015. Instruments for validation, which was performed from December 2014 to February 2015 by a group of experts. A value equal to or greater than 70% was considered for validation of agreement and relevance of the script and storyboard, using descriptive statistics for data analysis. Results: the script and storyboard were validated by 94% of the experts in the subject and 100% of the technicians. After validation and video recording, the pilot study was conducted with six individuals with neurogenic bowel - 100% of them evaluated the video positively. Conclusion: the video may contribute to the education of individuals with neurogenic bowel.

RESUMEN Objetivo: Producir y validar video educativo sobre maniobras de vaciamiento intestinal para capacitar individuos con intestino neurogénico sobre el proceso de rehabilitación intestinal. Método: Estudio metodológico desarrollado en cuatro etapas: guionado/storyboard, validación, producción del vídeo educativo y prueba piloto. Realizado entre enero 2013 y julio2015. Validación mediante instrumentos, efectuada por comité de expertos, con experiencia en vídeos de diciembre 2014 a febrero 2015. Valor de concordancia y pertinencia de guionado y storyboard considerado en 70% o superior. Datos analizados por estadística descriptiva. Resultados: Guionado y storyboard validados por 94% de expertos en temática y 100% de expertos técnicos. Validado y grabado el vídeo, se realizó prueba piloto con seis individuos con intestino neurogénico, 100% evaluó positivamente el vídeo. Conclusión: El vídeo contribuirá a educar a individuos con intestino neurogénico.

RESUMO Objetivo: produzir e validar vídeo educativo sobre manobras de esvaziamento intestinal para capacitação de indivíduos com intestino neurogênico, no processo de reabilitação intestinal. Método: estudo metodológico, desenvolvido em quatro etapas: produção do roteiro/storyboard, validação , produção do vídeo educativo e estudo-piloto. Ocorreu no período de janeiro de 2013 a julho de 2015. Para a validação, utilizaram-se instrumentos, sendo realizada por um comitê de especialistas, no período de dezembro de 2014 a fevereiro de 2015. Considerou-se valor igual ou superior a 70% para validação de concordância e pertinência do roteiro e storyboard, utilizando-se estatística descritiva para análise dos dados. Resultados: o roteiro e storyboard foram validados por 94% dos especialistas na temática e 100% dos especialistas técnicos. Após validação e gravação do vídeo, foi realizado estudo-piloto com seis indivíduos com intestino neurogênico, dos quais 100% avaliaram o vídeo positivamente. Conclusão: o vídeo poderá contribuir para a educação de indivíduos com intestino neurogênico.

Reabilitação de pessoas com lesão medular traumática: estudo do intestino neurogênico e sua relação com a qualidade de vida, satisfação e estilo de vida / Rehabilitation of people with spinal cord injury: a study of the neurogenic intestine and relation with quality of life, satisfaction and lifestyle

Estudo quantitativo, exploratório, descritivo e transversal, com objetivo de avaliar o manejo do intestino neurogênico e sua relação com a qualidade de vida (QV), satisfação e estilo de vida em pessoas com lesão medular traumática (LMT). Seguidos os preceitos éticos, a amostra foi composta por 81 adultos com LMT, de dois centros de reabilitação dos estados de São Paulo e Santa Catarina. Os dados foram coletados a partir de cinco instrumentos previamente validados (questionários sociodemográfico e de caracterização da LMT, Índice de Tratamento do Intestino e da Bexiga (BBTI) e dois data sets de função intestinal e QV desenvolvidos pela International Spinal Cord Society (ISCoS)). Foram realizadas análises descritivas e correlacionais. A maioria dos participantes era do sexo masculino, jovens, com idade média de 36 anos no momento da lesão, baixa escolaridade, beneficiários da previdência social, com baixa renda familiar (até três salários mínimos) e com a LMT no nível torácico. As principais causas da LMT foram acidentes de trânsito e queda, o tempo médio da LMT era de 4,7 anos. Os participantes utilizavam principalmente medidas conservadoras (massagem abdominal, manobra de Valsalva e estímulo dígito-anal) como método para esvaziamento intestinal. Cerca de 90% necessitava de até 30 minutos para o manejo intestinal, e tinha frequência de defecação acima de duas vezes por semana. Aproximadamente metade dos participantes relatou incontinência fecal. A independência para o cuidado intestinal não foi associada ao nível da LMT, no entanto esteve associada à satisfação com a rotina de cuidados intestinais e ao tempo da LMT, assim quanto maior o tempo de lesão, maior foi a independência para o manejo intestinal. Aproximadamente 40% e 35% referiram alterar suas rotinas diárias devido à incontinência fecal e constipação, respectivamente. O impacto na QV devido aos problemas intestinais foi relatado por 77,8% da amostra. Não houve diferença estatisticamente significativa entre QV geral, com a saúde psicológica e com a saúde física (p>0,05). A QV geral esteve associada ao tempo de LMT, e foi menor entre as pessoas que tiveram que alterar suas rotinas devido a perdas fecais e entre aquelas que precisavam utilizar fraldas. As pessoas satisfeitas com suas rotinas de cuidado intestinal apresentaram maior QV geral e maior satisfação com a saúde psicológica. Ainda há que se progredir na reabilitação intestinal das pessoas com LMT, desenvolvendo estratégias de capacitação para o manejo intestinal, com a finalidade de reduzir os fatores que impedem ou dificultam a pessoa com LMT a retornar para suas atividades sociais e laborais, acarretando prejuízos na vida pessoal e para a economia do país já que a maioria dessas pessoas era economicamente ativa e agora dependem da previdência social e dos serviços de saúde com mais frequência. Os achados deste estudo podem subsidiar a prática clínica nos serviços de reabilitação, considerando que um programa de reabilitação precocemente iniciado e individualmente planejado pode auxiliar a pessoa com LMT a ter um funcionamento intestinal adequado e consequentemente uma melhor QV, satisfação e estilo de vida

Quantitative, exploratory, descriptive and transversal study, with the aim to assess the management of the neurogenic intestine and its relationship with the quality of life (QOL), satisfaction and lifestyle on people with traumatic spinal cord injury (TSCI). In accordance with the ethical requirements, the sample was composed by 81 adults with TSCI, from two rehabilitation centers from the states of Sao Paulo and Santa Catarina. The data was collected from five previously validated instruments (socio-demographic questionnaires and of characterization of TSCI, Index of Bladder and Intestine Treatment (BBTI) and two data sets of intestinal function and QOL developed by the International Spinal Cord Society (ISCoS)). Descriptive and correlational analyses were carried out. Most of the participants were male, young, with an average age of 36 years at the time of the injury, low schooling, and social security beneficiaries with low family income (up to three minimum wages) and with the TSCI at thoracic level. The main causes of the TSCI were traffic accidents and falls, the average time TSCI was of 4.7 years. Participants used mainly conservative measures (abdominal massage, Valsalva maneuver and digital anal stimulus) as a method for bowel emptying. Around 90% needed up to 30 minutes for the intestinal management, and had defecation frequency above twice a week. Approximately half of the participants reported fecal incontinence. Intestinal care independence was not associated with the level of the TSCI, however it was associated with satisfaction with bowel care routine and to the time of TSCI, so the longer the time of injury, the greater the independence for the bowel management was. Approximately 40% and 35% reported altering their daily routines due to fecal incontinence and constipation, respectively. The impact on the QV due to intestinal problems was reported by 77, 8% of the sample. There was no significant statistical difference between general QOL with psychological health and physical health (p>0,05). General QOL was associated with the time of TSCI and was lower among the people who had to alter their routines due to fecal losses and among those who needed to use diapers. The people satisfied with their routines of intestinal care presented higher general QOL and higher satisfaction with their psychological health. There is still progress to be made in the intestinal rehabilitation of people with TSCI, developing training strategies for the intestinal management, with the purpose to reduce the factors that prevent people with TSCI to return to their social and labor activities, causing losses in personal life and for the country's economy since most of these people were economically active and now depend on social welfare and health services more frequently. The findings of thid study can provide clinical practice in rehabilitation services, considering that a rehabilitation program prematurely launched and individually planned can assist the person with TSCI to have proper bowel function and consequently a better QOL, satisfaction and lifestyle

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.

Anorectal Manometric and Urodynamic Parameters According to the Spinal Cord Injury Lesion

OBJECTIVE: To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion. METHODS: Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive. RESULTS: In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function. CONCLUSION: The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.

Self care in neurogenic intestine in subjects with spinal cord injury: an integrative review / Autocuidado para el intestino neurogénico en sujetos con trauma raquimedular: revisión integrativa / Autocuidado para intestino neurogênico em sujeitos com lesão raquimedular: revisão integrativa

Aim: To identify the nursing interventions that promote self-care in the neurogenic intestine in subjects with spinal cord injury, related to the nursing diagnoses listed as Risk of Constipation, Constipation and Intestinal Incontinence. Method: This study used the integrative review of electronic databases using descriptors. In the analysis of data, we used the Theory of Self-Care Deficit. Results: The most mentioned interventions of self-care were; nutritional orientation, consumption of liquids, going to the toilet at the same time every day, abdominal massage, decubitus change and Valsalva maneuver. Discussion: The gastrointestinal dysfunction can cause constraints and it can also harm interpersonal relationships. The nurse must evaluate the eliminatory standard of this clientele, prioritizing non-pharmacological and less invasive actions, considering dietary preferences, cultural habits and the economic resources of the subjects available to invest in a certain diet. Conclusion: Nurses can contribute to the promotion of self-care for patients with neurogenic intestine, and the Theory of Self-Care Deficit can be used as an important tool in this process.

Objetivo: Identificar las intervenciones de enfermería en la promoción del autocuidado para intestino neurogénico en los sujetos con lesión de la médula espinal, relacionadas a los diagnósticos de enfermería en Riesgo de constipación, constipación e incontinencia intestinal. Método: Revisión integrativa en las bases electrónicas utilizándose descriptores. En el análisis se utilizó la Teoría del Déficit de Autocuidado. Resultados: Intervenciones más citadas para el autocuidado: Orientación nutricional, consumo de líquidos, indicar ida al baño en el mismo horario, masaje abdominal, cambio de decúbito y maniobra de Valsalva. Discusión: La disfunción gastrointestinal puede causar restricciones y perjudicar las relaciones personales. El enfermero debe evaluar el patrón eliminatorio de este paciente, priorizar acciones no farmacológicas y poco invasivas, considerar las preferencias alimenticias, los hábitos culturales y los recursos económicos de los sujetos para invertir en la dieta. Conclusión: Los enfermeros pueden contribuir con la promoción del autocuidado para el intestino neurogénico y la Teoría del Déficit de Autocuidado puede ser utilizada como una importante herramienta en ese proceso.

Objetivo: Identificar as intervenções de enfermagem na promoção do autocuidado para intestino neurogênico nos sujeitos com lesão raquimedular, relacionadas aos diagnósticos risco de constipação, constipação e incontinência intestinal. Método: Revisão integrativa nas bases eletrônicas utilizando-se descritores. Na análise utilizou-se a Teoria do Déficit de Autocuidado. Resultados: intervenções mais citadas para o autocuidado: orientação nutricional, consumo de líquidos, indicar ida ao banheiro no mesmo horário, massagem abdominal, mudança de decúbito e manobra de Valsalva. Discussão: a disfunção gastrointestinal pode causar constrangimentos e prejudicar as relações pessoais. O enfermeiro deve avaliar o padrão eliminatório desta clientela, priorizar ações não-farmacológicas e pouco invasivas, considerar as preferências alimentares, os hábitos culturais e os recursos econômicos dos sujeitos para investir na dieta. Conclusão: Os enfermeiros podem contribuir com a promoção do autocuidado para o intestino neurogênico e a Teoria do Déficit de Autocuidado pode ser utilizada como uma importante ferramenta nesse processo.

Funcionamento intestinal e a relação com a independência funcional de indivíduos com lesão medular / Bowel function and the relationship with functional independence of individuals with spinal cord injury / Funcionamiento intestinal y relación con la independencia funcional de individuos con lesión de médula espinal

OBJETIVOS: Caracterizar indivíduos adultos que sofreram lesão de medula espinhal; avaliar a independência funcional considerando o nível da lesão; descrever a ocorrência de problemas de funcionamento intestinal e a relação com o nível de independência funcional. MÉTODO: Estudo observacional, transversal. Para investigar a independência funcional foi utilizada a escala Medida de Independência Funcional. Para avaliar o funcionamento intestinal, as orientações recebidas e as práticas de autocuidado, utilizaram-se as Diretrizes do Consórcio de Medicina da Lesão Medular. RESULTADOS: Dos 22 participantes, 91% eram homens, com média de idade de 38 anos (DP 11,7) e 50,0% apresentavam dependência mínima e participavam de programa de reabilitação. Verificou-se alteração no padrão de funcionamento intestinal pós-lesão. CONCLUSÃO: A literatura enfatiza a importância de instituir programas de intervenção por meio de estratégias educativas para o controle do intestino neurogênico.

OBJECTIVES: To describe adults who have suffered spinal cord injury; evaluate their functional independence considering the level of injury; describe the occurrence of problems in bowel function and the relationship with the level of functional independence. METHOD: Cross-sectional and observational study. Functional independence was investigated using the Functional Independence Measure. To assess bowel function, the guidance the patients received and their self-care practices, we used the Guidelines of the Consortium for Spinal Cord Injury Medicine. RESULTS: Of all 22 participants, 91% were men, mean age 38 years (SD 11.7), and 50.0% had minimal dependence and participated in a rehabilitation program. A change in the pattern of bowel function was observed after injury. CONCLUSION: Literature emphasizes the importance of establishing intervention programs through educational strategies for the control of neurogenic bowel.

OBJETIVOS: Caracterizar individuos adultos que sufrieron lesión medular espinal; evaluar su independencia funcional considerando nivel de la lesión; relatar ocurrencia de problemas del funcionamiento intestinal y la relación con el nivel de independencia funcional. MÉTODO: Estudio de observación, transversal. Para investigar la independencia funcional se utilizó la escala medida de independencia funcional. Para evaluar el funcionamiento intestinal, las orientaciones recibidas por el paciente y las prácticas de autocuidado, se usaron Directivas del Consorcio de Medicina de la Lesión Medular. RESULTADOS: De 22 participantes, 91% eran hombres, edad promedio 38 años (DE 11,7), 50,0% presentaba dependencia mínima y participaba de programas de rehabilitación. Se verificó alteración en el patrón de funcionamiento intestinal post-lesión. CONCLUSIÓN: La literatura enfatiza la importancia de instituir programas de intervención mediante estrategias educativas para controlar el intestino neurogénico.

Plain Abdominal Radiograph as an Evaluation Method of Bowel Dysfunction in Patients With Spinal Cord Injury

OBJECTIVE: To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). METHODS: Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. RESULTS: The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). CONCLUSION: Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.

Práticas de autocuidado para funcionamento intestinal em um grupo de pacientes com trauma raquimedular / Self-care practice for bowel functioning in a group of patients with spinal cord injury

Estudo descritivo exploratório. Objetivo: caracterizar os indivíduos com trauma raquimedular (TRM) atendidos em um Centro de Reabilitação de um hospital terciário do interior do estado de São Paulo e identificar as suas práticas de autocuidado intestinal. Método: Após a aprovação do Comitê de Ética em Pesquisa e o consentimento dos participantes, os dados foram coletados por meio de análise do prontuário e entrevista. Dos 30 indivíduos entrevistados, houve predomínio do sexo masculino, estado civil solteiro, ensino médio completo, com idade média de 35 anos. Resultado: A principal causa do TRM foi acidente automotor com prevalência de lesão completa em nível cervical. As práticas de autocuidado mais referidas foram o controle nutricional seguido da massagem abdominal. Quanto às complicações intestinais relatadas, houve predomínio de impactação fecal seguida por incontinência fecal. Conclusão: Programa de reabilitação intestinal deve ser instituído para indivíduos com TRM o mais precoce possível de modo a minimizar complicações.

This was a descriptive and exploratory study. Objective: To characterize individuals with spinal cord injuries (SCI) treated at a Rehabilitation Center in a tertiary hospital in the interior of São Paulo state, and to identify their self-care practices related to bowel management. Method: After being approved by the Research Ethics Committee and receiving consent from the participants, the data was collected through an interview and by analyzing their medical records. Thirty individuals were interviewed, most of whom were male, single, had a complete secondary education, and a mean age of 35 years. Results: The main cause for the SCI was automobile accident with a prevalence of cervical injuries. The most common self-care practices were nutritional management followed by abdominal massage. Regarding the bowel problems, fecal impaction predominated followed by fecal incontinence. Conclusion: The bowel rehabilitation program should be instituted for individuals with SCI as early as possible to minimize complications.

The Change of Neurogenic Bowel Dysfunction in Spinal Cord Injury Patients during Admission

OBJECTIVE: To investigate the change of neurogenic bowel dysfunction (NBD) in spinal cord injury (SCI) patients during admission. METHOD: Thirty eight SCI patients were enrolled. The NBD score by Krogh was converted to the Korean-version of NBD score. The questionnaires of NBD score included questions about neurogenic bowel symptoms, signs, gender, age, duration, injury level, American spinal cord injury association impairment scale (AIS) and Spinal cord independence measure (SCIM) were used for evaluation of the functional impairment of the SCI. The Korean version of NBD score was applied to the SCI patients at the time of admission and discharge. Neurogenic bowel was treated according to scheduled bowel care. The subcomponents of bowel care protocol were education of bowel habit, abdominal massage, triggered defecation, oral medication and rectal stimulants insertion. RESULTS: The NBD score at the time of discharge decreased significantly in all patients within three months after SCI (p0.05). CONCLUSION: We could reveal the significant improvement of NBD in patients within three months after SCI during admission. The change was more evident in AIS A, C, D patients.

Effects of the Electrical Stimulation for the Neurogenic Bowel according to the Level of Spinal Cord Injury

Objective: To evaluate the baseline colon transit time and rectoanal manometry and the effects of the electrical stimulation to the sacral dermatomes for the neurogenic bowel according to the level of spinal cord injury. METHOD: To determine the baseline differences, thirty three patients were classified into two groups: cord injured level above T9 and from T9 to L2. And thirteen patients were included in follow-up study to evaluate the effects of 4 weeks electrical stimulation. RESULTS: There was no significant difference in the baseline colon transit time on two groups. After electrical stimulation, the left and rectosigmoid transit time was more improved in lower level injured group comparing with upper level injured group. In the rectoanal manometry the mean resting anal pressure, mean squeezing pressure, high pressure zone, and threshold of rectoanal inhibitory reflex were increased after the electrical stimulation on two groups. And the mean squeezing pressure on T9-L2 injured patients was significantly increased (p<0.05). CONCLUSION: The elecrical stimulation to the sacral dermatomes increased the mean squeezing pressure of rectoanal manometry more significantly on the T9-L2 injured patients than the group of spinal cord injured level above T9. However, there was no statistically significant difference in the colon transit time before and after the electrical stimulation between two groups

Effect of Rectal Electrical Stimulation in Patients with Neurogenic Bowel due to Spinal Cord Injury

OBJECTIVE: This study was designed to investigate the effect of the rectal electrical stimulation in patients with neurogenic bowel due to SCI. METHOD: Twelve patients with SCI who have the symptoms of neurogenic bowel were recruited as subjects. Before and after electrical stimulation, anorectal angle and anal pressure was measured. RESULTS: 1. There was a reverse correlation between pre- electrical stimulation anorectal angle and colon transit time in rectosigmoid segment (p<0.05). 2. Anal pressure of post-electrical stimulation was significantly decreased compared with that of pre-electrical stimulation (p<0.05). 3. Anorectal angle of post-electrical stimulation was significantly increased compared with that of pre-electrical stimulation (p<0.05). CONCLUSION: This study suggested that rectal electrical stimulation for neurogenic bowel in patients with SCI could be helpful defecation method for bowel emptying.

Effects of Psyllium Husk for the Management of Neurogenic Bowel in Chronic Spinal Cord Injured Persons

OBJECTIVE: The purposes were to determine the baseline colon transit time (CTT) and to assess the effect of dietary fiber (psyllium husk) on neurogenic bowel function in chronic spinal cord injured (SCI) persons. METHOD: Eleven chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were participated. Personal interview were carried out for all studied subjects at pre and post treatment period. The baseline colon transit time (CTT) were measured for the right (rCTT), left (lCTT), rectosigmoid (rsCTT) colons as well as for the entire colon using radio-opaque markers. After 4 weeks treatment of psyllium husk, the subjects were reevaluated for their CTTs and the results were compared to the pretreatment values. RESULTS: The mean age of the subjects was 33.9+/-11.0 years and the level of injury ranged from C3 to T10. The mean duration after SCI was 22.6 months (6~47 months). The rCTT, lCTT, rsCTT and tCTT were not affected after the treatment of psyllium husk. Also their bowel care patterns and satisfaction were unaffected by the treatment. CONCLUSION: The results of this study suggest that the use of psyllium husk in chronic spinal cord injured persons do not show the same effect on bowel function as has been previously reported in general population with idiopathic constipation.

The Effect of Sympathetic Nervous System and Oxybutynin to Colon Transit Time in Spinal Cord Injured Patients

OBJECTIVE: The aims of this study is to determine the influence of the imbalance between sympathetic and parasympathetic nervous input to colon transit control in spinal cord injured patients and the effect of the anticholinergic medication forneurogenic bladder on colon transit time. METHOD: Eighty-six patients with cervical and thoracic cord injury were enrolled. The colon transit time (CTT) accord ing to the severity and lesion of injury and also the administration routes of oxybutynin were compared by indepen dent t-test. RESULTS: Total CTT was 56.7 hours, with right CTT 16.9 hours, left CTT 21.3 hours and rectosigmoid CTT 18.5 hours. The rectosigmoid CTT of the patients with the lesion at T6 or below were prolonged than that of the patients with the lesion above T6 (p<0.05). According to administration route of oxybutynin, instillation group showed more shortened rectosigmoid CTT than oral route group (p<0.05). CONCLUSION: The imbalance between parasympathetic and sympathetic outflow from the spinal cord has play an im portant role in colon transit control of spinal cord injured patients. The management of neurogenic bowel and bladder considering colon transit time is needed for the effective management of spinal cord injured patients.

Effects of the Electrical Stimulation for the Neurogenic Bowel of the Spinal Cord Injured Patients

OBJECTIVE: To evaluate effects of the electrical stimulation to the sacral dermatomes for the neurogenic bowel of the spinal cord injured patients. METHOD: Eleven patients with cervical and thoracic cord injury were enrolled, and classified into two groups, control and electrical stimulation (ES) group. The colon transit time before and after electrical stimulation for 4 weeks to the sacral dermatomes were measured on the ES group, and measured at the same time on control group. The rectoanal manometries were performed after studies of colon transit time on the ES group. RESULTS: The colon transit time measured before electrical stimulation were 16.1+/-13.8 hours for the right colon; 20.1+/-23.3 hours for the left colon; 14.7+/-12.3 hours for the rectosigmoid colon; and the total transit time was 51.0+/-23.4 hours. The time of after electrical stimulation was 8.0+/-5.7 hours for the right colon; 12.8+/-2.2 hours for the left colon; 15.4+/-13.8 hours for the rectosigmoid colon; and the total transit time was 36.2+/-12.8 hours. The left colon transit time and total colon transit time before electrical stimulation were significantly improved compared to after electrical stimulation on the ES group (p<0.05). The left colon transit time of the ES group was significantly improved compared with control group (p<0.05). In the rectoanal manometry, the mean resting anal pressure and threshold of rectoanal inhibitory reflex were increased after the electrical stimulation. CONCLUSION: The electrical stimulation to the sacral dermatomes on the spinal cord injured patient could effectively enhance colon transit, especially on the left colon. In addition, muscular activity of the anal sphincter was enhanced.

Evaluation of the Neurogenic Bowel by Colon Transit Time and Anorectal Manometry in the Spinal Cord Injured Patients

OBJECTIVE: To evaluate changes of colon transit time according to prokinetic medication and characteristics of the anorectal manometry in patients with neurogenic bowel due to spinal cord injury. METHOD: Twelve patients with cervical and thoracic cord injury were enrolled, and classified into complete and incomplete spinal cord injury according to the severity of injury. The colon transit time before and after prokinetic medications were measured. The anorectal manometry was performed after the first study of colon transit time. RESULTS: The colon transit time of pre-prokinetic medications were 17.1+/-12.6 hours for the right colon, 26.9+/-13.2 for the left colon, 21.5+/-14.0 for the rectosigmoid colon, and the total transit time was 65.5+/-5.3 hours. The time of post-prokinetic medications was 14.3+/-7.6 hours for the right colon, 25.8+/-10.3 for the left colon, 7.4+/-5.3 for the rectosigmoid colon, and the total transit time was 33.1+/-11.5 hours. The rectosigmoid colon transit time and total colon transit time were significantly different between pre- and post-prokinetic medications (p<0.05). In the anorectal manometry, mean resting anal pressure was 33.3+/-10.7 mmHg and maximal resting anal pressure was 99.0+/-43.4 mmHg. There were no difference in the colon transit time and anorectal manometry between complete and incomplete injured patients. CONCLUSION: The difficulties of defecation in spinal cord injured patients were not only due to uncontrolled anal sphincter but also due to dysfunction of colon motility. The prokinetic medications were effective in reducting the rectosigmoid and total colon transit time.

Effect of Combined Therapy of Cisapride and Lactulose on Neurogenic Bowel Dysfunction in Spinal Cord Injury

OBJECTIVE: To calculate the colonic transit time (CTT) and to evaluate the effect of combined therapy of cisapride and lactulose on neurogenic bowel dysfunction in patients with chronic spinal cord injury. METHOD: This study was prospectively designed. Right (rCTT), left (lCTT), rectosigmoid (rsCTT), and total (tCTT) colonic transit times were measured using the radio-opaque marker technique in twenty patients with spinal cord injury (SCI group), of which mean age was 39 years (range: 13~67 years) and median duration after SCI was 15 months (4-252 months). Ten ambulatory stroke patients (mean age 49 years, median duration, 12 months) were also evaluated as control group. All CTTs in both groups were compared by unpaired Student's t-test. In SCI group, the therapeutic effect of combined administration of cisapride (10 mg p.o. t.i.d) and lactulose (134.0 g/100 ml, 30-45 ml per day p.o.) was statistically analyzed by paired Student's t-test. RESULTS: Total (p<0.0001) and segmental CTT (p<0.01) except right colon were significantly delayed in SCI group when compared to the control group. In SCI group, tCTT of non-ambulatory patients (n=13) and rCTT, lCTT, rsCTT and total CTT of ambulatory patients (n=7) were significantly decreased after the combined drug therapy (p<0.05). In ambulatory SCI patients, duration after injury showed negative correlation with tCTT (Pearson's correlation coefficient r = 0.8407, p=0.0178). CONCLUSION: Combined therapy of cisapride and lactulose can improve tCTT in SCI patients with neurogenic bowel dysfunction.

Colon Transit Time and Management of Upper Motor Neuron Type Neurogenic Bowel in Spinal Cord Injury

OBJECTIVE: The aims of this study were to evaluate the common gastrointestinal problems, diet and bowel care patterns, and to estimate the colon transit time in spinal cord injury (SCI). METHOD: Fifteen chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were studied by measuring the colonic transit time and interviews. The colon transit time was studied by using radioopaque markers. RESULTS: Mean total colonic transit time was 43.79 h with right colonic transit time 13.71 h, left colonic transit time 20.36 h, and rectosigmoid colonic transit time 9.71 h. The right colonic transit time was delayed in 35.7% of the subjects, left colonic transit time in 64.3%, and rectosigmoid colonic transit time in 21.4%. The common gastrointestinal problem in SCI were constipation (66.7%). The defecation difficulty (73.3%) was the most significant subjective symptom. Delayed colonic transit time was shown in 80% of perceived 'constipation' group. The average time spent for the defecation was 64.7 minutes per day. 73.3% of the subjects did not control the diet. CONCLUSION: Spinal cord injured persons of upper motor neuron type neurogenic bowel in Korea showed significantly delayed colonic transit time than non SCI adults, similar delayed colon transit time as Western SCI persons who consume less fibers in daily diets.

Neurogenic Bowel Dysfunction in Spinal Cord Injury Patients

No abstract available.

Chronic Gastrointestinal Problems and Bowel Dysfunction in Spinal Cord Injury Patients

Among complications arising from spinal cord injury (SCI), chronic gastrointestinal(G-I) problems and bowel dysfunction have not received as much attention as the other fields of medical and rehabilitation research, even though their incidence is not negligible. Among SCI patients, we therefore investigated chronic G-I problems and bowel dysfunction, where the degree of these was such that activities of daily living(ADL) were significantly affected or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The incidence of chronic G-I problems was very high(62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL in particular, they restricted diet (80%), restricted out door ambulation(64%), and caused unhappiness with bowel care(62%). These chronic G-I symptoms were vague and very subjective, but significant enough to affect quality of life. Bowel dysfunction was not related to severity of injury, and bowel habits had generally settled within six months of SCI. With regard to frequency, time, and method of defecation, bowel care habits varied very considerably among individuals, and in relation to the extent to which practical results matched the level of expectation generated by a physician's recommended care program, individual satisfaction was also very subjective. We therefore suggest that an appropriate bowel program should be properly designed and adequate training provided during the early stage of rehabilitation.