RESUMEN
Background: The inclusion of people living with spinal cord injury (SCI) in research has allowed for an informed understanding of priorities of recovery of which bowel dysfunction and bladder dysfunction have been continuously identified. Research has also demonstrated the global disparities in SCI outcomes particularly when comparing high- and low-income countries. Currently, there is a lack of direct comparison between countries when assessing SCI outcomes. Objectives: This is an exploratory study to better understand bowel and bladder dysfunction amongst individuals with SCI in India and Canada. Methods: Data from 33 participants were analyzed. Participants completed an online questionnaire assessing demographic information and the Neurogenic Bowel Dysfunction (NBD) score, Wexner score, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Instrument (I-QOL). Continuous data were compared using t tests. For not normally distributed data, the independent Mann-Whitney U test was used. Categorical variables were evaluated for association using Fisher's exact or chi-square test, depending on the sample size. Results: Independent Mann-Whitney U test demonstrated that the Canadian participants had poorer bowel function with higher total NBD scores (p = .007) and less frequent bowel movements (p = .036), and they were more likely to experience uneasiness, headaches, and perspiration during bowel movements (p < .001). NBSS results indicated a small but significantly higher proportion of the Indian participants were unsatisfied or unhappy with their bladder function (p = .049). The distribution of Wexner and I-QOL scores were the same across countries. Conclusion: Potential explanations for differences include lifestyle, management, financial resources, patient and caregiver education, and societal pressures, which are all heavily influenced by cultural, geographical, and economic circumstances.
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Calidad de Vida , Traumatismos de la Médula Espinal , Humanos , India , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Canadá , Masculino , Adulto , Persona de Mediana Edad , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Neurogénica/fisiopatología , Encuestas y Cuestionarios , Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Anciano , Adulto JovenRESUMEN
Background: Guidelines fail to recommend objective measures to assist with treatment of neurogenic bowel dysfunction (NBD) in spinal cord injury (SCI). Objectives: The main objective was to review the literature to identify the objective measures used in all NBD populations and to present their results and any correlations performed to validated subjective measures. Methods: A systematic review of the literature was performed in accordance with PRISMA (2020) guidelines, including all records from January 2012 to May 2023 with MeSH terms like "neurogenic bowel" indexed in the following databases: PubMed, EMBASE, CINAHL, Cochrane Central Trials Register, and ClinicalTrials.gov. Abstracts were excluded if they did not include objective measures or if they only mentioned the esophagus, stomach, and/or small bowel. Records were screened independently by at least two collaborators, and differences were resolved by unanimous agreement. Results: There were 1290 records identified pertaining to NBD. After duplicates were removed, the remaining records were screened for a total of 49 records. Forty-one records (82%) included subjective measures. Two-thirds of the articles involved the population with SCI/disease (n = 552) and one-third were non-SCI NBD (n = 476). Objective measures were categorized as (1) transit time, (2) anorectal physiology testing, and (3) miscellaneous. Of the 38 articles presenting results, only 16 (42%) performed correlations of objective measures to subjective measures. Conclusion: There is an abundance of literature supporting the use of objective outcome measures for NBD in SCI. Strong correlations of subjective measures to objective outcome measures were generally lacking, supporting the need to use both measures to help with NBD management.
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Intestino Neurogénico , Traumatismos de la Médula Espinal , Humanos , Intestino Neurogénico/terapia , Intestino Neurogénico/fisiopatología , Intestino Neurogénico/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
Neurogenic bowel dysfunction, including hyperreflexic and areflexic bowel, is a common complication in patients with spinal cord injury (SCI). We hypothesized that removing part of the colonic sympathetic innervation can alleviate the hyperreflexic bowel, and investigated the effect of sympathectomy on the hyperreflexic bowel of SCI rats. The peri-arterial sympathectomy of the inferior mesenteric artery (PSIMA) was performed in T8 SCI rats. The defecation habits of rats, the water content of fresh faeces, the intestinal transmission function, the defecation pressure of the distal colon, and the down-regulation of Alpha-2 adrenergic receptors in colon secondary to PSIMA were evaluated. The incidence of typical hyperreflexic bowel was 95% in SCI rats. Compared to SCI control rats, PSIMA increased the faecal water content of SCI rats by 5-13% (P < 0.05), the emptying rate of the faeces in colon within 24 h by 14-40% (P < 0.05), and the defecation pressure of colon by 10-11 mmHg (P < 0.05). These effects lasted for at least 12 weeks after PSIMA. Immunofluorescence label showed the secondary down-regulation of Alpha-2 adrenergic receptors after PSIMA occurred mainly in rats' distal colon. PSIMA mainly removes the sympathetic innervation of the distal colon, and can relieve the hyperreflexic bowel in rats with SCI. The possible mechanism is to reduce the inhibitory effect of sympathetic activity, and enhance the regulatory effect of parasympathetic activity on the colon. This procedure could potentially be used for hyperreflexic bowel in patients with SCI.
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Intestino Neurogénico/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Simpatectomía/métodos , Animales , Colon/fisiopatología , Defecación/fisiología , Heces , Femenino , Motilidad Gastrointestinal/fisiología , Masculino , Modelos Animales , Intestino Neurogénico/complicaciones , Intestino Neurogénico/cirugía , Ratas , Ratas Sprague-Dawley , Traumatismos de la Médula Espinal/complicacionesRESUMEN
BACKGROUND: As one of the important manifestations of neurogenic bowel dysfunction, constipation is characterized by high incidence and harmful effects. It has a negative impact on both physical and psychological health of patients. And there are no effective treatment options for this type of disease clinically. Therefore, this study is designed to examine the effect of the therapy of "combination 3 methods progression" in patients with neurogenic bowel dysfunction (constipated type). METHODS: This is a randomized, controlled, parallel-design clinical trial. A total of 60 patients with neurogenic bowel dysfunction (constipated type) will be randomly assigned to intervention group and control group. The control group will receive 4âweeks of usual rehabilitation care, the intervention group will receive 4âweeks of the therapy of "combination 3 methods progression" in addition to usual rehabilitation care. The primary outcome is the number of spontaneous bowel movement per week. Secondary outcomes are stool characteristics, degree of difficulty in defecation, level of anxiety, level of depression, and level of self-efficacy. DISCUSSION: The interventions of this protocol have been programmed to alleviate constipation in patients with neurogenic bowel dysfunction. Findings may provide preliminary evidence for clinical efficacy of the therapy of "combination 3 methods progression." TRIAL REGISTRATION: Chinese Clinical Trial Registry, IDF: ChiCTR2000041463. Registered on December 26, 2020.
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Estreñimiento/terapia , Medicina Tradicional China/métodos , Intestino Neurogénico/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad , Estudios de Casos y Controles , Estreñimiento/epidemiología , Estreñimiento/etiología , Estreñimiento/rehabilitación , Defecación/fisiología , Depresión , Humanos , Incidencia , Persona de Mediana Edad , Intestino Neurogénico/fisiopatología , Autoeficacia , Resultado del TratamientoRESUMEN
BACKGROUND: The neurogenic bowel dysfunction is a kind of familiar sequelae of the spinal cord injury (SCI), occurring in 70 to 80 percent of the SCI patients. The nursing intervention based on quantitative evaluation is to fully consider and assess the disease condition of patients, implement the personalized programs of nursing intervention, meet the patient's nursing needs to the maximum extent, improve the quality of nursing, and then facilitate the rehabilitation of patients. Our aim is to implement this program to evaluate the impact of this nursing intervention based on quantitative evaluation on the quality of life and bowel function in the neurogenic bowel dysfunction patients after SCI. METHODS: The experiment is a randomized clinical research which will be implemented from May 2021 to October 2021 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (No.100238765). Fifty neurogenic bowel dysfunction patients after SCI confirmed via the imaging are included in this study. The patients with the history of bowel diseases or patients who are unwilling to cooperate with the evaluation will be excluded. The primary outcomes are bowel function recovery and satisfaction of the patients. The secondary outcomes are quality of life evaluated by SF-36 questionnaire. The questionnaire involves physical pain, role physiology, physiological functions, social functions, vitality, general health, mental health and role-motional. RESULTS: Comparison of clinical parameters between the 2 groups will be shown in Table 1. CONCLUSION: Nursing intervention based on the quantitative evaluation can improve the quality of life and recovery of intestinal function for the neurogenic intestinal dysfunction patients after SCI. TRIAL REGISTRATION NUMBER: researchregistry6143.
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Intestino Neurogénico/enfermería , Intestino Neurogénico/terapia , Planificación de Atención al Paciente/organización & administración , Humanos , Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Planificación de Atención al Paciente/normas , Calidad de la Atención de Salud , Calidad de Vida , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitaciónRESUMEN
Neurogenic bowel has received surprisingly little attention. Among individuals with spinal cord injury, bowel function is considered a major physical and psychological problem that stems from the severe negative impact on social life and mobility. With transanal irrigation, individuals with neurogenic bowel have received an additional tool that may simplify life and improve independence. A recent survey showed that as many as 37% of the spinal cord injury patients interviewed had not heard about transanal irrigation. It should be a high priority at spinal cord injury centers to support patients with the right tools for proper bowel management and care.
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Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Intestino Neurogénico/terapia , Traumatismos de la Médula Espinal/complicaciones , Irrigación Terapéutica/métodos , Humanos , Irrigación Terapéutica/instrumentaciónRESUMEN
The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.
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Dieta Mediterránea , Terapia por Ejercicio/métodos , Intestino Neurogénico/dietoterapia , Traumatismos de la Médula Espinal/complicaciones , Adulto , Capacidad Cardiovascular/fisiología , Terapia Combinada/métodos , Fibras de la Dieta , Frutas , Humanos , Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Paratletas , Ingesta Diaria Recomendada , Conducta Sedentaria , Traumatismos de la Médula Espinal/fisiopatología , Verduras , Granos EnterosRESUMEN
Bowel dysfunction after chronic spinal cord injury (SCI) is a common source of morbidity and rehospitalization. Typical complications include constipation, fecal impaction, incontinence, abdominal distention, autonomic dysreflexia, and the necessity of interventions (i.e., suppositories, digital stimulation) to defecate. Numerous surveys have confirmed that the remediation of bowel complications is more highly valued for quality of life than improvements in walking. Much of what is known about bowel function after SCI for diagnosis and research in humans has been gained using anorectal manometry (ARM) procedures. However, ARM has been underutilized in pre-clinical animal work. Therefore, a novel combination of outcome measures was examined in the current study that incorporates functional output of the bowel (weekly fecal measurements), weight gain (pre-injury to terminal weight), and terminal ARM measurement with external anal sphincter electromyography under urethane anesthesia. The results indicate higher fecal output after contusion during the sub-acute period (4-7 days) post-injury, changes in the composition of the feces, and functionally obstructive responses in a specific section of the rectum (increased baseline pressure, increased frequency of contraction, and reduced ability to trigger a giant contraction to a distension stimulus). These results demonstrate significant bowel dysfunction in the rodent SCI contusion model that is consistent with data from human research. Thus, the combined measurement protocol enables the detection of changes and can be used, with minimal cost, to assess effectiveness of therapeutic interventions on bowel complications.
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Canal Anal/fisiología , Contusiones/fisiopatología , Manometría/métodos , Intestino Neurogénico/fisiopatología , Recto/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Animales , Contusiones/complicaciones , Masculino , Intestino Neurogénico/etiología , Ratas , Ratas Wistar , Traumatismos de la Médula Espinal/complicacionesRESUMEN
Neurogenic bowel following spinal cord injury (SCI) leads to decreased colonic motility, remodeling of the neuromuscular compartment and results in chronic evacuation difficulties. The distal colon of the rat serves a dual role for fluid absorption and storage that is homologous to the descending colon of humans. Dysmotility of the descending colon is one component of neurogenic bowel. We investigated the integrity of the enteric neuromuscular transmission responsible for the generation of excitatory and inhibitory junction potentials (EJPs and IJPs, respectively) in the distal colon of rats. We previously demonstrated a chronic reduction in colonic enteric neurons from rats with acute and chronic high-thoracic (T3) SCI and hypothesized that neurogenic bowel following T3-SCI results from diminished enteric neuromuscular transmission. Immunohistochemical labeling for myenteric neuronal nitric oxide synthase (nNOS) and choline acetyltransferase (ChAT) neurons demonstrated a significant loss of presumptive nitric oxide (NO) and acetylcholine (ACh) immunoreactive neurons in both 3-day and 3-week injured animals. Colonic neuromuscular transmission in response to transmural electrical stimulation of the colon was significantly reduced 3-days and 3-weeks following SCI in male rats. Specifically, cholinergic-mediated excitatory junction potentials (EJPs) and nitrergic-mediated slow inhibitory junction potentials (IJPs) were significantly reduced while ATP-mediated fast IJPs remained unaffected. We conclude that a reduction in excitatory and inhibitory enteric neuromuscular transmission contributes to neurogenic bowel observed following SCI, and that these loss-of-function changes involve enteric-mediated cholinergic and nitrergic pathways.
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Colon/inervación , Plexo Mientérico/fisiopatología , Intestino Neurogénico/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Transmisión Sináptica/fisiología , Animales , Intestino Neurogénico/etiología , Unión Neuromuscular/fisiopatología , Ratas , Traumatismos de la Médula Espinal/complicacionesRESUMEN
AIM: To compare the quality of life (QoL) in children with spina bifida with a control group of their peers using a validated questionnaire, the Neurogenic Bowel Dysfunction Score (NBDS). METHODS: The NBDS questionnaire was prospectively distributed to children attending a multi-disciplinary Spina Bifida clinic and healthy controls attending pediatric urology clinics. A score (out of 41) was assigned to each child based on their responses to the validated questionnaire. A lower score indicates better bowel function-related quality of life. SPSS software (v.25) was used for all statistical analysis. RESULTS: There were 98 respondents to the questionnaire, 48 children with spina bifida and 50 controls. The average age of respondents was 7.88 years (3-16 years). Of those with Spina Bifida, 33 (69%) were on retrograde rectal irrigations, [19 (58%) Peristeen® system, 11 (33%) tube rectal irrigations, and 3 (9%) Willis system], 6 (12%) were on laxatives, and 9 (19%) were on no treatment. The median NBDS for Spina Bifida patients was significantly higher 13.5 (2-32) compared to the control group 2 (0-26, p < 0.001). Amongst Spina Bifida patients, there was no difference in quality of life between the modalities of bowel management (p = 0.203). CONCLUSIONS: Despite active bowel management, children with spina bifida report a worse quality of life compared to the control group. In those with spina bifida, the lack of a difference between various bowel management strategies, including no treatment, indicates the need for a longitudinal study to evaluate the basis for this unexpected finding.
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Intestino Neurogénico/complicaciones , Intestino Neurogénico/diagnóstico , Calidad de Vida , Disrafia Espinal/complicaciones , Encuestas y Cuestionarios , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Intestino Neurogénico/fisiopatologíaRESUMEN
INTRODUCTION: Patients with neurogenic bowel dysfunction (NBD) suffer severe constipation and/or fecal incontinence that are very difficult to treat. Most medication-based and interventional treatments have been unsuccessful. The goal of this study was to assess the medium-term effectiveness of the Malone procedure in all patients with NBD, as an alternative to colostomy. PATIENTS AND METHODS: In this retrospective single-center study, 23 patients who underwent Malone's surgical treatment were analyzed. The main criteria were the usage of antegrade colonic enemas (ACE) after Malone's procedure at the most recent follow-up and comparison of quality of life scores before and after surgery. RESULTS: The post-procedure mortality was zero, but an overall morbidity of 60% was observed, including minor complications (Clavien 1, 2) in 56%. The median follow-up was 33 months. At the most recent follow-up, the utilization rate of the neo-appendicostomy for ACE was 69.6%; 76.9% of the patients using ACE reported improvement in quality of life scores. Secondary colostomy was performed in 21.7% for functional failure of the Malone procedure. CONCLUSION: The Malone procedure is a reliable technique that can be used in the therapeutic strategy for managing NBD patients with incontinence/constipation refractory to usual treatments. It should be considered as a therapeutic step to take before resorting to colostomy.
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Estreñimiento/cirugía , Enema/métodos , Incontinencia Fecal/cirugía , Intestino Neurogénico/cirugía , Estreñimiento/fisiopatología , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intestino Neurogénico/fisiopatología , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
OBJECTIVES: Nerve transfer has been developed to restore partial function after serious nerve injuries, for example, restoring bladder control after spinal cord injury (SCI). Our aim here was to establish a preclinical proof-of-concept model using nerve transfer for restoring anorectal function after SCI. SETTING: We used laminectomy to model SCI, and bilateral spinal ventral and dorsal nerve root anastomosis to re-establish connectivity to the anorectal musculature. METHODS: Multidisciplinary methods were used to assess the anatomical and functional integrity of the alternative spinal-to-anorectal nerve circuit. Adult rats were used to establish the model. Bilateral anterior and posterior L5 nerve roots were surgically matched with anterior and posterior of S1 nerve roots by microscopic anastomosis to establish an artificial rectal reflex arc with complete sensory and motor pathways. Twelve weeks later, we used retrograde nerve tracing and neurohistomorphological analysis to assess anatomical integrity of the new artificial rectal reflex arc. Anorectal manometry was used to assess the function of the new nerve circuit. RESULTS: Retrograde tracing with recombinant attenuated pseudo rabies virus indicated that the new neural pathway was successfully established to the anorectal musculature after experimental SCI. Toluidine blue-stained sections of the anastomosis site revealed normal-appearing nerve fiber morphology and regeneration, and transmission electron microscopy revealed myelinated axons. Anorectal manometry revealed significant anorectal functional recovery. CONCLUSION: These results suggest that our model is a feasible first step in developing an alternative reflex pathway after laminectomy at L4 to S2 and shows promise for effective restoration of anorectal function.
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Vías Eferentes , Transferencia de Nervios , Intestino Neurogénico/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Raíces Nerviosas Espinales/cirugía , Animales , Vías Eferentes/fisiopatología , Vías Eferentes/cirugía , Femenino , Ratas , Ratas Sprague-Dawley , Reflejo/fisiologíaRESUMEN
Objective: In order to encourage the inclusion of bladder and bowel outcome measures in preclinical spinal cord injury (SCI) research, this paper identifies and categorizes 1) fundamental, 2) recommended, 3) supplemental and 4) exploratory sets of outcome measures for pre-clinical assessment of bladder and bowel function with broad applicability to animal models of SCI.Methods: Drawing upon the collective research experience of autonomic physiologists and informed in consultation with clinical experts, a critical assessment of currently available bladder and bowel outcome measures (histological, biochemical, in vivo functional, ex vivo physiological and electrophysiological tests) was made to identify the strengths, deficiencies and ease of inclusion for future studies of experimental SCI.Results: Based upon pre-established criteria generated by the Neurogenic Bladder and Bowel Working Group that included history of use in experimental settings, citations in the literature by multiple independent groups, ease of general use, reproducibility and sensitivity to change, three fundamental measures each for bladder and bowel assessments were identified. Briefly defined, these assessments centered upon tissue morphology, voiding efficiency/volume and smooth muscle-mediated pressure studies. Additional assessment measures were categorized as recommended, supplemental or exploratory based upon the balance between technical requirements and potential mechanistic insights to be gained by the study.Conclusion: Several fundamental assessments share reasonable levels of technical and material investment, including some that could assess bladder and bowel function non-invasively and simultaneously. Such measures used more inclusively across SCI studies would advance progress in this high priority area. When complemented with a few additional investigator-selected study-relevant supplemental measures, they are highly recommended for research programs investigating the efficacy of therapeutic interventions in preclinical animal models of SCI that have a bladder and/or bowel focus.
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Modelos Animales , Intestino Neurogénico/fisiopatología , Evaluación de Resultado en la Atención de Salud , Investigación , Traumatismos de la Médula Espinal/fisiopatología , Vejiga Urinaria Neurogénica/fisiopatología , Animales , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Electromyographic studies have shown that external anal sphincter activity is modified in response to distension in animals with spinal cord injury. Gonadotropin-releasing hormone and its agonist leuprolide acetate have neurotrophic properties in animals with spinal cord injury. AIM: This study was to determine the effects of leuprolide acetate treatment on electromyographic activity of the external anal sphincter and anorectal manometry in ovariectomized rats with spinal cord injury. METHODS: Adult ovariectomized rats were divided in three groups: (a) sham of spinal cord injury, (b) spinal cord injury treated with saline solution, and (c) spinal cord injury treated with leuprolide acetate. The spinal cord injury was induced by clamping at level T9. Leuprolide acetate dosage of 10 µg/kg was proctored intramuscular for 5 weeks, commencing the day after the lesion. Electromyography of the external anal sphincter, anorectal manometry, and volume of the cecum were evaluated in all groups. RESULTS: The electromyographic study of the external anal sphincter activity showed a significant improvement in injured rats treated with leuprolide acetate. Manometric analysis and cecum volume data obtained in animals with leuprolide acetate were very similar to those found in the sham group. CONCLUSIONS: These results demonstrate that leuprolide acetate treatment improves the neurogenic colon in ovariectomized rats with spinal cord injury.
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Canal Anal/efectos de los fármacos , Hormona Liberadora de Gonadotropina/agonistas , Leuprolida/farmacología , Intestino Neurogénico/fisiopatología , Ovariectomía , Recto/efectos de los fármacos , Traumatismos de la Médula Espinal/fisiopatología , Canal Anal/fisiopatología , Animales , Ciego/efectos de los fármacos , Ciego/fisiopatología , Electromiografía , Femenino , Manometría , Intestino Neurogénico/etiología , Ratas , Ratas Wistar , Recto/fisiopatología , Traumatismos de la Médula Espinal/complicacionesRESUMEN
The symptoms of neurogenic bowel dysfunction (NBD) comprise constipation and fecal incontinence. These have a major impact on quality of life and dignity. Bowel symptoms occur in the majority of patients with chronic neurological diseases like multiple sclerosis, spinal cord injury, and Parkinson's disease. Management relies on obtaining a careful bowel history, including assessment of bowel function prior to the onset of neurological symptoms. Objective measures of NBD are available and important in terms of monitoring response for what are often intensely personal and difficult-to-elicit symptoms. Conservative management begins by establishing an effective and regular bowel regime by optimizing diet and laxative use. If this is insufficient, as seen in about half of patients, transanal irrigation has been shown to reduce NBD symptoms and improve quality of life. Failing that, there are more invasive surgical options available. This review aims to provide practical guidance for the clinician who encounters these patients, focusing on a stepwise approach to assessment, interventions, and monitoring.
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Estreñimiento/etiología , Incontinencia Fecal/etiología , Intestino Neurogénico/fisiopatología , Humanos , Esclerosis Múltiple/fisiopatología , Intestino Neurogénico/complicaciones , Enfermedad de Parkinson/fisiopatología , Calidad de Vida , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
This study demonstrates significantly improved bowel symptoms and satisfaction with Peristeen® use in pediatric patients with neurogenic bowel. The longer patients used Peristeen®, the greater the reduction in severity of their Neurogenic bowel and the greater the satisfaction with their bowel management.
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Defecación/fisiología , Intestino Neurogénico/terapia , Irrigación Terapéutica/métodos , Adolescente , Canal Anal , Niño , Preescolar , Estreñimiento/etiología , Estreñimiento/fisiopatología , Estreñimiento/terapia , Enema/métodos , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Intestino Neurogénico/complicaciones , Intestino Neurogénico/fisiopatología , Resultado del TratamientoRESUMEN
PURPOSE OF REVIEW: To evaluate and report current evidence regarding the management of bowel dysfunction in spinal cord injury. There is a paucity of high-quality large studies on which to base management advice. RECENT FINDINGS: Recent research has focused on defining the nature of symptomatology of bowel dysfunction in SCI and describing the effects on quality of life and social interactions. Technical aspects of colonoscopy have received attention, and aspects of understanding the pathophysiology in relation to both neural and non-neural dysfunction have been studied. There has been refinement and expansion of the pharmacological and non-pharmacological treatment options for bowel dysfunction in SCI. Management of bowel dysfunction in SCI requires a comprehensive and individualized approach, encompassing lifestyle, toileting routine, stimulation, diet, medications, and surgery. Further high-quality research is required to inform best practice.
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Enfermedades Gastrointestinales/fisiopatología , Intestino Neurogénico/terapia , Traumatismos de la Médula Espinal/epidemiología , Estreñimiento/etiología , Estreñimiento/fisiopatología , Estreñimiento/psicología , Estreñimiento/terapia , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/psicología , Incontinencia Fecal/terapia , Enfermedades Gastrointestinales/etiología , Humanos , Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Intestino Neurogénico/psicología , Calidad de Vida , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/psicologíaRESUMEN
BACKGROUND: Evidence-based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance. AIMS: To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009. MATERIALS AND METHODS: A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013. RESULTS: The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management. DISCUSSION: The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.
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Incontinencia Fecal/terapia , Intestino Neurogénico/terapia , Incontinencia Fecal/diagnóstico , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Humanos , Esclerosis Múltiple/complicaciones , Intestino Neurogénico/diagnóstico , Intestino Neurogénico/etiología , Intestino Neurogénico/fisiopatología , Enfermedad de Parkinson/complicaciones , Traumatismos de la Médula Espinal/complicacionesRESUMEN
INTRODUCTION: In the last few decades, sacral neurostimulation (SNS) has proven to be an effective treatment option for functional bowel disorders. Experience concerning the role of SNS in the treatment of chronic constipation due to neurogenic bowel dysfunction (NBD) however is limited. METHODS: In this report, we present the case of a 44-year old patient, with chronic refractory neurogenic constipation after a spontaneous cerebral hemorrhage, who was treated with SNS. RESULTS: Prior to treatment with SNS, the Constipation Scoring System showed a score of 22/30. Three months after SNS implantation, this score was reduced to 5/30. Patient had successful evacuation of stool every one to two days. Medication could be reduced to 15 drops of picosulphate per day. Patient experienced a significant improvement in quality of life. CONCLUSIONS: We believe that SNS could offer a safe, effective and relatively cost-effective treatment for patients with NBD refractory to conservative treatment.
Asunto(s)
Estreñimiento/terapia , Defecación/fisiología , Terapia por Estimulación Eléctrica/métodos , Intestino Neurogénico/complicaciones , Adulto , Estreñimiento/etiología , Estreñimiento/fisiopatología , Humanos , Plexo Lumbosacro , Intestino Neurogénico/fisiopatología , Calidad de VidaRESUMEN
Around 50% of people with multiple sclerosis (MS) experience neurogenic bowel dysfunction (constipation and/or faecal incontinence), reducing quality of life and increasing carer burden. No previous qualitative studies have explored the experiences of bowel problems in people with MS, or the views of their family carers. This study sought to understand 'what it is like' to live with bowel dysfunction and the impact this has on people with MS and carers. Using exploratory qualitative methods, 47 semi-structured interviews were conducted with participants recruited from specialist hospital clinics and community sources using purposive and chain-referral sampling. Data were analysed using a pragmatic inductive-deductive method. Participants identified multiple psychological, physical and social impacts of bowel dysfunction. Health care professional support ranged from empathy and appropriate onward referral, to lack of interest or not referring to appropriate services. Participants want bowel issues to be discussed more openly, with clinicians instigating a discussion early after MS diagnosis and repeating enquiries regularly. Bowel dysfunction impacts on the lives of people with MS and their carers; their experience with care services is often unsatisfactory. Understanding patient and carer preferences about the management of bowel dysfunction can inform clinical care and referral pathways.