Management Of Bowel Dysfunction Research Articles

Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury

BackgroundNeurogenic bowel dysfunction (NBD) is a common problem among people with spinal injury; management of bowel dysfunction and related problems are considered significant factors in daily life after injury. But despite the critical relevance of bowel dysfunction in the daily life of SCI survivors, there have been few published studies on the management of NBD. So, this study aimed to describe the bowel programmers utilized by people with SCI in China and the impact of bowel dysfunction on the quality of life (QoL).DesignA cross-sectional online survey.SettingRehabilitation Medicine Department of Wuhan’s Tongji Hospital.ParticipantsSCI patients who had been diagnosed with neurogenic bowel dysfunction and who were receiving regular medical monitoring at the rehabilitation medicine department were invited to participate in our study.Outcome measuresA neurogenic bowel dysfunction (NBD) score is a questionnaire developed to evaluate the severity of neurogenic bowel dysfunction. A Short Form-12 (SF-12) was designed to measure the quality of life in people with SCI. Demographic and medical status information was extracted from their medical records.ResultsThe two questionnaires were sent to 413 SCI patients. Two hundred ninety-four subjects (43.1 ± 14.5 years of age; men, 71.8%) responded. Most of the respondents performed their bowel movement daily 153 (52.0%), a defecation time was 31–60 min among 70 (23.8%) of them, 149 (50.7%) used medication (drops or liquid) to treat constipation, and 169 (57.5%) used digital stimulation more than once per week to boost the bowel evacuation. This study found a significant association between the QoL score and the time used for each defecation, autonomic dysreflexia (AD) symptoms, taking medication to treat fecal incontinence, using digital stimulation, having uncontrollable flatus and perianal skin problems.ConclusionManagement of bowel dysfunction is complex and associated with QoL in people with SCI. Items of the NBD questionnaire that greatly deteriorated the QoL were time in one defecation > 60 min, symptoms of AD during or before defecation, taking medication (drops or liquid), and using digital stimulation. Dealing with those problems can improve the life quality of spinal cord injury survivors.

Evolving Evidence Supporting Use of Rectal Irrigation in the Management of Bowel Dysfunction: An Integrative Literature Review.

Disorders of bowel function are prevalent, particularly among patients with spinal cord injuries and other neurological disorders. An individual's bowel control significantly impacts quality of life, as predictable bowel function is necessary to actively and independently participate in everyday activities. For many patients with bowel dysfunction, initial lifestyle adjustments and other conservative therapeutic interventions (eg, digital stimulation, oral laxatives, suppositories) are insufficient to reestablish regular bowel function. In addition to these options, rectal irrigation (RI) is a safe and effective method of standard bowel care that has been used for several decades in adults and children suffering from bowel dysfunction associated with neurogenic or functional bowel etiologies. Rectal irrigation is an appropriate option when conservative bowel treatments are inadequate. Unlike surgical options, RI can be initiated or discontinued at any time. This report summarizes the clinical, humanistic, and economic evidence supporting the use of RI in clinical practice, noting features (eg, practical considerations, patient education) that can improve patients' success with RI treatment.

Bowel Dysfunction in Spinal Cord Injury.

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 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.

"It's just horrible": a qualitative study of patients' and carers' experiences of bowel dysfunction in multiple sclerosis.

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.

Clinical Management of Bowel Dysfunction After Low Anterior Resection for Rectal Cancer

The American Cancer Society estimated that 39,610 new cases of rectal cancer were diagnosed in the United States in 2015. Surgery is the primary treatment for rectal cancer, with the majority of patients undergoing sphincter-preserving surgery with low anterior resection. Although low anterior resection can prevent patients from having a permanent colostomy, bowel dysfunction may occur in 60% to 90% of patients. Bowel dysfunction symptoms may include fecal and gas incontinence, urgency, frequent bowel movements, clustering of stools, and difficulty emptying. The symptoms collectively are referred to as low anterior resection syndrome (LARS) and adversely affect quality of life. There are no specific therapies for management of LARS. This comprehensive literature review evaluates evidence-based, clinical nonsurgical interventions for symptom management of LARS and will assist advanced practitioners in recognizing symptoms and implementing clinical interventions in the outpatient setting for management of LARS.

Outcomes in non-surgical management for bowel dysfunction.

This retrospective review considers clinical outcomes of patients following non-surgical management of bowel dysfunction (faecal incontinence and constipation), within a tertiary centre's pelvic floor unit. Between November 2010 and January 2013, 443 patients were entered into a database and the results of their treatment were recorded. To capture the treatment modalities that patients received they were grouped into three categories: defaecatory techniques and/or pelvic floor exercises; dietary advice and/or medication recommendations; rectal irrigation or the use of anal plugs. Patients received a median number of three sessions with a specialist nurse or physiotherapist. After completing a programme of therapy, 81% of patients had an improved St Mark's incontinence score and 75% of patients had an improved Thompson's functional constipation score. Subjective symptom improvement was reported in 78% of patients. The majority of these patients were discharged in 2011 and 2012 and have not required follow-up, suggesting that non-surgical management is effective on a medium-term basis.

Finding Key Words in a Question Stem

Finding Key Words in a Question Stem

Uncovering anorexia nervosa in a biofeedback clinic for bowel dysfunction

Biofeedback is a conservative treatment based on behavioural techniques, which can be used in the management of bowel dysfunction. This article reports the results of a retrospective review of the clinical notes of 87 female patients attending a biofeedback service at St Mark's Hospital, Harrow. The initial review was conducted to examine the incidence of polycystic ovary syndrome (PCOS) in patients attending this service. Seven percent were found to have PCOS, which is within the normal range. However, a signifcant proportion of patients (11.5%) had a current history of anorexia nervosa, a higher rate than in the general population, which prompted further investigation. In this article, Sonya Chelvanayagam, Julie Duncan, Brigitte Collins and Lorraine O'Brien report on the results of this review and discuss the signifcance of its fndings.

Intérêt des irrigations transanales dans la gestion des troubles intestinaux et ano-rectaux chez les blessés médullaires

Bowel dysfunction and disordered defecation are very common after spinal cord injury (SCI) and can have a major impact on patients' social life and quality of life. The aim of this study was to assess the safety and efficacy of transanal irrigations (TAI) in the management of Bowel dysfunction in SCI patients. Forty-five consecutive SCI patients using TAI were retrospectively included. TAI efficacy was assessed through Neurogenic Bowel Dysfunction (NBD) score recorded before and after 8 weeks of regular use. Possible side effects were assessed with a semi-structured questionnaire. Patients who started TAI use at least 6 months previously were contacted to assess long-term compliance, efficacy and safety of TAI. After 8 weeks of regular use of TAI, the average NBD scores decreased by four points (P<0.0001) with a specific improvement in the items related to stool frequency (P: 0.036), occurrence of malaise, headache, or sweating during defecation (P: 0.043), use of drugs against constipation (P: 0.007) and frequency of fecal incontinence (P: 0.001). The main side effects were bleeding (10%) and abdominal pain (8%). At 6 months, 80% of the assessed patients had continued regular use of TAI with no particular problem. This study showed good medium and long-term efficacy and safety of TAI in the management of bowel dysfunction and defecation disorders in spinal cord-injured patients.

Management of bowel dysfunction in the community after spinal cord injury: a postal survey in the Republic of Korea

A cross-sectional postal survey. To describe defecation stimulation methods and their outcomes, and to investigate the impact of bowel dysfunction on the quality of life (QoL) in community-dwelling persons with spinal cord injury in South Korea. Community-based, Korea. A cross-sectional postal survey was conducted. Questionnaires were sent to 459 chronic spinal cord injury (SCI) patients who were registered as members of the Korean Spinal Cord Injury Association. Defecation stimulation methods and their outcomes, the impact of bowel dysfunction on the QoL were investigated. A total of 388 subjects (44.5±10.8 year of age; men, 76.0%; duration of time since the onset of SCI, 14.2±9.5 years) responded. Bowel-related general, social and home QoL deterioration was found in >60%. Suppositories (Supp) were most frequently used, followed by digital rectal stimulation (DRS). The mini enema (ME), which is exclusively used in Korea, was utilized in 18.8%. A defecation time of 30 min was more frequently reported in patients who stimulated defecation with Supp than in those who used DRS. The use of MEs and warm-water irrigations were newly identified in Korea. Bowel care-related factors that greatly deteriorate the QoL were fecal incontinence, time in one defecation >60 min, perianal skin problem, flatus incontinence and hemorrhoids. Alleviating these factors might help to improve the QoL. In particular, stimulation methods to reduce time for defecation might be recommended to persons with chronic SCI.

Transanal irrigations in the management of bowel dysfunction and disordered defecation after spinal cord injury

Transanal irrigations in the management of bowel dysfunction and disordered defecation after spinal cord injury

Percutaneous endoscopic sigmoid colostomy for irrigation in the management of bowel dysfunction of adults with central neurologic disease

Bowel dysfunction results in a major lifestyle disruption for many patients with severe central neurologic disease. Percutaneous endoscopic sigmoid colostomy for irrigation (PESCI) allows antegrade irrigation of the distal large bowel for the management of both incontinence and constipation. This study prospectively assessed the safety and efficacy of PESCI. A PESCI tube was placed endoscopically in the sigmoid colon of 25 patients to allow antegrade irrigation. Control of constipation and fecal incontinence was improved for 21 (84%) of the 25 patients. These patients were followed up for 6-83 months (mean, 43 months), with long-term success for 19 (90%) of the patients. No PESCI had to be removed for technical reasons or for PESCI complications. Late removal of the PESCI was necessary for 2 of the 21 patients. A modified St. Marks Fecal Incontinence Score to assess bowel function before and after PESCI showed a highly significant improvement (P < 0.0001). There were no procedure-related deaths. Complications included minor sepsis at the initial PESCI tube site in four patients and bumper migration in two patients, but there were no complications related to the button device. This study showed that PESCI is a simple, safe, and effective technique for distal antegrade irrigation in the management bowel dysfunction for selected patients with central neurologic disease. A successful PESCI is very likely to continue functioning satisfactorily for a long time without technical problems or local complications.

Management of Bowel Dysfunction in Neurological Rehabilitation - A Review

Management of Bowel Dysfunction in Neurological Rehabilitation - A Review

Management of bowel dysfunction in people with multiple sclerosis

Bowel dysfunction is a common problem for people with MS. It impacts upon both physical disability and psychosocial wellbeing. This article reviews the limited evidence underpinning best practice. The evidence highlights the importance of a thorough bowel assessment and adequate fluid and fibre intake together with the benefits of pelvic floor exercises. Biofeedback therapy, aerobic exercise and anal plugs are helpful for some people with MS. The use of pharmacological interventions needs to be considered with care.

Fecal incontinence 1,2

Fecal incontinence 1,2

Pathophysiology and management of bowel dysfunction in multiple sclerosis.

The prevalence of bowel dysfunction in multiple sclerosis (MS) patients is higher than in the general population. Up to 70% of patients complain of constipation or faecal incontinence, which may also coexist. This overlap can relate to neurological disease affecting both the bowel and the pelvic floor muscles, or to treatments given. Bowel dysfunction is a source of considerable ongoing psychosocial disability in many patients with MS. Symptoms related to the bladder and the bowel are rated by patients as the third most important, limiting their ability to work, after spasticity and incoordination. Bowel management in patients with MS is currently empirical. Although general recommendations include maintaining a high fibre diet, high fluid intake, regular bowel routine, and the use of enemas or laxatives, the evidence to support the efficacy of these recommendations is scant. This review will examine the current state of knowledge regarding the pathophysiological mechanisms underlying bowel dysfunction in MS, outline the importance of proper clinical assessment of constipation and faecal incontinence during the diagnostic work-up, and propose various management possibilities. In the absence of clinical trial data on bowel management in MS, these should be considered as a consensus on clinical practice from a team specialized in bowel dysfunction.

ANORECTAL MANOMETRY IN PAEDIATRIC PATIENT WITH BOWEL DYSFUNCTION

Introduction: Bowel dysfunction in children presented as abdominal distension, colic, constipation or soiling is common. Besides conventional history and physical examination plus abdominal radiograph, suction rectal biopsy is usually required to rule out Hirschsprung’s disease. We adopted the manometric measurement in the assessment of the children with bowel dysfunction and see whether it helps to manage the problem.Method: Patients were placed in a calm environment and a microtransducer probe was used to measure the anal pressure. Rectoanal inhibitory reflex was measured with a balloonless method using room air injection as trigger. A conventional anal sphincter pressure profile was measured in several different directions in selected cases.Results: We have performed 74 measurements from 1996 till now. The procedure was well tolerated by most of the children. Positive rectoanal inhibitory reflex excluded the presence of Hirschsprung’s disease and spared the patients from invasive suction rectal biopsy. Anal dyskinesia was diagnosed with a negative rectoanal reflex plus presence of ganglion in suction rectal biopsy, and bowel management programs could be applied. The anal pressure profile generated important information as a functional assessment of the sphincter integrity especially for those patients received anorectal surgery.Conclusion: Anorectal manometry is a very useful and noninvasive adjunct in the management of bowel dysfunction in children.

Management of bowel dysfunction: evacuation difficulties.

Bowel dysfunction affects many people and encompasses a variety of problems. This article examines the different forms of bowel dysfunction and considers the nurse's role in caring for patients with this disorder, including manual evacuation.

Management of bowel dysfunction in children with spinal cord disease or injury by means of the enema continence catheter

Because bowel dysfunction in children with spinal cord impairment is a common and disabling problem that does not have adequate treatment, we evaluated the enema continence catheter developed in Toronto, Canada. Thirty-one children and their families were taught to administer a 20 ml/kg saline enema through this device. The children's bowel functions were evaluated 18 and 20 months after the start of the program. Six of the children dropped out of the study in the first 2 weeks and nine dropped out after between 18 and 30 months. For those remaining in the study, the proportion of continent stools rose from 28% to 94% (p less than 0.01); constipated stools dropped from 55% to 15% (p less than 0.01). Satisfaction with the bowel program increased, and five children were able to switch from diapers to lined underwear. No adverse effects were reported, and the amount of time required for toileting did not increase. Although compliance with the regimen was difficult for some families and its use carries potential risks, we believe that it can provide significant improvement in the bowel care of selected persons with spinal cord impairment.