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Rectal Stimulation

Michelle R finds that the multi-faceted bowel care program has improved Mr. RB’s constipation. However, Michelle R has noticed that various forms of rectal stimulation have been used successfully by other patients and recommends this to Mr. RB.
Q11. What are the various forms of rectal stimulation and what is the evidence for each?
1. Forms of rectal stimulation are digital rectal stimulation, electrical stimulation of abdominal muscles, functional magnetic stimulation, sacral anterior root stimulation, and posterior tibial nerve stimulation.
2. Digital rectal stimulation increases motility in the left colon in individuals with SCI (see figure 6).
3. Electrical stimulation of the abdominal wall muscles can improve bowel management for individuals with tetraplegia (see figure 7).
4. Functional magnetic stimulation may reduce colonic transit time in individuals with SCI.
5. Sacral anterior root stimulation reduces severe constipation in individuals with SCI (see figure 8).
6. Posterior tibial nerve stimulation is a relatively new treatment and while preliminary results show promise, the sample size is limited and more research is needed to warrant the use of this new modality.

Figure 6. Digital rectal stimulationFrom Memorial University of Newfoundland (2010)

Figure 7. Schematic showing electrode placement for anterior electrical stimulation

Figure 8. Sacral anterior root stimulation organization where electrical signals are sent to bladder and bowel nerves. The user controls the implant with the external control box (about the size of a personal CD player). Source: Duke of Cornwall Spinal Treatment Centre (2009).