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Dietary Fibre

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It is well known that fibre, in appropriate quantities, is an important part of a healthy diet. There are different types of fibre, each benefiting the body in different ways. Soluble fibre mixes with water in the intestine to form a gel-like substance, which acts as a trap to collect certain body wastes and then move them out of the body. Insoluble fibre absorbs and holds water, producing uniform stool and helping to push gut contents through the digestive system quickly. Insoluble fibre in appropriate amounts and with additional fluid intake can promote bowel regularity and improve constipation.

The Consortium for Spinal Cord Medicine (1998) recommends an initial diet with no less than 15 grams of fibre daily, and the Multidisciplinary Association of Spinal Cord Injury Professionals (MASCIP) (2009) group recommends an average intake of 18 grams, however, they acknowledge that adjustments should be made if problems arise with stool consistency. It is currently not recommended to uniformly place individuals with SCI on high fibre diets due to individual differences and tolerances (Consortium for Spinal Cord Medicine 1998).

Table 4: Dietary Fibre for Managing Neurogenic Bowel after a Spinal Cord Injury

Discussion

While many individuals with SCI report that adjusting their diet improves bowel function (Coggrave et al. 2006b), there is scant evidence to support this. Cameron et al. (1996) looked at increasing dietary fibre and found that this does not have the same effect in individuals with SCI as has been previously demonstrated in individuals without neurogenic bowel dysfunction. The effect may actually be the opposite of the desired result. Therefore, adding more fibre alone does not improve bowel function; for individuals with low fibre intake and constipation, fibre in the diet may be increased gradually and the effect on bowel function carefully observed. More evidence is required to assess the effectiveness of adding fibre to the diet of individuals with SCI.

Conclusion

There is level 4 evidence (from one case series; N=11) (Cameron et al. 1996) that indicates high fibre diets may lengthen colonic transit time in individuals with SCI.

  • There is a need for further research to examine the optimal level of dietary fibre intake in patients with SCI.