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Key Points

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  • There is limited and conflicting evidence in support of multifaceted bowel management programs for managing neurogenic bowel dysfunction.
  • There is a need for further research to examine the optimal level of dietary fibre intake in patients with SCI.
  • Digital rectal stimulation increases motility in the left colon in individuals with reflex neurogenic bowel dysfunction after SCI.
  • Digital evacuation of stool is a very common intervention for bowel management after SCI, reducing duration of bowel management and fecal incontinence.
  • There is contrasting evidence on the effectiveness of abdominal massage in treating neurogenic bowel dysfunction. Further research is needed.
  • Electrical stimulation of the abdominal wall muscles can improve bowel management for individuals with tetraplegia.
  • Functional magnetic stimulation may reduce colonic transit time in individuals with SCI.
  • Sacral anterior root stimulation reduces severe constipation in individuals with SCI.
  • Transanal irrigation can improve all bowel management outcomes in individuals with chronic neurogenic bowel dysfunction following SCI.
  • The Malone Antegrade Continence Enema is a safe and effective treatment for significant GI problems in persons with SCI when conservative and transanal irrigation are unsuccessful or inappropriate.
  • Pulsed water transanal irrigation may help to remove stool in individuals with SCI.
  • In very small studies prucalopride, metoclopramide, neostigmine, and fampridine have been found to improve constipation in individuals with SCI.
  • Prucalopride is not currently available the United States but is available in Canada and Europe. More research is required on prokinetic agents prior to their regular use in neurogenic bowel dysfunction.
  • Polyethylene glycol-based bisacodyl suppositories (10 mg.) are more effective in stimulating reflex evacuation as part of abowel management program in persons with an upper motor neuron SCI than bisacodyl in vegetable oil suppositories.
  • Elective stoma formation is a safe and effective treatment for significant neurogenic bowel management problems and perianal pressure ulcers in persons with SCI, and greatly improves their quality of life.