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Bowel Dysfunction and Management

Stimulation of Reflexes in the Gastrointestinal Tract

Utilization of the preserved gastrointestinal reflexes can be beneficial in bowel management following SCI. The gastro-colic reflex is stimulated by gastric distention due to eating and can activate bowel motility and promote defecation (Sloots et al. 2003Ford et al. 1995). Digital stimulation of ano-rectal reflexes has been shown to result in increased rectal contractions and could be useful in bowel evacuation following SCI (Shafik et al. 2000).

Discussion

A single pre-post study demonstrates that digital rectal stimulation increases peristaltic waves in the left colon, thus increasing motility in this segment and aiding evacuation of stool in those with reflex bowel dysfunction (Korsten et al. 2007). Stimulation of ano-rectal reflexes in individuals with SCI above the conus can therefore be incorporated into bowel routines; pharmacological rectal stimulants can be used to trigger evacuation at a chosen time in combination with digital rectal stimulation. There is conflicting evidence regarding the strength of the gastrocolic reflex after SCI (Glick et al. 1984Aaronson et al. 1985Menardo et al. 1987) but this noninvasive intervention may be helpful in individuals with any level of injury and is worthy of evaluation when developing an individual program.

Conclusion

There is level 4 evidence (from one pre-post study; N=6) (Korsten et al. 2007) that digital rectal stimulation increases motility in the left colon.

Author Year;

Country

Score

Research Design

Total Sample Size

Methods Outcome
Korsten et al., 2007; USA

Pre-post

N=6

Population: Six male participants with SCI (4 with paraplegia [3 complete, 1 incomplete]; 2 with tetraplegia [1 complete, 1 incomplete); Age: mean 50.2yrs, range 44-50yrs; Level of injury: C5-T10; AIS A-C; Duration of injury: 10-29yrs.

Treatment: Digital rectal stimulation to facilitate bowel evacuation.

Outcome Measures: Colorectal monometry: mean number of peristaltic waves per minute; amplitude of contractions; colonic motility.

  1. Compared with no digital rectal stimulation (0 waves/min), the mean number of peristaltic waves/min increased during digital rectal stimulation (1.9±0.5/min) and immediately after digital rectal stimulation (1.5±0.3/min) (mean ± SEM).
  2. Average amplitude of the peristaltic contractions was 43.4±2.2 mmHg (range 0.7-250 mmHg).
  3. Peristaltic contractions in the left colon were accompanied by increased motility of the left colon and improvement in evacuation of barium as documented by fluoroscopy.
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