Clinical evaluation and management of neurogenic bowel after spinal cord injury Prucalopride Is Effective in Patients with Severe Chronic Constipation in Whom Laxatives Fail to Provide Adequate Relief High prevalence of incontinence among young adults with spina bifida: description, prediction and problem perception Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients Constipation and other chronic gastrointestinal problems in spinal cord injury patients Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis The influence of ispaghula husk on bowel habit Microchip implants on the anterior sacral roots in patients with spinal trauma: Does it improve bowel function?
Objectives : To assess the state of the neurological bowel in spinal cord injured ( SCI ) patients , design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome . Setting : Out-patient in a Rehabilitation Service . Subjects : Thirty-eight SCI patients , 12 ( 32 % ) with complete lesions of more than 5 years duration . Design : Observational , longitudinal and prospect i ve . Pre and post intervention . Method : Pre and post SCI intestinal function was evaluated clinical ly prior to beginning program . The presence of GI symptoms were studied . Laboratory work-up included colonic transit time ( CTT ) ,  anorectal manometry  and  recto-colonoscopy .  An intestinal program was design ed , in order to achieve an effective and efficient evacuation in a predictable and socially acceptable time , to avoid short and long term complications and eliminate inadequate intestinal evacuation habits . Outcome measures : Pre and post SCI difficulty in intestinal evacuation ( DIE ) was increased ( from 2.6 % to 26.3 % ) . The most frequent GI symptom was abdominal distention ( 53 % ) . Colonic inertia was present in 49 % of CTT , internal anal sphincter pressure was normal or increased in 77 % and rectoanal inhibitory reflex was present in 88 % . With the intestinal program , the incidence of DIE was reduced to 8.8 % , manual extraction ( ME ) was reduced from 53 % to 37 % . Excellent and good results were obtained in 56 % of the patients . Conclusion : The proposed intestinal program is effective in the rehabilitation of SCI patients with neurogenic bowel . It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury ; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future Spinal Cord ( 2000 ) 38 , 301–308 Background : Chronic constipation ( CC ) is common and there is a need for more effective and better-tolerated agents that normalize bowel function without affecting secretion . Prucalopride is a novel , selective serotonin4 receptor agonist with enterokinetic properties . Aims : Pilot study to compare the efficacy and tolerability of prucalopride and placebo in patients with severe CC referred to a tertiary centre . Methods : After 4-weeks ’ run in , patients were r and omized to 4 weeks ’ once daily , double-blind treatment with either prucalopride 4 mg ( n = 27 ) or placebo  ( n = 26 ) . A 50 % dose reduction after 2 weeks ’ treatment was possible for patients with an excessive gastrointestinal response to the study medication ( severe cramps , abdominal pain , and diarrhea ) . Patients assessed efficacy using a visual analogue scale ( VAS ) and recorded bowel function in daily diaries . The investigator assessed efficacy and total gut transit time ( marker study ) . Results : Patient VAS assessment demonstrated that prucalopride was significantly more effective than placebo in softening stools , and decreasing straining and time to first stool . Prucalopride also had a positive effect on stool frequency , feeling of complete evacuation and total gut transit time , although these differences were not statistically significant compared with placebo . The most common adverse events were gastrointestinal symptoms and headache ; most were mild to moderate . There were no clinical ly relevant effects on cardiovascular or laboratory parameters . Conclusions : Once-daily prucalopride 4 mg for 4 weeks is effective and well tolerated in patients with severe CC . It improves whole gut transit , reducing straining , softening stools and reducing time to first bowel movement Study design : Cross-sectional study . Objectives : To study the prevalence of incontinence , problem perception and determinants of urinary and faecal incontinence  in young adults with spina bifida . Setting : Nation-wide study in the Netherl and s. Participants : A total of 179 of 350 invited patients participated , including 37 patients with spina bifida occulta and 142 with spina bifida aperta , of whom 119 had hydrocephalus ; 41 % were male and mean age was 20.4 ( range 16–25 years ) . Methods : Data were collected from interviews , physical examination , neuropsychological tests and medical records . Results : Urinary and faecal incontinence was common in young adults with spina bifida ( 60.9 and 34.1 % , respectively ) , regardless of the bladder and bowel management they used . The majority of urinary and faecal incontinent patients perceived this as a problem ( 69.7 and 77.0 % , respectively ) . Spina bifida aperta , hydrocephalus and a level of lesion of L5 or above were associated with patients suffering from urinary and /or faecal incontinence . Predictors of perceiving urinary incontinence as a problem were , in addition to being incontinent , not having hydrocephalus and having a level of lesion of L5 or above . The only predictor of perceiving faecal incontinence as a problem was the frequency of incontinence . Conclusion : A majority of young adults with spina bifida suffer from urinary and faecal incontinence and most of them perceive their incontinence as a problem . Therefore , further efforts are important to improve urinary and faecal continence Study design : Cost-effectiveness analysis following international guidelines and taking the societal viewpoint . Objectives : To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management . Setting : A r and omized clinical trial was conducted at five spinal centres situated in Denmark , Germany , Italy , United Kingdom and Sweden . Estimates of re sources and unit costs were made for the German health care system . Methods : Efficacy outcomes were drawn from a r and omized controlled trial conducted in 2003–2005 . Adult spinal cord-injured patients with neurogenic bowel dysfunction were r and omized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management .  Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany . Unit costs were obtained from the Federal Statistical Office Germany and product list prices . Results : When comparing outcome measures at termination , transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction . Product-related costs were higher for transanal irrigation using the self-administered system ; however , costs for a carer to help with bowel management and changes/washing due to leakage were lower . For transanal irrigation , costs associated with urinary tract infections and patient time spent were reduced . Thus , the total cost to society is lower when patients use transanal irrigation . The results were shown to be robust in the sensitivity analysis . Conclusion : Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management . Sponsorship : The study was supported by Coloplast From a question naire sent to 90 spinal cord injury ( SCI ) patients it is concluded that 58 % of patients with a complete SCI above L2 suffer from constipation , defined as two or fewer bowel movements per week , or the use of aids such as laxatives , manual evacuation or enemas . Tetraplegic patients had the highest prevalence of constipation , while patients with low paraplegia were less prone to constipation . The use of anticholinergic drugs was found to predispose to constipation . Preserved rectal sensation did not influence the presence of constipation . Faecal incontinence was rare . Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62 % of these OBJECTIVES To determine whether gut focused behavioural treatment ( biofeedback ) is a useful therapy in multiple sclerosis patients referred for constipation , incontinence , or a combination of these symptoms . Most patients with multiple sclerosis complain of constipation , faecal incontinence , or a combination of the two . Patients rate these bowel symptoms as having a major impact on their life . Until now the management of these problems has been empirical , with a lack of evaluated therapeutic regimes . METHODS Thirteen patients ( eight women , median age 38 years , median duration of multiple sclerosis 10 years ) complaining of constipation , with or without faecal incontinence underwent a median of four sessions of behavioural treatment .  Anorectal physiological tests were performed before therapy . Impairment and disability were rated with the Kurtzke score and the Cambridge multiple sclerosis basic score ( CAMBS ) . Patients were contacted a median of 14 months after completion of treatment . RESULTS A beneficial effect was attributed to biofeedback in five patients . Mild to moderate disability , quiescent and non-relapsing disease , and absence of progression of multiple sclerosis over the year before biofeedback were predictive of symptom improvement . No physiological test predicted the response to therapy . CONCLUSION Biofeedback retraining is an effective treatment in some patients with multiple sclerosis complaining of constipation or faecal incontinence . A response is more likely in patients with limited disability and a non-progressive disease course Frequency of defaecation , faecal form , straining at the start and end of defaecation , feelings of incomplete evacuation of faeces and urgency of defaecation were recorded in 69 healthy volunteers during three distinct 28-day study phases : pre-treatment , treatment with ispaghula husk and post-treatment . During treatment there was a significant increase ( P<0.001 ) in stool frequency and significant decreases in straining at the start ( P<0.001 ) and end ( P<0.001 ) of defaecation and in feelings of incomplete evacuation ( P<0.001 ) . There was evidence of a beneficial residual effect after treatment had stopped . There are indications that ispaghula husk ( Fybogel ® Orange ) is of benefit in relieving  constipation symptoms in apparently healthy people PURPOSE : This study evaluated the effect of anterior sacral roots stimulator implants on bowel function of patients with spinal cord trauma . METHOD : Eight patients with spinal cord injury and constipation had anterior sacral roots stimulator implants inserted for concomitant bladder dysfunction . Question naires on bowel function and anorectal manometry tests were given before and after insertion of the implants . RESULTS : Six patients achieved improvement in bowel function . Four of these patients could defecate spontaneously following stimulation . Two patients had no improvement in bowel function . Anorectal manometry studies showed a negative rectoanal pressure difference at the time of stimulation . All patients were unable to defecate during stimulation . Positive rectoanal pressure difference was recorded in the six patients who had improved bowel function . This may be attributable to the slower relaxation of the smooth rectal muscle compared with the easily fatigable striated external anal sphincter . CONCLUSION : Anterior sacral roots stimulator implants can improve bowel function in patients with spinal cord trauma
BACKGROUND People with central neurological disease or injury have a much higher risk of both faecal incontinence and constipation than the general population .
There is often a fine line between the two symptoms , with any management intended to ameliorate one risking precipitating the other .
Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people .
Current bowel management is largely empirical , with a limited research base .
This is an up date of a Cochrane review first published in 2001 and subsequently up date d in 2003 and 2006 .
The review is relevant to individuals with any disease directly and chronically affecting the central nervous system ( post-traumatic , degenerative , ischaemic or neoplastic ) , such as multiple sclerosis , spinal cord injury , cerebrovascular disease , Parkinson 's disease and Alzheimer 's disease .
OBJECTIVES To determine the effects of management strategies for faecal incontinence and constipation in people with a neurological disease or injury affecting the central nervous system .
AUTHORS ' CONCLUSIONS There is still remarkably little research on this common and , to patients , very significant issue of bowel management .