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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Injuries at thoracic level usually cause paraplegia; breathing is not as badly affected, and patients usually retain the use of their arms and hands. Spinal cord injury, though, can result in neurogenic bowel dysfunction. Patients may depend on routine interventional bowel care, including the digital (manual) removal of faeces (DRF). Lesions above T6 predispose patients to autonomic dysreflexia – an excessive autonomic response to a stimulus below the level of the SCI, for example, a blocked catheter or constipation. A patient safety alert (NHS Improvement 2018) was issued following the identification of 61 reports of significant delays in providing DRF, which resulted in 3 cases of autonomic dysreflexia. The extreme rise in blood pressure could lead to some types of stroke or even death (Nazarko 2018) and is a medical emergency which requires prompt treatment to prevent complications.
Impairment of swallowing, liver, and defecation functions
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Defecation refers to expulsion of waste and undigested food as fecal matter (8). Inability to control bowel movement results in incontinence. Inability to initiate bowel movement results in constipation. In neurogenic bowel dysfunction, there is also loss of sensation of bowel fullness and loss of sensation of bowel movement. Neurological cause, frequency of bowel movement, response to fiber supplements and suppositories, need for prokinetic agents, and mandate for colostomy are essential variables to define impairment class in constipation. Integrated Evaluation of Disability assigns an impairment of 37% for incontinence, that is, inability to control bowel movement associated with lack of sensation of bowel fullness and movement. Table 12.3 describes various impairments of defecation function.
Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
Neurogenic bowel dysfunction is common in patients who have sustained a spinal cord injury or have spinal cord lesions, affecting around 40% of patients. Patients with complete lower motor neuron lesions often spend more time on bowel care, clearing the rectum digitally to prevent un-sensed, uncontrolled evacuations. Many patients have reduced mobility following SCI, and this exacerbates the misery caused by lack of bowel control. Nearly one-half of patients report bowel dysfunction to moderately or severely affect their quality of life, with around one-third of patients ranking gastrointestinal symptoms to be worse than bladder and sexual dysfunction. The costs associated with bowel care nursing are considerable.
Chronic refractory constipation due to neurogenic bowel dysfunction can be successfully treated by sacral neurostimulation
Published in Acta Chirurgica Belgica, 2018
Frederiek Nuytens, Mathieu D’Hondt
In this case report, symptoms of constipation begun immediately after the cerebral hemorrhage and had worsened ever since. In light of this causality and because other causes of constipation had been excluded in the diagnostic work up, the constipation can be classified as neurogenic bowel dysfunction (NBD). This is defined as the loss of normal bowel function due to nerve injury, neurological disease or congenital defect to the nervous system. Symptoms vary from constipation and faecal incontinence to bloating and abdominal discomfort [8]. The most frequent causes for NBD are multiple sclerosis and spinal injury. When the latter is the cause of NBD, in up to 95% of the cases some form of constipation is present. There are a number of treatment options for chronic constipation in NBD patients including laxatives, suppositories, digital stimulation, abdominal massage, rectal irrigation, SNS and finally faecal diversion by means of a permanent stoma [9]. Due to the great heterogeneity in etiology and pathophysiology in this population of patients, large comparative studies concerning optimal treatment strategies, including the role of SNS are scarce [8,9]. This might explain why SNS for chronic constipation in NBD patients is not approved nor reimbursed by regulatory authorities in most European countries. A prospective trial by Khan et al. [9] in 18 patients with NBD showed promising results with a significant reduction in Global Assessment of Symptoms (GA) as well as improved Patient Assessment of Constipation-Symptoms (PAC-SYM) scores and Patient Assessment of Constipation-Quality Of Life (PAC-QoL) scores. This study also confirmed good response to PNE as a predictive factor for good functional response after SNS.
Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Sevda Demir Ture, Guven Ozkaya, Koncuy Sivrioglu
Neurogenic bowel dysfunction (NBD), defined as colonic dysfunction resulting from loss of neurological control,1 is among the most common secondary health problems in individuals with spinal cord injury (SCI).2,3 NBD causes complications such as constipation, fecal incontinence, abdominal pain, bloating, hemorrhoids, difficulty during bowel evacuation, and autonomic hyperreflexia.4–6 Moreover, 11% of re-hospitalizations of people with SCI result from gastrointestinal complications.7 A systematic review found that bowel and bladder functions are rated among the highest functional priorities for individuals with SCI.8
Outcome and negative events in thoracic disc herniation surgery: a Danish registry study
Published in British Journal of Neurosurgery, 2021
Thea Overgaard Wichmann, Mindaugas Bazys, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Peter Duel, Kestutis Valancius, Niels Katballe, Mikkel Mylius Rasmussen
Among eight patients who presented with neurogenic bowel dysfunction at baseline, two experienced improvement in bowel function, while one experienced deterioration at short-term follow-up. At long-term follow-up, two presented with normal or improved bowel function.