Bladder and Bowel Dysfunction in Patients with Spinal Cord Injury – Nursing Intervention
Abstract
Spinal cord injury (SCI) has severe consequences on patients’ mobility and body organ function. In particular, its effects on bladder and bowel have been thoroughly studied since, in addition to their adverse effect on patients’ quality of life, they are also associated with increased mortality.
The aim of this study is to review therapeutic interventions for the management of bladder and bowel disorders in SCI patients, focusing on the nursing role, as a member of the rehabilitation team in the acute and chronic phase of injury. This is a narrative literature review using the Pubmed internet database. Papers were searched with the use of the following keywords: (“neurogenic bladder” OR “neurogenic bowel”) AND “spinal cord injury”. Among the 214 publications evaluated, 124 were rejected, leaving 90 studies for the present review.
Treatment modalities in SCI patients with neurogenic bladder include clean intermittent catheterization, indwelling catheters, bladder function training and assisted bladder emptying. Neurogenic bowel may be treated with adequate and appropriate intake of food and fluids, use of dietary supplements and oral medications, selection of appropriate methods to aid defecation and emptying and colostomy surgery. The role of nursing care is of vital importance as it can prevent further injury and contribute to improvement of patients’ quality of life.
Downloads
References
Barboglio Romo PG, Gupta P. Peripheral and Sacral Neuromodulation in the Treatment of Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am. 2017;44(3):453-61.
Hamid R, Averbeck MA, Chiang H et al. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J Urol. 2018;36(10):1517-27.
Moghalu O, Stoffel JT, Elliott S et al. Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury. Spinal Cord. 2021;59(9):987-96.
Pires JM, Ferreira AM, Rocha F et al. Assessment of neurogenic bowel dysfunction impact after spinal cord injury using the International Classification of Functioning, Disability and Health. Eur J Phys Rehabil Med. 2018;54(6):873-79.
Borsh S, Sikka S, Callender L et al. Implementation of a Neurogenic Bowel Program for Spinal Cord Injury in the Acute Care Setting: Perceptions of Patients and Staff. Occup Ther Health Care. 2019;33(3):306-22.
Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2020;26(2):108-15.
Kreydin E, Welk B, Chung D et al. Surveillance and management of urologic complications after spinal cord injury. World J Urol. 2018;36(10):1545-53.
Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol. 2018;50(6):1005-16.
Wheeler TL, de Groat W, Eisner K et al. Translating promising strategies for bowel and bladder management in spinal cord injury. Exp Neurol. 2018;306:169-76.
Akkoç Y, Ersöz M, Çınar E et al.. Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey. Turk J Phys Med Rehabil. 2021;67(2):225-32.
Lu J, Cheng B, Lin L et al. Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury. Ann Palliat Med. 2021;10(3):3171-78.
Denys P, Chartier-Kastler E, Even A et al. How to treat neurogenic bladder and sexual dysfunction after spinal cord lesion. Rev Neurol (Paris). 2021;177(5):589-93.
Qi Z, Middleton JW, Malcolm A. Bowel Dysfunction in Spinal Cord Injury. Curr Gastroenterol Rep. 2018;29;20(10):47.
Fang H, Lin J, Liang L et al.. A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder. Int J Nurs Pract. 2020;26(2):e12761.
Romo PGB, Smith CP, Cox A et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol. 2018;36(10):1555-68.
Zamli AH, Mustafah NM, Sa’at N, Shaharom S. Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury. Med J Malaysia. 2020;75(6):642-648.
Andretta E, Landi LM, Cianfrocca M et al.. Bladder management during pregnancy in women with spinal-cord injury: an observational, multicenter study. Int Urogynecol J. 2019;30(2):293-300.
AlSaleh AJ, Qureshi AZ, Abdin ZS et al. Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective. J Spinal Cord Med. 2020;43(3):374-79.
Oh SW, Jung JH, Cho IK et al. Changes in the Trend in Bladder Emptying Methods in Patients With Spinal Cord Injury: A 20-Year Single-Center Retrospective Study. Ann Rehabil Med. 2020;44(3):228-37.
Joshi AD, Shukla A, Chawathe V et al. Clean intermittent catheterization in long-term management of neurogenic bladder in spinal cord injury: Patient perspective and experiences. Int J Urol. 2022 Jan 12.
Lapides J, Diokno AC, Silber SJ et al. Intermittent Self-Catheterization in the Treatment of Urinary Tract Disease. J Urol. 2017;197(2S):S122-S124.
Gomelsky A, Lemack GE, Castano Botero JC et al. Current and future international patterns of care of neurogenic bladder after spinal cord injury. World J Urol. 2018;36(10):1613-19.
Jeong SJ, Oh SJ. Recent Updates in Urinary Catheter Products for the Neurogenic Bladder Patients with Spinal Cord Injury. Korean J Neurotrauma. 2019;15(2):77-87.
Del Popolo G, Antonucci L. Disability and sustainability: reusable versus single-use catheters for persons with neurogenic bladder due to spinal cord injury. Spinal Cord Ser Cases. 2020;6(1):90.
New PW. The evidence supporting single-use intermittent catheters in people with spinal cord injury. Spinal Cord Ser Cases. 2020;6(1):89.
Welk B, Isaranuwatchai W, Krassioukov A, Husted Torp L, Elterman D. Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective. J Med Econ. 2018;21(7):639-48.
Lane GI, Driscoll A, Tawfik K et al.. A cross-sectional study of the catheter management of neurogenic bladder after traumatic spinal cord injury. Neurourol Urodyn. 2018;37(1):360-67.
Neyaz O, Srikumar V, Equebal A et al. Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization. J Spinal Cord Med. 2020;43(3):347-52.
Roth JD, Pariser JJ, Stoffel JT et al. Patient subjective assessment of urinary tract infection frequency and severity is associated with bladder management method in spinal cord injury. Spinal Cord. 2019;57(8):700-07.
Morin JP, King AB, Goetz LL et al. Racial disparities in bladder management in veterans with spinal cord injury and disorders. Neurourol Urodyn. 2019;38(3):968-74.
Miller CA, Kennelly MJ. Pulse article: survey of neurogenic bladder management in spinal cord injury patients around the world. Spinal Cord Ser Cases. 2021;7(1):16.
Skelton-Dudley F, Doan J, Suda K et al.. Spinal Cord Injury Creates Unique Challenges in Diagnosis and Management of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil. 2019 Fall;25(4):331-39.
Patel DP, Herrick JS, Stoffel JT et al. Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourol Urodyn. 2020;39(1):211-19.
Kinnear N, Barnett D, O’Callaghan M et al. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 2020;39(2):854-62.
Moghalu O, Stoffel JT et al. Time-Related Changes in Patient Reported Bladder Symptoms and Satisfaction after Spinal Cord Injury. J Urol. 2022;207(2):392-99.
Welk B, Myers JB, Kennelly M et al. Using conjoint analysis to measure the importance of psychosocial traits in the choices of bladder management after spinal cord injury. Neurourol Urodyn. 2021;40(6):1643-50.
Zlatev DV, Shem K, Elliott CS. Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most. Neurourol Urodyn. 2018 Mar;37(3):1106-1112.
Elliott CS, Stoffel JT, Myers JB et al. Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury. Arch Phys Med Rehabil. 2019;100(10):1939-44.
Gilbert C, Linsenmeyer TA. The burst catheter balloon: A comparison of fragmentation rates and overinflation burst volumes in Foley catheters with special considerations in SCI. J Spinal Cord Med. 2022;2:1-6.
Velaer KN, Welk B, Ginsberg D, Myers J et al. Time Burden of Bladder Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2021;27(3):83-91.
Crescenze IM, Myers JB, Lenherr SM et al. Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization. Neurourol Urodyn. 2019;38(5):1332-38.
Theisen KM, Mann R, Roth JD et al. Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study. Spinal Cord. 2020 Dec;58(12):1274-81.
Rude T, Moghalu O, Stoffel J et al. The Role of Health Insurance in Patient Reported Satisfaction with Bladder Management in Neurogenic Lower Urinary Tract Dysfunction Due to Spinal Cord Injury. J Urol. 2021;205(1):213-18.
Myers JB, Lenherr SM, Stoffel JT et al. Patient Reported Bladder Related Symptoms and Quality of Life after Spinal Cord Injury with Different Bladder Management Strategies. J Urol. 2019 Sep;202(3):574-84.
Stoffel JT, Barboglio-Romo P, Lenherr SM et al. Factors impacting bowel symptoms in a contemporary spinal cord injury cohort: results from the Neurogenic Bladder Research Group Registry. Spinal Cord. 2021;59(9):997-1002.
Bourbeau D, Bolon A, Creasey G et al. Needs, priorities, and attitudes of individuals with spinal cord injury toward nerve stimulation devices for bladder and bowel function: a survey. Spinal Cord. 2020;58(11):1216-26.
Tang F, Cheng Z, Wen X et al. Effect of continuous care intervention on the quality of life in patients with neurogenic bladder dysfunction. J Int Med Res. 2019;47(5):2011-17.
Welk B, Myers JB, Kennelly M et al. A qualitative assessment of psychosocial aspects that play a role in bladder management after spinal cord injury. Spinal Cord. 2021;59(9):978-86.
Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: A Review. Top Spinal Cord Inj Rehabil. 2019;25(3):195-204.
Toh SL, Lee BB, Ryan S et al. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial. Spinal Cord. 2019;57(7):550-61.
Chen SF, Jiang YH et al. Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury. Toxins (Basel). 2022;14(1).
Chen SF, Jiang YH, Kuo HC et al. Single onabotulinumtoxinA 200U dose improved clinical symptoms but not urothelial dysfunction in neurogenic detrusor overactivity due to spinal cord injury. J Formos Med Assoc. 2019;118(1 Pt 1):125-33.
Lee CL, Jhang JF, Jiang YH et al.. Real-World Data Regarding Satisfaction to Botulinum Toxin A Injection into the Urethral Sphincter and Further Bladder Management for Voiding Dysfunction among Patients with Spinal Cord Injury and Voiding Dysfunction. Toxins (Basel). 2022;14(1).
Cakici OU, Kaya C, Sanci A et al. Gabapentin add-on therapy for patients with spinal cord injury associated neurogenic overactive detrusors that are unresponsive to combined anticholinergic and beta-3 adrenergic therapy. Cent European J Urol. 2021;74(4):547-51.
Hoen L, Ecclestone H, Blok BFM et al. Long-term effectiveness and complication rates of bladder augmentation in patients with neurogenic bladder dysfunction: A systematic review. Neurourol Urodyn. 2017;36(7):1685-702.
Myers JB, Lenherr SM, Stoffel JT et al. The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization. Neurourol Urodyn. 2019;38(1):285-94.
Wyndaele JJ, Birch B, Borau A et al. Surgical management of the neurogenic bladder after spinal cord injury. World J Urol. 2018;36(10):1569-76.
Daia C, Bumbea AM, Badiu CD et al.. Interferential electrical stimulation for improved bladder management following spinal cord injury. Biomed Rep. 2019;11(3):115-22.
Elmelund M, Biering-Sørensen F, Due U et al.. The effect of pelvic floor muscle training and intravaginal electrical stimulation on urinary incontinence in women with incomplete spinal cord injury: an investigator-blinded parallel randomized clinical trial. Int Urogynecol J. 2018;29(11):1597-606.
Herrity AN, Aslan SC, Ugiliweneza B et al.. Improvements in Bladder Function Following Activity-Based Recovery Training With Epidural Stimulation After Chronic Spinal Cord Injury. Front Syst Neurosci. 2020;14:614691.
Nardone R, Versace V, Sebastianelli L et al. Transcranial magnetic stimulation and bladder function: A systematic review. Clin Neurophysiol. 2019;130(11):2032-37.
Niu T, Bennett CJ, Keller TL, Leiter JC et al.. A Proof-of-Concept Study of Transcutaneous Magnetic Spinal Cord Stimulation for Neurogenic Bladder. Sci Rep. 2018;8(1):12549.
Parittotokkaporn S, Varghese C, O’Grady G et al.. Transcutaneous Electrical Stimulation for Neurogenic Bladder Dysfunction Following Spinal Cord Injury: Meta-Analysis of Randomized Controlled Trials. Neuromodulation. 2021;24(7):1237-46.
Parittotokkaporn S, Varghese C, O’Grady G, et al. Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: A systematic review. Clin Neurol Neurosurg. 2020;194:105822.
Bourbeau DJ, Creasey GH, Sidik S et al. Genital nerve stimulation increases bladder capacity after SCI: A meta-analysis. J Spinal Cord Med. 2018;41(4):426-34.
Brose SW, Bourbeau DJ, Gustafson KJ. Genital nerve stimulation is tolerable and effective for bladder inhibition in sensate individuals with incomplete SCI. J Spinal Cord Med. 2018;41(2):174-81.
Inskip JA, Lucci VM, McGrath MS et al. A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia. J Neurotrauma. 2018;35(9):1091-105.
Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med. 2022;2:1-9.
Elmelund M, Klarskov N, Biering-Sørensen F. Fecal Incontinence and Neurogenic Bowel Dysfunction in Women With Traumatic and Nontraumatic Spinal Cord Injury. Dis Colon Rectum. 2019;62(9):1095-104.
Pryor J, Haylen D, Fisher M. Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service. J Clin Nurs. 2021;30(11-12):1633-44.
Pryor J, Haylen D, Fisher MJ. The usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life. Disabil Rehabil. 2021;1:1-7.
Zhang Y, Xia X, Zhuang X. Effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. J Clin Nurs. 2018;27(5-6):e1146-e1151.
Todd C, Woodward S. Experience of Nurses Caring for Patients With Neurogenic Bowel Dysfunction: A Qualitative Study. J Wound Ostomy Continence Nurs. 2018;45(2):163-67.
Dietz N, Sarpong K, Ugiliweneza B et al. Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2021;27(4):53-67.
Attabib N, Kurban D, Cheng CL et al. Factors Associated with Recovery in Motor Strength, Walking Ability, and Bowel and Bladder Function after Traumatic Cauda Equina Injury. J Neurotrauma. 2021;38(3):322-29.
Johns JS, Krogh K, Ethans K et al. Pharmacological Management of Neurogenic Bowel Dysfunction after Spinal Cord Injury and Multiple Sclerosis: A Systematic Review and Clinical Implications. J Clin Med. 2021;10(4).
Putz C, Alt CD, Hensel C et al. 3T MR-defecography-A feasibility study in sensorimotor complete spinal cord injured patients with neurogenic bowel dysfunction. Eur J Radiol. 2017;91:15-21.
Durney P, Stillman M, Montero W et al. A Primary Care Provider’s Guide to Neurogenic Bowel Dysfunction in Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2020;26(3):172-76.
Bernardi M, Fedullo AL, Bernardi E et al. Diet in neurogenic bowel management: A viewpoint on spinal cord injury. World J Gastroenterol. 2020;26(20):2479-97.
Stoffel JT, Van der Aa F, Wittmann D et al. Neurogenic bowel management for the adult spinal cord injury patient. World J Urol. 2018;36(10):1587-92.
Yeung HY, Iyer P, Pryor J et al. Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature. Disabil Rehabil. 2021;43(9):1208-19.
Paily A, Preziosi G, Trivedi P et al. Anti-muscarinic drugs increase rectal compliance and exacerbate constipation in chronic spinal cord injury: Anti-muscarinic drug effect on neurogenic bowel. Spinal Cord. 2019;57(8):662-68.
Round AM, Joo MC, Barakso CM et al. Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury: Impact of Laxatives and Opioids. J Clin Med. 2021;10(8).
Ong B, Wilson JR, Henzel MK. Management of the Patient with Chronic Spinal Cord Injury. Med Clin North Am. 2020;104(2):263-78.
Nelson MES, Orr M. Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature. J Spinal Cord Med. 2021;44(4):525-32.
Wincentak J, Xu Y, Rudden L, Kassam-Lallani D, Mullin A, Truong C, et al. Current State of Knowledge on Digital Rectal Stimulation in Individuals With Traumatic and Nontraumatic Spinal Cord Injury: A Scoping Review. Arch Phys Med Rehabil. 2021 Sep;102(9):1816-25.
Hultling C. Neurogenic Bowel Management Using Transanal Irrigation by Persons with Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2020;31(3):305-18.
Deng Y, Dong Y, Liu Y et al. A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury. Medicine (Baltimore). 2018 Oct;97(41):e12778.
Boucher M, Dukes S, Bryan S et al. Early Colostomy Formation Can Improve Independence Following Spinal Cord Injury and Increase Acceptability of Bowel Management. Top Spinal Cord Inj Rehabil. 2019;25(1):23-30.
van Ginkel F, Post MWM, Faber WXM, et al. Spinal cord injuries and bowel stomas: timing and satisfaction with stoma formation and alterations in quality of life. Spinal Cord Ser Cases. 2021;7(1):10.
Korsten MA, Lyons BL, Radulovic M et al. Delivery of neostigmine and glycopyrrolate by iontophoresis: a nonrandomized study in individuals with spinal cord injury. Spinal Cord. 2018;56(3):212-17.
Copyright (c) 2023 Acta Orthopaedica Et Traumatologica Hellenica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
