Other treatments

Authors: SCIRE Community Team | Reviewer: Bonnie Nybo | Published: 20 March 2018 | Updated: 23 October 2024

Standing and exercise have long been thought to assist with bowel management after SCI. Standing and exercise are thought to help move abdominal contents toward the rectum. However, there is not enough evidence at this time to determine whether standing and exercise are effective to help with managing bowel changes after SCI.

A number of devices also exist to help with bowel management. These devices are typically used together with regular bowel care techniques, and may include:

• Commodes, raised or padded toilet seat, or automated toilet seat
• Suppository inserter or digital stimulator
• Mirrors
• Anal plugs
• Footstools
• Bowel irrigation systems

However, limited research has been done on assistive devices for bowel care, so we do not yet know if these treatments are useful to help manage bowel changes after SCI.

Most people are able to manage their bowel function effectively with a bowel routine made up of conservative techniques and medications. However, some people may require the use of additional treatments to achieve optimal bowel care.

Colostomy and ileostomy are surgical procedures that may be used if conservative techniques do not work well or as a way to streamline bowel care. Both of these procedures involve a surgically-created hole between the intestine and the outside of the abdomen. Once the opening is formed, a pouch (collection bag) is attached to allow stool to be collected outside of the body, bypassing the rectum and anus entirely.

A colostomy is when the hole (or stoma) is created between the colon (large intestine) and the outside of the body. An ileostomy is when the hole is created between the ileum (last part of the small intestine) and the outside of the body.

A colostomy is a surgically created opening between the large intestine (colon) and an external collection device (colostomy bag).¹⁹

Although these types of surgeries are invasive, a number of different studies have shown that there are many benefits for bowel care. There is weak evidence that colostomy surgery:

• Simplifies bowel routines and reduces the amount of time spent on bowel care
• Reduces the need for use of laxatives and dietary changes in bowel care
• Reduces the number of hospitalizations related to bowel problems
• Improves independence and quality of life

These studies showed that, while there were some complications related to stoma surgeries, such as opening of the surgical wound, these were uncommon, and the majority of people were satisfied with the results of their surgery.

Bowel irrigation is the use of water or other fluids (including medications) to stimulate the bowel muscles and flush stool from the bowel. This is done to help loosen stools and treat constipation. Bowel irrigation is sometimes referred to as an enema, although it typically uses more fluid than an enema. The fluid may be introduced into the bowel through the anus (called transanal irrigation) or through a surgically created stoma (called antegrade irrigation).

In MACE, the appendix is made into a stoma.²⁰

Transanal irrigation is done through a catheter that is inserted into the rectum through the anus. The catheter may be surrounded by a balloon that can be inflated to hold the catheter in place and prevent leaking of water. The catheter is connected by a tube to a hand pump or electrical pump system to push water into the bowel. Pulsed water transanal irrigation involves quick pulses of water into the rectum to help loosen stools. There is weak evidence that transanal irrigation and pulsed water transanal irrigation helps improve bowel function after SCI.

When fluid is introduced through a stoma (antegrade irrigation), it is usually done through a small stoma into the beginning of the large intestine (the cecum) called a cecostomy or as part of a surgical technique called the Malone Antegrade Continence Enema (MACE) procedure, where the appendix is made into a stoma. Irrigation is not usually done through an ileostomy because this can cause dehydration. There are several studies which provide weak evidence that MACE is a safe and useful alternative for bowel irrigation after SCI.

Electrical and magnetic stimulation techniques are available to assist with bowel care. However, these treatments are not usually available in most healthcare settings.

Functional magnetic stimulation is a non-invasive procedure in which a magnet is placed over the spinal cord to administer magnetic waves which can stimulate nerve cells to fire. There is weak evidence that functional magnetic stimulation help improve bowel transit time after SCI.

Abdominal muscle stimulation is another non-invasive procedure in which electrodes are placed on the abdominal muscles to stimulated muscle activity. It has been proposed that activating the abdominal muscles might help to increase pressure within the abdominal cavity, which may assist with bowel emptying for people who do not have abdominal control (injuries above T7).

Sacral anterior root stimulation is an invasive procedure in which electrodes and a controlling device are implanted onto the sacral nerves during surgery. The device is controlled by an external transmitter and can stimulate the nerves which help empty the bowel.

There is moderate evidence that sacral anterior root stimulation may help improve constipation after SCI. Sacral root stimulation is an emerging area of research and further research in the future may provide more information about whether this treatment works.