Bowel Control Strategies Used by Veterans With Long-Standing Spinal Cord Injuries

Experiences of people with non-traumatic spinal cord injuries returning home after inpatient rehabilitation

PURPOSE

The aim of this study was to explore the experience of people with non-traumatic spinal cord injuries who have recently returned home from inpatient rehabilitation.

METHODS

Semi-structured interviews were conducted with seven adults with non-traumatic spinal cord injuries who had been discharged from inpatient rehabilitation from an Australian rehabilitation hospital, within the last two years.

RESULTS

Three themes were identified: the practicalities of coming home; adjusting to "my altered home life"; pursuing recovery. When people felt prepared by their rehabilitation service, and had appropriate support from others, they had a more positive adjustment experience, although not one without challenges. Due to less independence and inability to participate in meaningful life roles, participants experienced a sense of lost or changed identity. Maintaining hope for physical recovery was very important and motivated participants to actively engage in rehabilitation efforts.

CONCLUSIONS

This study adds to the knowledge regarding the lived experience of people with non-traumatic spinal cord injury transitioning from rehabilitation to home. Facilitators for successful rehabilitation discharge included ensuring community services contacted patients immediately after they left hospital, and providing support for carers. Health care workers can positively influence the adjustment process of people with NTSCI by facilitating re-engagement in meaningful roles.IMPLICATIONS FOR REHABILITATIONThe transition home from inpatient rehabilitation after non-traumatic spinal cord injury (NTSCI) is facilitated by early discharge planning and follow-up from services after discharge.Establishing routines helped participants adjust to their new circumstances.The emotional and practical support of carers is vital for successful adjustment to living in the community with an NTSCI.Health care workers can positively influence the adjustment process of people with NTSCI by facilitating their re-engagement in meaningful roles.

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

PURPOSE

To describe 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.

METHODS AND MATERIALS

Descriptive and interpretive thematic analysis of transcribed semi-structured interviews with 11 men living with spinal cord injury, aged 23-77 years, 8-45 years post injury.

RESULTS

Participants had different levels and types of injuries. While there were common aspects of the bowel care routines of study participants, none was exactly the same as any other. Each had developed a routine in accordance with the needs of their own body, preferences, and convenience in relation to availability of carers and work commitments. Personal factors in the person with SCI were important for successful integration of bowel care into their everyday life.

CONCLUSION

An appropriate and consistent bowel care routine was found to be significant in enabling people with spinal cord injury to experience wellness and quality in their everyday lives. Characteristics and actions of the person with SCI enabled the person to actively drive the process of integrating bowel care into their everyday life. How best to foster the development of these personal factors warrant further investigation.IMPLICATIONS FOR REHABILITATIONSupport for the ongoing development of self-management of bowel dysfunction expertise by people living with spinal cord injury needs to continue after discharge from hospital.Characteristics of the person with spinal cord injury, such as a state of mind indicating acceptance of their situation, motivation to avoid bowel accidents and constipation, and willingness to take responsibility, are important factors influencing the integration of bowel care into everyday life.Actions undertaken by the person with spinal cord injury, such as discipline to establish, refine and maintain a bowel care regime, and proactive self-management are important factors influencing the integration of bowel care into everyday life.This small study suggests the role of personal factors in the development of self-management expertise, for example the development of a self-management mindset and the acquisition of skills to drive that process, should be considered during rehabilitation.

Current State of Knowledge on Digital Rectal Stimulation in Individuals With Traumatic and Nontraumatic Spinal Cord Injury: A Scoping Review

OBJECTIVES

To map and characterize the nature of the evidence on the use of digital rectal stimulation for bowel management in individuals with spinal cord injury (SCI).

DATA SOURCES

Five electronic databases were searched (ie, MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and Cochrane Incontinence Group) from 1990 to November 2019.

STUDY SELECTION

Articles that provided information on the use of digital rectal stimulation either alone or in combination with treatments were included. Title and abstract screening was split between 2 reviewers after reaching consensus on the first 100 studies screened. Full-texts were reviewed independently by 2 reviewers. Discrepancies were resolved by a third reviewer.

DATA EXTRACTION

The data extraction form was developed by 2 reviewers and piloted. Data were extracted by one reviewer and checked for accuracy by a second reviewer.

DATA SYNTHESIS

A total of 4841 studies were screened, including 425 full text articles; 33 articles were identified. Thirty-two studies focused solely on individuals with SCI and 1 study explored the experiences of caregivers of individuals with SCI. The majority of participants were aged between 30 and 59 years old. Most studies used quantitative methods (n=30, 91%). Fourteen of the studies (42%) were cross-sectional. Within experimental or quasiexperimental designs, digital rectal stimulation was commonly studied as an adjunct to other methods such as suppositories or enemas. Incontinence and defecation time were the most commonly examined outcomes.

CONCLUSION

There were few studies found that focus on digital rectal stimulation. Further studies examining experience, effectiveness, complications, and long-term outcomes are warranted.