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Cited by 226Spinal Cord Injury ResearchGastrointestinal motility and disordersUrinary Bladder and Prostate Research

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

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the SCIRE Research Team, Krassioukov, A, Eng, J J, Claxton, G, Sakakibara, B M, Shum, S·2010·Spinal Cord
DOI 10.1038/sc.2010.14PMC PMC3118252
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Abstract

Study design Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

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  • Pharmacologic augmentation of cholinergic activity with neostigmine, administered with glycopyrrolate to mitigate systemic adverse effects, has demonstrated efficacy in randomized, double-blind trials in spinal cord injury.

    “Pharmacologic augmentation of cholinergic activity with neostigmine, administered with glycopyrrolate to mitigate systemic adverse effects, has demonstrated efficacy in randomized, double-blind trials (Krassioukov et al., 2010).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Krassioukov et al., 2010

    The Pharmacological agents section (page not available in our copy) reports two good-quality randomized controlled trials supporting neostigmine, alone or with glycopyrrolate, for bowel evacuation after spinal cord injury. It does not establish that the trials were double-blind or state that glycopyrrolate was given to mitigate systemic adverse effects. (LLM, conf=0.86)

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References 80 · Cited by 226

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Authors
the SCIRE Research Team, Krassioukov, A., Eng, J. J., Claxton, G., Sakakibara, B. M., & Shum, S.
Affiliations
  • International Collaboration On Repair Discoveries (CA)
  • Vancouver Coastal Health (CA)
Corresponding author
Krassioukov, A
ORCID
Venue
Spinal Cord
Publisher
Springer Science and Business Media LLC
Published
2010-03-09
Volume
48
Issue
10
Pages
718-733
ISSN
  • 1362-4393 (ISSN-L)
  • 1476-5624
DOI
10.1038/sc.2010.14
PMC
PMC3118252
OpenAlex
W2108057872
Cited by
226
References
80
Citations by year
2026: 12 · 2025: 11 · 2024: 17 · 2023: 16 · 2022: 25 · 2021: 22 · 2020: 19 · 2019: 15 · 2018: 17 · 2017: 18 · 2016: 18 · 2015: 9 · 2014: 12 · 2013: 7 · 2012: 6
FWCI
0.59
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Spinal Cord (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Ontario Neurotrauma Foundation
  • Michael Smith Health Research BC
  • Canadian Institutes of Health Research (63617, MSH63617)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords
neurogenic bowel dysfunction, spinal cord injury, bowel management, constipation, fecal incontinence, transanal irrigation, prokinetic agents, intestinal surgery, non-pharmacological treatment, pharmacological interventions
MeSH terms
Humans, Spinal Cord Injuries, Randomized Controlled Trials as Topic, Databases, Factual, Guidelines as Topic, Neurogenic Bowel

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