SCI: Fluid and Neurogenic Bowel 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
SCI: Fluid and Neurogenic Bowel: Estimating Fluid Needs to Promote Optimal Stool Consistency
The registered dietitian should estimate the fluid needs of persons with spinal cord injury with neurogenic bowel by using the guidelines of the Consortium on Spinal Cord Medicine, as follows:
- One ml fluid per kcal estimated energy needs plus 500ml or
- 40ml per kg body weight plus 500ml.
A minimum of 1.5L of fluid per day may promote optimal stool consistency in persons with spinal cord injury and neurogenic bowel. Persons with spinal cord injury and neurogenic bowel often have an increase in colonic transit time, resulting in excessive fluid reabsorption and the formation of hardened stools.
Further research is needed to establish fluid intake guidelines for this population.
Risks/Harms of Implementing This Recommendation
- Provision of inadequate or excessive fluid may result in poor clinical outcomes
- Provision of inadequate fluid per day (less than 1.5L fluid per day) or more than 40ml per kg of body weight fluid per day may result in poor clinical outcomes; adjustment should be made for individual needs such as medical conditions (including but not limited to congestive heart failure, renal disease) or bladder management programs.
Conditions of Application
This recommendation applies to all patients with spinal cord injury with neurogenic bowel.
Potential Costs Associated with Application
No organizational costs are associated with implementation of this recommendation.
- One non-randomized clinical trial (Badiali et al, 1997) found that provision of 1.5L water and 15g fiber to spinal cord injured patients resulted in significant improvements in bowel function, evidenced by a reduction in transit time, more evacuations per week, greater predictability and an improved evacuation stimuli score
- One systematic review (Consortium on Spinal Cord Injury, 1998), based on expert consensus, recommended that initial fluid needs for spinal cord-injured patients be figured at 500ml fluid per day above National Research Council recommendations for the general population.
Recommendation Strength Rationale
- Recommendation based on expert consensus only
- Very few studies answering the question.
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the recommended fluid intake for bowel and bladder management in persons with Spinal Cord Injury?
Badiali D, Bracci F, Castellano V, Corrazziari E, Fuoco U, Habib FI, Scivoletto G. Sequential treatment of chronic constipation in paraplegic subjects. Spinal Cord 1997; 35: 116-120.
Consortium for Spinal Cord Medicine. Neurogenic Bowel Management in Adults with Spinal Cord Injury: Clinical Practice Guidelines for Health-Care Professionals. Washington, DC: Paralyzed Veterans of America, 1998.