Spinal Cord Injury

SCI: Fiber and Neurogenic Bowel (2007)

• Intervention
  What is the recommended fluid intake for bowel and bladder management in persons with Spinal Cord Injury?

  • Conclusion

    The amount of fluid needed to promote optimal stool consistency must be balanced with the amount needed for bladder management.  The clinical practice guidelines developed by the Consortium of Spinal Cord Medicine suggest a fluid intake of 500 ml/day greater than the guidelines established by the National Research Council for the general public.  One study, which has been published since that time, reported that a fluid intake of 1.5 liters per day resulted in significant improvements in bowel function.  Further research on fluid intake in people with spinal cord injury is needed.  

     

  • Grade: IV
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What is the recommended fluid intake for bowel and bladder management?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
  • Search Plan and Results: Fluid Intake 2006
     
  What level of fiber is recommended to manage neurogenic bowel in Spinal Cord Injury patients and how should it be introduced?

  • Conclusion

    The incidence of chronic bowel dysfunction may be as high as 60% in the spinal cord-injured population.  Management of lower motor neuron bowel tends to be more problematic than upper motor neuron bowel.  The clinical practice guidelines developed by the Consortium of Spinal Cord Medicine, based on the scientific literature published from 1966 - 1997, suggest an initial fiber intake of 15 grams per day, with gradual increases as tolerated.  Diets that are higher in fiber (20 - 30 grams per day) have been associated with longer transit times in the spinal cord-injured population than the non-injured population.  One study, which has been published since that time, reported that a fiber intake of 15 grams per day resulted in significant improvements in bowel function.   

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What level of fiber is recommended to manage neurogenic bowel; and how should it be introduced?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • 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.
      • Han TR, Kim JH, Kwon BS. Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury. Spinal Cord 1998; 36: 485-490.
      • Yim SY, Yoon SH, Lee IY, Rah EW, Moon HW.  A comparison of bowel care patterns in patients with spinal cord injury:  upper motor neuron bowel vs lower motor neuron bowel.  Spinal Cord 2001;39:204-207.
  • Search Plan and Results: Fiber and Neurogenic Bowel 2006