Treatment of Fecal Incontinence and Constipation in Patients With Spinal Cord Injury
Treatment of Fecal Incontinence and Constipation in Patients With Spinal Cord Injury
The study aims to compare a newly developed system for transanal colonic irrigation
 (Peristeen Anal Irrigation) with a bowel management regime that does not include irrigation
 in a prospective, randomized trial in spinal cord lesion patients (SCL- patients) with faecal
 incontinence and/or constipation.

 Population; 80 SCL- patients with faecal incontinence and/or constipation from five
 countries.

 Focus on:

 Bowel symptom score Neurogenic Bowel Dysfunction score Symptom related quality of life
 questionnaire Time expenditure for performance of bowel care ans side effects
The magnitude of bowel dysfunction in spinal cord injury patients has been documented in
 several studies. Spinal cord injury affects colorectal motility, transit times, and bowel
 emptying often leading to constipation, fecal incontinence or a combination of both. Although
 these symptoms are not life-threatening, they may have a severe impact on quality of life as
 well as increase levels of anxiety and depression.

 Various bowel management programs have been empirical, and individual solutions have been
 sought on a trial-and-error basis. Transanal irrigation has been used in selected patients
 with constipation or fecal incontinence. The majority of spinal cord injured patients in a
 recent study benefited from the treatment. However, there is limited evidence in the
 literature supporting any bowel management program in spinal cord injury in favor of another
 and well-designed controlled trials are still lacking. Therefore, the present study aims to
 compare transanal irrigation with conservative bowel management, defined as best supportive
 bowel care without irrigation, in a prospective, randomized, controlled, multicentre study
 among spinal cord injured patients with neurogenic bowel dysfunction.
Inclusion Criteria:

 -  Aged 18 or over

 -  Spinal cord lesion at any level at least 3 months from injury

 -  At least one or more of the following symptoms:

 -  Spending ½ hour or more attempting to defecate each day or every second day

 -  Symptoms of autonomic dysreflexia before or during defecation

 -  Abdominal discomfort before or during defecation

 -  Episodes of faecal incontinence once or more per month

 -  The patient is able to understand the treatment and is willing to comply with the
 prescribed regimen

 -  The patient is able to perform transanal colonic irrigation seated on a toilet commode
 with or without assistance

 -  Signed informed consent has been obtained

 Exclusion Criteria:

 -  Co-existing major unsolved physical problems due to the injury

 -  Perform transanal retrograde irrigation on a regular basis

 -  Evidence of bowel obstruction

 -  Evidence of inflammatory bowel disease

 -  History of cerebral palsy or cerebral apoplexy

 -  Multiple sclerosis

 -  Diabetic polyneuropathy

 -  Previous abdominal or perianal surgery (not including minor surgery as appendectomy or
 haemorrhoidectomy)

 -  Pregnant or lactating

 -  Evidence of spinal chock

 -  Mentally unstable

 -  Treatment with more than 5 mg prednisolon per day.

 -  PNS implant (sacral nerve stimulation)