Few SCI patients feel normal desire to defecate and most use a variety of methods to initiate defecation, including laxatives, enemas, suppositories or digital stimulation of the rectum and anal canal. SCI results in severely prolonged colonic transit times both in the acute and chronic phase. However, the type of colorectal dysfunction depends on the level of SCI (Krogh et al. 2000; Stiens et al. 1997). Colorectal problems often restrict their participation in social activities and influence their quality of life. Krogh et al. (2000) and Nino-Murcia et al. (1990) measured colonic transit time in individuals using ingested radiopaque markers and abdominal radiographs taken at 24 hour intervals. They found that the mean transit time through the entire colon in SCI patients was significantly longer than normal adults. Future studies on colonic transit times and anorectal dynamics could aid in the approach used to manage bowel dysfunction in SCI patients. Difficulty with evacuation has been attributed to prolongation of the colonic transit time in individuals with SCI.

The Consortium for Spinal Cord Medicine developed guidelines for neurogenic bowel management (Consortium for Spinal Cord Medicine 1998). A comprehensive evaluation of bowel function, impairment, and possible problems is recommended at the onset of SCI and at least once annually.  The evaluation may include a patient history, physical exam, an assessment of the ability of the individual or his caregiver to perform procedures safely and effectively, as well as of the bowel program design, assistive techniques/devices used, and the patient’s diet. More recently, the Multidisciplinary Association of the Spinal Cord Injury Professionals (MASCIP 2009) in affiliation with the Spinal Cord Injury Centres of the United Kingdom and Ireland released guidelines for the management of neurogenic bowel. These guidelines provide standards for care for both those being admitted for rehabilitation and those living in the community.

Management of neurogenic bowel complications is reliant on the clinician to recognize common complications and their clinical presentation (Consortium for Spinal Cord Medicine, 1998, MASCIP 2009). Common complications include constipation, fecal impaction and hemorrhoids. Recommended management protocols for constipation include the establishment of a balanced diet with adequate fluid and fibre intake, increased daily activity, and if possible, reduction or elimination of medication contributing to constipation. If these recommendations fail, prokinetic medication may be used to promote transit through the gastrointestinal tract.  The step-wise management recommended for fecal impaction is first manual evacuation, then if not successful, oral stimulants, and finally oil retention enemas. To minimize the development of hemorrhoids, oral agents (to maintain soft-formed stool), minimize straining during bowel efforts, and minimal physical trauma during anal stimulation are recommended. Once hemorrhoids have developed, topical anti-inflammatory creams or suppositories are suggested as early treatment. Overall, the Consortium for Spinal Cord Medicine recommends further research in all bowel management areas (Consortium for Spinal Cord Medicine, 1998).