Gastrointestinal (GI) complications are frequent following a SCI and their daily challenges can severely affect the quality of life of an individual.  In addition, GI complications can lead to visits to physicians, re-hospitalizations, and even death.  The evidence suggests that a multi-faceted approach to bowel management is effective and includes consideration of diet, medications, fluid intake, and evacuation schedules.  When severe constipation persists and a bowel program cannot be attained, surgical options such as a colostomy or implanted stimulator may be considered.

• There is level 1 evidence (from one RCT; N=68) (Coggrave et al. 2009) that systematic use of less invasive interventions do not reduce the need for oral laxatives and invasive interventions. There is also level 1 evidence (Coggrave et al. 2009 that use of multifaceted bowel management programs increase the duration of time required for bowel management. This is in contrast with  level 4 evidence (from three pre-post studies; aggregate N=65) (Coggrave et al. 2006; Correa and Rotter 2000; Badiali et al. 1997;) that multifaceted bowel management programs reduce gastrointestinal transit time, incidences of difficult evacuations, and duration of time required for bowel management.
• There is level 4 evidence (from 1 case series; N=11) (Cameron et al. 1996) that indicates high fibre diets may lengthen colonic transit time.
• There is level 4 evidence (from 1 pre-post study; N=6) (Korsten et al. 2007) that digital rectal stimulation increases motility in the left colon.
• There is level 1 evidence (from 1 RCT) (Korsten et al. 2004) that electrical stimulation of the abdominal wall muscles can improve bowel management for individuals with tetraplegia.
• There is level 2 evidence (from 1 prospective controlled trial) (Binnie et al. 1991) that support the use of sacral anterior root stimulation to reduce severe constipation in complete injuries.
• There is level 4 evidence (from 3 pre-post studies) (Tsai et al. 2009, Lin et al. 2001; 2002) that functional magnetic stimulation may reduce colonic transit time in individuals with SCI.
• There is level 4 evidence (from 1 pre-post study with two subjects) (Mentes et al. 2007) that posterior tibial nerve stimulation improves bowel management for those with incomplete SCI.
• There is level 4 evidence (from 1 pre-post study with two subjects) (Johnston et al. 2005) that the Praxis FES system increases the frequency of defecation and decreases time required for bowel care in individuals with SCI.
• There is level 4 evidence (from 1 case series study) (Puet et al. 1997) that supports using pulsed water irrigation (intermittent rapid pulses) to remove stool in individuals with SCI.
• There is level 1 evidence (from 1 RCT) (Christensen et al. 2006) that supports the use of transanal irrigation (Peristeen Anal Irrigation system) over conservative bowel treatment (as outlined by the Paralyzed Veterans of America clinical practical guidelines).
• There is level 4 evidence (from 1 case series study, and one post-test) (Faaborg et al. 2008; Christensen et al. 2000) that supports the use of an Enema Continence Catheter to treat the neurogenic bowel.
• Cisapride: There is level 1 evidence (from 3 RCTs) (De Both et al. 1992; Rajendran et al. 1992; Geders et al. 1995) that cisapride significantly reduces colonic transit time for chronic constipation.
• Prucalopride: There is level 1 evidence (from 1 RCT) (Krogh et al. 2002) that prucalopride increases stool frequency, improves stool consistency and decreases gastrointestinal transit time.
• Metoclopramide: There is level 2 evidence (from 1 prospective controlled trial; N=20) (Segal et al. 1987) that intravenous administration of metoclopramide corrects impairments in gastric emptying.
• Neostigmine: There is level 1 evidence (from 1 RCT) (Korsten et al. 2005) that neostigmine, administered with or without glycopyrrolate, leads to a greater expulsion of stool.
• There is level 1 evidence that neostigmine with glycopyrrolate decreases total bowel evacuation times and improves bowel evacuation.
• Fampridine: There is level 1 evidence (from 1 RCT) (Cardenas et al. 2007) that fampridine can increase the number of days with bowel movements.
• There is level 1 evidence (from 1 RCT) (House and Stiens 1997) to support polyethylene glycol-based suppositories for bowel management. There is a clinically significant decrease in the amount of nursing time for persons requiring assistance and less time performing bowel care for the independent individual.
• There is level 4 evidence (from six studies) (Frisbie et al. 1986; Stone et al. 1990; Kelly et al. 1999; Rosito et al. 2002; Branagan et al. 2003, Munck et al. 2008) that colostomy reduces the number of hours spent on bowel care.
• There is level 4 evidence (from 1 retrospective pre-post study) (Frisbie et al. 1986) that colostomy greatly simplifies bowel care routines.
• There is level 4 evidence (from 1 case study) (Rosito et al. 2002) that colostomy reduces the number of hospitalizations caused by gastrointestinal problems and improves physical health, psychosocial adjustment and self-efficacy areas within quality of life.
• There is level 4 evidence (from 4 retrospective reviews) (Teichman et al. 1998; Christensen et al. 2000; Teichman et al. 2003, Worsoe et al. 2008) that the Malone Antegrade Continence Enema successfully treats the neurogenic bowel.
• There is level 4 evidence (from 1 retrospective review) (Christensen et al. 2000) that the Enema Continence Catheter can be used to treat the neurogenic bowel.  
• There is level 5 evidence (from 1 case report with one subject) (Hoenig et al. 2001) that a standing table alleviates constipation in individuals with SCI.
• There is level 4 evidence (from 1 post-test study) (Uchikawa et al. 2007) that a newly developed washing toilet seat with a CCD camera monitor for visual feedback reduces time spent on bowel care.
• There is level 4 evidence (from 1 pre-post study; N=24) (Ayas et al. 2006) that the abdominal massage is ineffective for treating the neurogenic bowel.