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The National Spina Bifida Patient Registry (NSBPR) assesses bladder and bowel incontinence using ordinal categories, but prior NSBPR analyses employed binary classification. Our aims were to 1) perform the first NSBPR analysis of bladder and bowel incontinence as ordinal outcomes to compare to the binary definition and subject variables; 2) explore the correlation of incontinence with undergarment usage, and 3) assess incontinence status following continence surgeries. Data from NSBPR participants' most recent clinic visit from 2013 to 2020 were analyzed. Ordinal categories of incontinence were compared to previously used binary definitions. Incontinence surgical outcomes were analyzed for those with data at least three months post-operatively. Chi-square tests evaluated associations among categorical variables. Univariate and ordinal logistic regression models were used to test associations of ordinal incontinence status with patient and condition factors. Statistical tests were 2-sided; p values < 0.05 were considered significant. Analysis of 7217 individuals using ordinal incontinence outcomes showed little difference from previously used binary outcomes. The final multivariable logistic regression models with ordinal multinomial outcomes showed that associations of incontinence with age, sex, race/ethnicity, health insurance, level of lesion, and continence management technique were similar to prior studies. Among those reporting never being incontinent of both bladder and bowel, 14% reported using protective undergarments. Of the 500 individuals who had bladder outlet surgery, 38% reported never being incontinent of urine. Of 1416 individuals who had appendicostomy (ACE) bowel surgery, 48% reported never being incontinent of stool. Our current analysis showed that ordinal continence outcome classification had similar continence findings as previous studies using the binary definition of continence. Expanding the binary definition of continence to include monthly episodes of incontinence did not greatly increase the proportion of continent individuals and, therefore, would have not likely made meaningful differences in continence outcomes in prior NSBPR analyses. However, it is known that even mild incontinence can affect quality of life, therefore, capturing any level of incontiennce is of clinical importance. Confirmation of the association of continence outcomes with sociodemographic, condition-related, and interventional factors with both approaches further validates previous analyses using the binary definition of continence. The previously used binary definition of bladder and bowel continence appears robust. Undergarment choice was a poor surrogate for reported incontinence. After bladder and bowel continence surgeries, 38% and 48%, respectively, reported never being incontinent. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) disrupts intestinal barrier function, thereby increasing antigen permeation and leading to poor outcomes. Despite the intestinal tract's anatomic and physiologic heterogeneity, studies following SCI have not comprehensively addressed intestinal pathophysiology with regional specificity. Aims and Methods: We used an experimental model of high thoracic SCI to investigate (1) regional mucosal oxidative stress using dihydroethidium labeling; (2) regional paracellular permeability to small- and large-molecular probes via Ussing chamber; (3) regional intestinal tight junction (TJ) protein expression; and (4) hindgut perfusion via the caudal mesenteric artery. Results: Dihydroethidium staining was significantly elevated within duodenal mucosa at 3-day post-SCI. Molar flux of [14C]-urea was significantly elevated in duodenum and proximal colon at 3-day post-SCI, while molar flux of [3H]-inulin was significantly elevated only in duodenum at 3-day post-SCI. Barrier permeability was mirrored by a significant increase in the expression of pore-forming TJ protein claudin-2 in duodenum and proximal colon at 3-day post-SCI. Claudin-2 expression remained significantly elevated in proximal colon at 3-week post-SCI. Expression of the barrier-forming TJ protein occludin was significantly reduced in duodenum at 3-day post-SCI. Caudal mesenteric artery flow was unchanged by SCI at 3 days or 3 weeks despite significant reductions in mean arterial pressure. Conclusion: These data show that T3-SCI provokes elevated mucosal oxidative stress, altered expression of TJ proteins, and elevated intestinal barrier permeability in the proximal intestine. In contrast, mucosal oxidative stress and intestinal barrier permeability were unchanged in the hindgut after SCI. This regional heterogeneity may result from differential sensitivity to reduced mesenteric perfusion, though further studies are required to establish a causal link. Understanding regional differences in intestinal pathophysiology is essential for developing effective treatments and standards of care for individuals with SCI. [ABSTRACT FROM AUTHOR]

Guidelines fail to recommend objective measures to assist with treatment of neurogenic bowel dysfunction (NBD) in spinal cord injury (SCI). The main objective was to review the literature to identify the objective measures used in all NBD populations and to present their results and any correlations performed to validated subjective measures. A systematic review of the literature was performed in accordance with PRISMA (2020) guidelines, including all records from January 2012 to May 2023 with MeSH terms like "neurogenic bowel" indexed in the following databases: PubMed, EMBASE, CINAHL, Cochrane Central Trials Register, and ClinicalTrials.gov. Abstracts were excluded if they did not include objective measures or if they only mentioned the esophagus, stomach, and/or small bowel. Records were screened independently by at least two collaborators, and differences were resolved by unanimous agreement. There were 1290 records identified pertaining to NBD. After duplicates were removed, the remaining records were screened for a total of 49 records. Forty-one records (82%) included subjective measures. Two-thirds of the articles involved the population with SCI/disease (n = 552) and one-third were non-SCI NBD (n = 476). Objective measures were categorized as (1) transit time, (2) anorectal physiology testing, and (3) miscellaneous. Of the 38 articles presenting results, only 16 (42%) performed correlations of objective measures to subjective measures. There is an abundance of literature supporting the use of objective outcome measures for NBD in SCI. Strong correlations of subjective measures to objective outcome measures were generally lacking, supporting the need to use both measures to help with NBD management. [ABSTRACT FROM AUTHOR]

IntroductionHealth care providers caring for youth with physical disabilities encourage them to be as independent as possible, which includes obtaining higher education when feasible. However, little is known about the experiences of higher education students in managing their toileting.MethodsWe performed 1:1 semi-structured interviews with 13 current college students with physical disabilities (4 male, 9 female), of whom six were on a formal bladder and/or bowel management program. Three researchers analyzed all transcripts using constructivist grounded theory procedures.ResultsWe identified six themes, including: (1) adherence to prescribed programs, (2) importance of time management, (3) interfering with class, (4) balancing intake and toileting, (5) campus bathroom experiences, and (6) acclimating to new living situations. Students needed strong personal skills in time management, adaptability, and self-advocacy to both manage their toileting needs and engage in academic and social activities. This often took time to develop while in college. They faced barriers such as a lack of private, well-maintained bathrooms.ConclusionsHealth care providers should encourage their patients to develop these personal skills prior to starting college, while colleges need to better support these students through honoring their accommodation needs and ensuring the availability of private, accessible bathrooms.

Neurogenic bowel management in persons with spinal cord injury (SCI) is an important issue due to the associated morbidities causing a significant impact on the persons’ quality of life (QOL) and burden the caregiver and healthcare services. Complications such as constipation, diarrhoea, incontinence, social embarrassment and autonomic dysreflexia can be managed effectively and resourcefully to counter the ill effects. In India, the incidence of SCI is 15,000, with a prevalence of 0.15 million; most are educationally and economically underprivileged with substandard living conditions. Complications associated with neurogenic bowel tend to impede the implementation of vocational rehabilitation and community integration measures. The goals of management are to prevent complications and improve the QOL of persons with SCI. With the revolutionary progress in medical science, many pharmacological, non-pharmacological and surgical options have been formulated to satisfactorily and effectively manage the neurogenic bowel. In this narrative review, we have tried to compile some of the most popular and time-tested options for managing neurogenic bowel in persons with SCI.

Neurogenic bladder and bowel dysfunctions lead to physical, social, and emotional disability and affects one's quality of life. Initial treatment is conservative including several rehabilitation techniques such as pelvic floor muscle training, biofeedback, electrical stimulation, and posterior tibial nerve stimulation. In this case report, a 45-year-old woman with neurogenic bladder and bowel dysfunction was presented. Her urinary and fecal incontinence symptoms began twenty years before this episode of care, after an incomplete spinal cord injury secondary to spinal ependymoma and syringomyelia. She discontinued medical treatments due to side effects and ceased intermittent catheterization. A multimodal pelvic rehabilitation program was administered consisting of posterior tibial nerve stimulation, active pelvic floor muscle training accompanied by biofeedback, and electrical stimulation of pelvic floor muscles. There were clinically important favorable differences in the scores of King's health questionnaire (reductions in symptom severity from 25 to 18 and in each of the impact of incontinence, physical and social limitations, personal relationships, sleep/energy, and severity measures from 100 to 67), pelvic floor distress inventory (decreased from 257 to 146) and female sexual function index (increased from 15.1 to 25.1) after 12 weeks of a multimodal pelvic rehabilitation program. Manual muscle tests demonstrated improvements in pelvic floor muscle strength and endurance. A 12-week multimodal pelvic rehabilitation program reduced urinary and fecal incontinence symptoms, together with improvements in her sexual life and alleviation of neuropathic pain. [ABSTRACT FROM AUTHOR]

Conor Hamilton examines the key components healthcare practitioners should consider when using transanal irrigation. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. Methods: This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. Results: We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. Conclusions: The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Aims: This study aims to explore the experiences of rehabilitation specialist nurses in providing bowel care to stroke patients and to identify the factors that either facilitate or hinder their practice. Design: This was a descriptive qualitative design study. Methods: Between May 2022 and October 2022, we conducted in-depth and semistructured interviews with 12 rehabilitation specialist nurses from two tertiary hospitals in Changsha, China. Thematic analysis was employed to analyse the interview transcripts. Findings: Three key themes were revealed from our analysis: (1) acceptance of bowel care as a process, (2) high level of recognition improves the experience and (3) challenges stemming from limited knowledge and rights. Acceptance of bowel care as a dynamic process, coupled with a high level of recognition, enabled nurses to prioritize the health and safety of patients over personal feelings and achieve professional accomplishments. However, they encountered challenges in terms of professional development and restricted prescribing rights for bowel care. Conclusion: The experiences of rehabilitation specialist nurses in providing bowel care are dynamic. These findings have important implications for healthcare improvement, including the need for collaboration with healthcare professionals and nurturing nurses' self-identity, comprehensive training plans, innovative programs and expanding the scope of rehabilitation specialist nurses' rights. Impact: This study enhances our understanding of the challenges faced by rehabilitation specialist nurses caring for stroke patients with neurogenic bowel dysfunction. The findings provide insights into how to enhance bowel care experience and develop further in this field. Reporting Method: This study adhered to the EQUATOR guideline and utilized the COREQ checklist. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. Methods: Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. Results: Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3−64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00−1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03−1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12−1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7−170], p < 0.001). Conclusions: In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not. [ABSTRACT FROM AUTHOR]

Introduction. There are multiple tools available to optimize defecation in patients with anorectal malformation (ARM), such as habits, laxatives, and retrograde or anterograde irrigations, which are usually adapted in a progressive and combined fashion. The objective of this study was to assess the incorporation of transanal irrigation (TAI) to constipation and fecal incontinence treatment in patients with ARM. Materials and methods. A retrospective study of ARM patients with indication of TAI according to the colorectal pathology unit's intestinal management protocol from 2015 to 2022 was carried out. Following use for over 3 months, patients or their guardians completed a phone survey of our own approved by the ethics committee. Results. 39 ARM patients participated in the study. Pathologies included 11 rectourethral fistulas, 6 rectovesical fistulas, 16 cloacae, 2 rectovaginal fistulas, 2 perineal fistulas, and 2 vestibular fistulas. 44% of them had a sacral index < 0.4. 62% had constipation, and 38% had incontinence. Thanks to TAI, confidence and safety improved in a very high and a high degree in 89% of the patients, whereas time devoted to intestinal management decreased a lot in 68% of them. 79% reported a 9- and 10-point quality-of-life improvement. 92% rated overall satisfaction with TAI with a score of 8, 9, and 10 -- 10 meaning "completely satisfied." 100% recommend TAI. Conclusion. TAI is a good alternative for the intestinal management of fecal incontinence and constipation. [ABSTRACT FROM AUTHOR]

• Neurogenic bladder dysfunction negatively impacts quality of life in children with SCI. • Strengthening spared neurocircuitry through activity-dependent plasticity. • Children with SCI may experience improved bladder and bowel function through ABR-LT. • Implications of enhanced bladder and bowel control include reduced medication dependence. Bladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self-reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT. In a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12–14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training. Like our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed. [ABSTRACT FROM AUTHOR]

Spinal cord injury is a serious injury that can result in a series of complications that will impact the injured individual and their families. One of these complications is bowel dysfunction. The individual with spinal cord injury could have a total loss of bowel function and control post-injury, which can result in pain and discomfort. Establishing a safe and sustainable bowel programme is essential to controlling bowel movement and improving overall quality of life. The aims of this article are to provide healthcare professionals with an understanding of the impact of spinal cord injury on bowel function and to help establish a successful bowel programme for patients. In particular, how spinal cord injury affects and impacts bowel control; establishing goals of a bowel management programme for individuals; reviewing factors involved in establishing a successful bowel management regimen following spinal cord injury. [ABSTRACT FROM AUTHOR]

Objectives There is a risk that early neurogenic bladder and bowel dysfunction following acute spinal cord injury (SCI) may not be adequately managed on the acute hospital wards. The aim of this paper was to review optimal assessment and management of patients with neurogenic bladder and/or bowel dysfunction during acute care immediately following SCI. A secondary aim was to translate these findings into an accessible policy for clinical staff involved in the care of acute SCI patients. Methods A literature review was performed to identify the protocols and research describing the management of bladder and bowel dysfunction after acute SCI. The measures extracted were principles of practice, threshold measures and evaluation tools, and timelines of best care. Key findings relating to assessment, management and identification of the benefits of adhering to a protocol of clinical practice were summarised. Fidelity with evidence identified was evaluated, and practice gaps were recognised. Results A total of 12 papers and six guidelines for providing excellent care to patients with SCI were identified. Overall, a systematic and comprehensive assessment of bladder and bowel function and neurological impairment should be completed early following SCI. Management is best individualised to both prevent known sequelae and optimise current function and quality of life. Acute SCI bladder and bowel management pathways were developed based on evidence identified. Conclusions The study has identified that timely assessment and management of patients with spinal cord neurogenic bladder and/or bowel dysfunction during the acute phase is pivotal to optimising continence and mitigating risk of preventable harm prior to discharge to specialised spinal rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: To map available scientific evidence about the pediatric population with spina bifida submitted to transanal irrigation to manage signs and symptoms of neurogenic bowel. Source of data: This research was developed according to recommendations from the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Reviews. Searches were carried out in the databases: CINAHL, Medline/Pubmed, Scielo, Scopus, Web of Science, Embase, LILACS, Proquest, and the CAPES catalog of theses and dissertations. Quantitative and qualitative studies on the topic were included, as long as they dealt with this population. There was no predetermined time frame. Summary of the findings: The authors found 1.020 studies, selected 130 for close reading, and included 23 in the review, all of which had been published from 1989 to 2021. The authors mapped the characteristics of the studies, including their definitions of concepts and use of scales, criteria for the indication of transanal irrigation, training to carry out the procedure, devices and solutions used, number and frequency of transanal irrigations, health care actions, time spent, associated complications, complementary exams, adherence rate, follow-up, and outcomes, focusing on the benefits for bowel management. Conclusions: Despite the variability of evaluation parameters and term definitions, evidence suggests that transanal irrigation is a safe and effective method to manage fecal incontinence. Studies in the field are likely to grow, using standardized scales and longitudinal follow-ups. The authors suggest further research on transanal irrigation in the pediatric population with spina bifida in the Latin American context.

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Background: Neurogenic bowel is a dysmotility disorder following spinal cord injury (SCI) that negatively impacts quality of life, social integration, and physical health. Colonic transit is directly modulated by the enteric nervous system. Interstitial Cells of Cajal (ICC) distributed throughout the small intestine and colon serve as specialized pacemaker cells, generating rhythmic electrical slow waves within intestinal smooth muscle, or serve as an interface between smooth muscle cells and enteric motor neurons of the myenteric plexus. Interstitial Cells of Cajal loss has been reported for other preclinical models of dysmotility, and our previous experimental SCI study provided evidence of reduced excitatory and inhibitory enteric neuronal count and smooth muscle neural control. Methods: Immunohistochemistry for the ICC‐specific marker c‐Kit was utilized to examine neuromuscular remodeling of the distal colon in male and female rats with experimental SCI. Key Results: Myenteric plexus ICC (ICC‐MP) exhibited increased cell counts 3 days following SCI in male rats, but did not significantly increase in females until 3 weeks after SCI. On average, ICC‐MP total primary arborization length increased significantly in male rats at 3‐day, 3‐week, and 6‐week time points, whereas in females, this increase occurred most frequently at 6 weeks post‐SCI. Conversely, circular muscle ICC (ICC‐CM) did not demonstrate post‐SCI changes. Conclusions and Inferences: These data demonstrate resiliency of the ICC‐MP in neurogenic bowel following SCI, unlike seen in other related disease states. This plasticity underscores the need to further understand neuromuscular changes driving colonic dysmotility after SCI in order to advance therapeutic targets for neurogenic bowel treatment. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a serious medical condition which can lead to many complications, resulting in significant disability and morbidity in individuals. YouTube is one of the largest online platforms and also a potential source of information for patients. We aimed to analyze Youtube videos in terms of the reliability and quality levels on sexual dysfunction (SD), "neurogenic bladder (NBL)" and "neurogenic bowel (NBW)" in this study. YouTube search was performed on April 24th, 2022, about SCI and sexual dysfunction, neurogenic bladder and neurogenic bowel. DISCERN and Global Quality Score (GQS) were used to evaluate the quality and reliability of the videos. The characteristics of each video such as the number of likes and views, upload date, duration, popularity index were recorded. A total of 50 videos were analyzed. When the videos were evaluated according to their DISCERN scores, they were mostly categorized as "poor" quality and they were classified as medium-low quality due to their GQS scores. The rate of videos based on "patient experience" was 40%. The quality of the videos about "Sexual dysfunction" was significantly higher than the videos about "neurogenic bladder" and "neurogenic bowel". Neurogenic bowel videos were mostly uploaded by non-professional sources and had the lowest DISCERN scores. Most of the Youtube videos about sexual dysfunction, neurogenic bladder and neurogenic bowel after spinal cord injury, are helpful but low-to-medium quality videos. Although the videos included some basic topics, they did not provide enough information and were "limited use" videos for patients' use. [ABSTRACT FROM AUTHOR]

Purpose of review: In this review, the current literature available to patients and providers regarding neurogenic bowel dysfunction as it relates to the treatment of neurogenic bladder dysfunction will be addressed. Topics include the common pathophysiologic pathways, and the management of fecal incontinence and constipation that can occur simultaneously with urinary incontinence or retention, or which may result from the treatment of urinary incontinence or retention. Recent findings: The availability of newer pharmacotherapeutics, and the adoption of chemodenervation, nerve stimulation and neuromodulation has added to the armamentarium that providers have for treating this difficult clinical constellation. And while there have not been dramatic advances in the surgical management of neurogenic bladder, our understanding of the side effects of surgery continues to evolve. Summary: Until there is a cure for traumatic and other acquired myelopathies, the urologist remains the specialist best suited to manage the subsequent urinary retention and incontinence. Virtually all interventions can have an effect, either ameliorative or adverse on the symptoms and management of concomitant neurogenic bowel dysfunction. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. Methods: This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. Results: We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. Conclusions: The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.