Improving ward-based neurogenic bladder and bowel care after acute spinal cord injury: a narrative review.

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]