Transanal irrigation to treat chronic constipation in patients with spinal cord injury: a case study
This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient's suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse.
Transanal irrigation is a conservative bowel management treatment for constipation that allows washout of the lower bowel, descending colon (up to the splenic flexure), and is used as an alternative to surgery (Yates, 2019). Instillation of warm or tepid tap water at 36–38°C (Henderson et al, 2018) produces rectal distension and is thought to stimulate peristalsis, which can greatly improve the symptoms and reduce the severity of chronic constipation. It is self-administered by the patient at home, or by carers, family members or community nursing teams after adequate training in the use of equipment designed for this purpose. It is minimally invasive, safe and effective in the management of chronic constipation.
Definitions of chronic constipation vary. To some, the term ‘chronic constipation’ means infrequent bowel movements for prolonged periods of time, often weeks, whereas to others it means experiencing straining or difficulty in evacuating the stool for at least 3 months (Emmett et al, 2015).
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