Spinal Cord 1996 May;34(5):277-283
Assessment of the effect of increased dietary fibre intake on bowel
function in patients with spinal cord injury.
Cameron KJ, Nyulasi IB, Collier GR, Brown DJ
Spinal Injuries Unit, Austin Hospital, Heidelberg, Victoria, Australia.
It is common for constipation to occur following severe spinal cord injury
(SCI). Although a bowel management program including a high fibre diet is
an integral part of rehabilitation, the effect of a high fibre diet on
large bowel function in SCI has not been examined. The aims of this study
were to assess the nutrient intake of SCI patients, to determine baseline
transit time, stool weight and evacuation time and to assess the effect of
addition of bran on large bowel function. Eleven subjects, aged 32 +/- 10.5
years participated in the study. The level of injury ranged from C4 to T12;
only one patient had an incomplete injury. Baseline mean energy intake was
7823 +/- 1443 kJ/d, protein intake 93 +/- 21 g/d, carbohydrate intake 209
+/- 39 g/d and mean dietary fibre intake 25 +/- 8 g/d. Mean baseline stool
weight was 128 +/- 55 g/d and bowel evacuation time was 13 +/- 7.4 min/d.
Three subjects who consumed < 18 g dietary fibre/d had low stool weights of
60-70 g/d and two had very delayed transit times that were too slow to
enable quantitation. Mean mouth to anus transit time was 51.3 +/- 31.2 h,
mean colonic transit time 28.2 +/- 3.5 h, right colonic transit time 5.9
+/- 4.5 h, left colonic transit time 14.5 +/- 5.2 h and rectosigmoid
colonic transit time 7.9 +/- 5.6 h. Following the addition of bran, dietary
fibre intake significantly increased from 25 g/d to 31 g/d (P < 0.001).
However, the mean colonic transit time increased from 28.2 h to 42.2 h (P <
0.05) and rectosigmoid colon transit time increased from 7.9 to 23.3 h (P <
0.02). Stool weight, mouth to anus, left and right colon transit time and
evacuation time did not change significantly. Results of this study suggest
that increasing dietary fibre in SCI patients does not have the same effect
on bowel function as has been previously demonstrated in individuals with
'normally functioning' bowels. Indeed the effect may be the opposite to
that desired. This preliminary study highlights the need for further
research to examine the optimal level of dietary fibre intake in SCI
patients.
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Spinal Cord 1997 Feb;35(2):116-120
Sequential treatment of chronic constipation in paraplegic subjects.
Badiali D, Bracci F, Castellano V, Corazziari E, Fuoco U, Habib FI,
Scivoletto G
Cattedra di Gastroenterologia I, Universita 'La Sapienza', Roma, Italy.
Chronic constipation is the main gastrointestinal complaint of spinal cord
injury (SCI) patients, and has a significant effect on patients' lives,
concerning nursing dependence, morbidity and complications. Many therapies
have been proposed to treat chronic severe constipation, most of them with
limited effect or being unpredictable in their effect or being expensive or
very radical. Ten spinal cord injury patients have been submitted to a
therapeutic protocol based on a high residue diet, a standardised water
intake, and on the use of a sequential schedule of evacuating stimuli.
After four weeks of treatment the patients showed an increased frequency of
bowel movements per week, a decreased total gastrointestinal transit time,
and a decreased need for oral and rectal laxatives. This treatment seems to
be effective in modifying patients' bowel habits, and therefore could be
considered as a standardised protocol for the management of severe
constipation in those who are paraplegic.
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Simon Kruithof PT