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Volume 41 Number 1, January/February 2004
    Pages 95 — 100


Abstract - Difficulty with evacuation after spinal cord injury: Colonic motility during sleep and effects of abdominal wall stimulation

Mark A. Korsten, MD; Noel R. Fajardo, MD; Alan S. Rosman, MD; Graham H. Creasey, MB, ChB, FRCSEd; Ann M. Spungen, EdD; William A. Bauman, MD

Department of Veterans Affairs (VA) Rehabilitation Research and Development Center of Excellence, Spinal Cord Injury Services and Medical Services, VA Medical Center, Bronx, NY; Departments of Medicine, Rehabilitation Medicine, and Spinal Cord Damage Research Center, Mount Sinai School of Medicine, New York, NY; Louis Stokes VA Medical Center, MetroHealth Medical Center, and Case Western Reserve University, Cleveland, OH
Abstract — Difficulty with evacuation (DWE) is common in individuals with spinal cord injury (SCI). Numerous studies have concluded that constipation, impaction, and incontinence cause significant morbidity and, collectively, constitute an important quality-of-life issue in individuals with SCI. Colonic motor activity was assessed using a solid-state manometry probe. We report here that colonic pressure activity is depressed during sleep compared to that observed in able-bodied controls. In addition, pressure activity was decreased during sleep compared to pre-sleep and post-sleep. We suspect that this may contribute to delayed colon transit time after SCI. In addition, since contraction of the abdominal wall musculature plays a role in normal defecation, we assessed whether an abdominal belt with implanted electrodes would improve DWE. In this respect, we demonstrated that neuromuscular stimulation of the abdominal wall improves a number of indices of defecatory function, including time to first stool and total bowel care time.
Key words: bowel care, colon, constipation, difficulty with evacuation, motility, neuromuscular stimulation, spinal cord injury.

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