The National Rehabilitation Center for Persons with Disabilities was designated as the WHO Collaborating Centre for Disability Prevention and Rehabilitation in The terms of reference are To collaborate with WHO in the development of knowledge and resources for increasing access to quality health, rehabilitation services and sports for persons with disabilities in the Western Pacific Region To support and cooperate with WHO to conduct capacity development activities and share good practice and experiences regarding disability and rehabilitation across the region To work with WHO to increase the awareness and understanding of the needs and rights of persons with disabilities. National Rehabilitation Center for Persons with Disabilities WHO Collaborating Centre for Disability Prevention and Rehabilitation Note: This manual is published by National Rehabilitation Center for Persons with Disabilities which is a WHO Collaborating Centre, and it is not a publication of WHO. The publisher is responsible for the views expressed in this manual, and it doesn’t necessarily represent the decisions or policies of the World Health Organization. Rehabilitation Manual Manual for Bowel Management in Persons with Spinal Cord Injury July 31,2013 Editor Masami AKAI National Rehabilitation Center for Persons with Disabilities Kozo Nakamura, MD, PhD, President, Namiki, Tokorozawa City, Saitama Prefecture 359-8555, Japan Tel 81-4-2995-3100 Fax Email firstname.lastname@example.org
PREFACE Spinal cord injury causes bladder and bowel disturbance that affect the everyday lives of the injured persons. Despite being able to independently transfer from a wheelchair, these persons still have excretion difficulties because of injury to the autonomic nervous system. Bladder and bowel disturbance involve 2 disorders dysuria and dyschezia. In dysuria, a regular urological followup is essential even after urinary independence is achieved after urethral self-catheterization, because traditionally, renal failure affects prognosis. In contrast, dyschezia has received less attention. It is not well known that many persons with dyschezia need several hours fora single defecation, despite being able to evacuate every several days. For such persons, diet should be carefully considered many drugs, including oral medicine, are administered and fecal disimpaction is performed. Nevertheless, there are currently useful information other than empirical data This manual provides information on all aspects of bowel management, and I hope that the readers will find it useful.