Initial bowel management

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Initial bowel symptoms following spinal cord injury

The onset of paralytic ileus (a motility disorder of the intestine causing acute failure of peristalsis) may occur soon after acute injury to the spinal cord. There may be signs within minutes of cord injury or they may be delayed for up to 48 hours.

Paralytic ileus generally lasts 48-72 hours.

Unrecognised paralytic ileus can have serious consequences:

  • In a person with tetraplegia, decreased cough may lead to aspiration of gastric contents.
  • Progressive abdominal distension may contribute to ventilatory insufficiency by pressing up on the diaphragm and limiting its excursion.

Management of paralytic ileus

During paralytic ileus:

  • keep the person nil-by-mouth with a nasogastric tube inserted to decompress the stomach
  • administer intravenous fluid therapy to maintain hydration
  • check the rectum for the presence of stool on a daily basis
  • gently remove any stool manually, using a water-based lubricant.

After resolution of the paralytic ileus, when bowel sounds have returned and flatus passed, fluids and food can be gradually reintroduced, and a bowel management program commenced.

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