Bowel and Sexual Function: Changes after Neuro Injury

Question 1

Bowel management complications

Answer 1

Incontinence

impaction, pain or distension (can lead to AD)

Skin breakdown

Question 2

Sympathetic NS (segments and function relating to bowel)

Answer 2

T8-L2

maintain internal sphincter closure

Question 3

parasympathetic NS (segments and function relating to bowel)

Answer 3

S2-S4

inc. peristalsis

Relax anal sphincters

Question 4

Somatic NS (segments and function relating to bowel)

Answer 4

S2-S4

Striated muscle of external sphincter

anal sensation

Question 5

Primary reason for Bowl incontinence after CVA

Answer 5

cognitive factors

Question 6

Complete SCI & effect on bowel

Answer 6

disrupts voluntary and reflex control

key is whether the sacral reflex is intact

Question 7

Effects of SCI on bowel

Answer 7

Decreased gut motility (slow transit times for food, decrease colon compliance)

loss of rectal sensation

loss of reflex coordination of sphincters for defecation

Question 8

What will determine the bowel program?

Answer 8

Reflexive vs. Areflexive bowl

Question 9

Reflexive Bowel

Answer 9

S2-S4 are intact

internal sphincter will relax when the rectum is distended and the bowle can empty

Question 10

Areflexive Bowel

Answer 10

Injury to S2-S4

Loss of parasympathetic input causes a loss of evacuation reflex:

• internal sphincter is shut tight but EAS is flaccid
• Dry/harder stool forms => can lead to impaction or loss of EAS can lead to leakage

Question 11

Gioals for Bowel management strategies

Answer 11

Induce bowel movement at regular intervals

minimize episodes of incontinence

Question 12

Dietary factors affecting bowel management

Answer 12

Inc. Fiber and water in diet

by keeping stool soft

& Decreasing impaction

Question 13

Bowel Management strategies using meds

Answer 13

stool softeners (inc. water in stool, wont help continence useful when straining is an issue)

Laxatives/Enema (dec. effectiveness overtime)

Suppositories (contact irritant) for reflexive or areflexive, stimulate evacuation

Manual evacuation- areflexive: combined often with valsalva if safe, adaptive devices available to assist witht his

Question 14

Factors to consider while Bowl mmgt

Answer 14

Timing of meals witht he program

Positioning (sitting recommended)

must be made part of a daily routine

takes tiem for suppositories or an enema to work

Question 15

Management of reflexive bowel

Answer 15

Use suppositories followed by anal stimulation to trigger reflex evacuation.

Provide abdominal pressure to direct feces towards the rectum

if abs can contract increase pressure via valsalva if safe

Question 16

Management of areflexive bowel

Answer 16

Managed usually with suppositories followed by manual evacuation (harder more firm bowel easier to remove)

Question 17

Problem with sexual expression post stroke

Answer 17

Dec. in:

• Libido
• vaginal lubrication & erection
• Ejaculation
• Satisfactionw ith sex life

Comorbidities: DM, CAD, Depression

Question 18

Males normal physical function

Answer 18

Erection: psychogenic and reflexic (can use either or when injured)

Emission (typically injured n wont get ejaculation)

Ejaculation

Need cortical and spinal control for normal function

spinal shock first several weeks

Question 19

Orgasm

Answer 19

Cerebral, not just physical

SCI may have orgasms regardless of level of injury

Question 20

Fertility

Answer 20

Low in males secondary to poor sperm count & impaired erections/ejaculation

No change in females: high risk pregnancy due to AD, sensation issues

Question 21

Role of PT in sexual concerns

Answer 21

evaluation: physical capabilities/pscyhological issues

Education: counseling, teaching of A&P of sex, reaffirm sexuality, positioning