By Riva Preil
Individuals who have endured a spinal cord injury (SCI) often experience colorectal and anal sphincter dysfunction generally referred to as neurogenic bowel dysfunction (NBD). NBD includes constipation (in up to 80% of individuals), fecal incontinence (in up to 75% of individuals), and abdominal pain. In fact, approximately one-third of individuals who have sustained a SCI develop abdominal pain ten years or more post injury.
Approximately 50% of individuals who suffer SCI experience neuropathic pain, pain caused by damage or disease that affects the nervous system (refer to picture below regarding nervous system connections to the stomach). The nature of this delayed onset abdominal pain is not fully understood. Is the abdominal pain experienced by individuals with SCI neuropathic in nature or is it visceral (organ related) in nature similar to classic constipation and abdominal pain? Practically speaking, if the abdominal pain experienced by patients post-SCI is similar to visceral chronic idiopathic constipation (CIC) experienced by able-bodied individuals, then the same treatment that benefits those with CIC can also benefit patients with SCI.
Researchers at the Aarhus University Hospital in Denmark recently explored this topic. The study included 21 individuals who had sustained SCI and 15 individuals with CIC. They used radiopaque markers to assess the gastrointestinal transit time (GITT) over the course of a week. GITT reflects the colorectal transit time, also known as the amount of time it takes for food to pass from one end of the gastrointestinal system to the other end.
Although participants with SCI generally had longer GITT scores, there appeared to be very little association between GITT scores and pain levels. Participants also rated their pain levels with an assessment tool called the Cleveland Constipation Score. 81% of patients with SCI and 93% of patients with CIC reported abdominal pain within the past month. Approximately 50% of participants in both groups experienced increased postprandial (post-eating) abdominal pain. This supports the theory that abdominal pain is of visceral origin.
Therefore, even though there is probably a neuropathic component to abdominal pain amongst individuals with SCI, it is likely that there is an even stronger visceral component. This means that the same interventions that benefit individuals with CIC can also benefit patients with SCI who experience abdominal pain.
Fortunately, pelvic floor physical therapists are trained to treat bowel dysfunction. Treatment includes ILU colon massage, diaphragmatic breathing, proper toileting position, and education on proper usage of pelvic floor muscles. If your or someone you know experiences CIC or SCI related abdominal pain, please share the good news with them–physical therapy can help! We here at Beyond Basics Physical Therapy would be privileged to facilitate you along your road to recovery. Please contact us if you have any questions- we would love to have the opportunity to help.