SCI and the bowel ..... does that sound like a band?

OK, maybe not.

A couple of papers caught my attention today on bowel function.

More than 90% of acute and between 30-50% of chronic patients have bowel incontinence and/or diarrhoea. Even long after injury most individuals require at least one method to facilitate defecation when constipation and faecal retention are prevalent.

Andrew Gaudet, University of Colorado Boulder [#142.16] presented a nice piece of work being carried out in his lab on a rodent model/study of bowel function after SCI. SCI rats show characteristic alterations in body mass - losing weight initially before slowly regaining much of it - coupled with a compensatory increase in food intake during the weight recovery phase. Interestingly, transit time (bit of blue dye in the diet and time how long it takes for the poo to come out blue is their simple and effective way to measure this) is reduced which, Gaudet suggests could be seen as a correlate of incontinence.

With the increased food intake there is a corresponding increase in faecal output. His group also found a disruption to the normal circadian rhythms. As with humans, rats poo less at night. After SCI this distinction is abolished, they found. Other circadian rhythms are also disturbed. Temperature and general activity no longer follow the typical day/night cycle.

It's a small but important start towards developing models and understanding of bowel function in the SCI rodent, which is needed. Hopefully more will follow and we can start looking at developing treatments that address recovery of bowel function rather than merely manage it.

Which brings me to the poster of April Herrity, University of Louisville [#158.11]. Herrity is part of the Harkema team, famed for the work on epidural stimulation (ES) on patients that results in voluntary inducible stand/stepping outcomes in ASIA A patients, for example. In the papers about this work, Harlema et al., reported non-locomoter benefits to ES. These are being more systematically examined now.

Study of exercise and locomotor training (LT) on the bladder can be traced back as far as the 1930's. As a precursor to a poster presented tomorrow, Herrity's presented findings on the effect of LT in patients with SCI on not only bladder but also bowel and sexual function and the results were pretty interesting.

By LT they mean 80 treadmill sessions of 1 hr duration, 5 times per week. Eight patients (a mix of AIS A to D) where studied. If you're interested in your urodynamics, bladder capacity increased (105 ml to 205 ml), contraction duration  improved, there was a reduction in leak point pressure, improvements in bladder muscle responsiveness and contractability and voiding efficiency improved from 40% to 80%. Bladder compliance - that's the ability of the bladder to maintain safe pressure - also improved.

Other benefits included reduction in bladder medication, less time needed for bowel management and increased sexual desire. The poster reporting results from combining LT with epidural stimulation will be presented tomorrow.