SCI is associated with common gastrointestinal abnormalities including gastroesophageal reflux (GERD); delayed gastric emptying time; altered colonic motility with increased transit time; severe constipation; prolonged bowel evacuation time; abdominal distention; and hemorrhoids. Such alterations will become evident in isolation or in combination depending on the extent and level of the SCI. GERD and delayed gastric emptying time are more commonly seen in tetraplegic patients. Ileus can be seen a few days after SCI and typically in patients with complete lesions. Patients with lesions above T12 will have a spastic anal sphincter, thus retaining reflex bowel emptying. However, patients with lesions below T12 will have a flaccid anal sphincter with accompanying loss of both reflexive and voluntary reflex bowel emptying.

All SCI patients should receive adequate peptic ulcer prophylaxis and a bowel care regimen from admission (Table 187.1). Gastrointestinal care starts with adequate fluid administration and dietary intake. Fluids are very important for stool consistency. It has been recommended that SCI patients should receive at least 2 to 3 liters of fluids daily. A diet high in fiber (at least 15 g/day) may be beneficial to increase stool bulk. If adequate dietary management does not improve bowel function, then pharmacologic treatments should be instituted. Agents that have been used include stool softeners such as docusate; stool bulk formers such as calcium polycarbophil, methylcellulose, psyllium, or
lactulose; stimulants of peristalsis and prokinetic agents such as senna; and contact irritants such as bisacodyl or glycerin suppositories. Such programs should be consistent but individualized depending upon the SCI severity, level of injury, patient’s lifestyle, and plans to return to work. During the acute phase of spinal shock the rectum is usually flaccid. Therefore patients may require manual removal of stool from the rectum daily. Patients with cervical or thoracic spine lesions may retain their reflexive bowel responses. Such patients can be managed with digital stimulation of the rectum, which results in reflexive bowel emptying. Patients with incomplete SCI may not require any specific treatment beyond the dietary recommendations