Patient Safety Information: spinal cord lesion and bowel care

This patient safety information leaflet warns healthcare staff that patients with an established spinal cord lesion are at risk of developing autonomic dysreflexia if their specific bowel care needs are not met.

Some people with an established spinal cord lesion depend on manual bowel evacuation (the digital removal of faeces) as their routine method of bowel care because they have lost normal bowel function. Manual evacuation is rarely undertaken in NHS acute trusts and is unfamiliar to many nurses.

Autonomic dysreflexia is unique to people with a spinal cord lesion. It can result in the bowel becoming distended due to constipation or impaction and is considered a medical emergency. Outcomes can include cerebral haemorrhage, seizures and cardiac arrest.

The National Reporting and Learning Service recommends NHS organisations providing acute care take the following actions:

1. Have a policy for manual bowel evacuation.

2. Ensure nursing staff in all care areas are aware of:

• the risks associated with these patients developing constipation or an impacted bowel;
• the potential harmful outcomes of developing autonomic dysreflexia; and
• how to access staff able to undertake a manual evacuation.

3. Ensure experienced healthcare staff are available to undertake and teach the procedure.

4. Recognise that these patients are experts in managing their bowel care.