In individuals with high lesion levels, bowel care routines can exacerbate cardiovascular dysfunction by eliciting a condition known as autonomic dysreflexia (AD). This profound cardiovascular impairment is a key concern for individuals living with SCI and is linked to high cardiovascular morbidity and mortality following SCI. Individuals with high lesion levels (at or above T6) also commonly experience injury to the autonomic sympathetic nerves responsible for heart rate and blood pressure control. LMN lesions also result in loss of voluntary control of the bowel, but are accompanied by loss of sacral reflexive control with a lax external sphincter, resulting in a high frequency of faecal incontinence-an areflexive bowel. This often results in a spastic sphincter, with constipation and faecal retention that require intervention to trigger defecation -a hyperreflexive bowel. UMN lesions maintain reflex activity in the sacral segments of the cord, resulting in loss of voluntary bowel control, with preservation of reflexive defecation. Accordingly, NBD is classified as upper motor neuron (UMN) dysfunction or lower motor neuron (LMN) dysfunction, depending on whether the injury level is above or below the conus medullaris (L1), respectively. This neurogenic bowel dysfunction (NBD) is highly dependent on the level of injury. īowel impairments after SCI are primarily related to the impact of injury on gastrointestinal function, as the coordination of gastrointestinal motility is dependent on central motor and autonomic control, as well as intrinsic regulation by the enteric nervous system. We recently reported that bowel care concerns profoundly impact quality of life for community-dwelling individuals living with SCI, who identified bowel management as a key modifiable factor with the potential to improve their quality of life. In particular, autonomic dysfunction adversely impacts cardiovascular control and bowel function for individuals living with SCI, with the former complicating the latter. This loss of autonomic function occurs independently of motor and sensory disturbances, and impacts a range of physiological processes. In addition to the well-known loss of motor and sensory function following traumatic spinal cord injury (SCI), autonomic function is also severely impaired. Our findings contradict recommendations for lidocaine use during bowel care, suggesting that anaesthetic lubricants impair reflex bowel emptying, resulting in longer care routines with an increased burden of AD. ConclusionsĪt-home bowel care was a potent trigger for AD. Heart rate and rhythm disturbances were increased during AD, particularly with lidocaine use. beat p = 0.018) indicating a higher burden of AD.
Overall, SAP was higher for longer with lidocaine (6.5 × 10 5 ± 0.9 × 10 5 mmHg All participants experienced AD on both days, but maximum SAP was higher with lidocaine (214.3 ± 10.5 mmHg) than placebo (196.7 ± 10.0 mmHg p = 0.046).
Participants displayed reduced autonomic function (LF SAP 3.02 ± 0.84 mmHg 2), suggesting impaired autonomic control.
Injury to spinal autonomic (sympathetic) nerves was determined from low-frequency systolic arterial pressure (LF SAP) variability. Participants ( n = 13 age 44.0 ± 3.3 years) with high-level SCI (C3-T4) performed their normal at-home bowel care on two days, each time using a different lubricant, with continuous non-invasive cardiovascular monitoring. The objective of this study was to assess whether lidocaine lubricant (Xylocaine 2%) ameliorates AD during at-home bowel care compared with standard lubricant (placebo). Lidocaine lubricant is recommended during bowel care with the rationale to minimise the sensory stimulus, reducing AD. AD can be life threatening so strategies to minimise AD are prioritised after SCI. Bowel care is a potential trigger for autonomic dysreflexia (AD paroxysmal hypertension elicited by sensory stimuli below the level of lesion). Spinal cord injury (SCI) impacts autonomic function and bowel management.
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