Physiology and management of bladder and bowel continence following spinal cord injury

Patients with spinal cord injury commonly develop bladder and bowel symptoms that can affect their quality of life. The level of spinal cord injury is an important factor in considering bladder and bowel management strategy options to facilitate re-establishment of some level of elimination control. Bladder management involves choosing a drainage method appropriate to individual capabilities; options include clean intermittent or indwelling catheterization, Credé's method, reflex voiding, and surgical options. Bowel management strategies incorporate schedule, nutrition, stimulation, and surgical approaches. Bladder and bowel management regimens must include a thorough physical evaluation, patient/caregiver education, follow-up care, and a multidisciplinary team approach. Additional research to help clinicians recommend safe, effective, and evidence-based elimination management strategies to patients with spinal cord injuries is needed.