NURSING CARE IN BOWEL RE-EDUCATION PROGRAMS FOR PATIENTS WITH NEUROGENIC BOWEL

bibliographic, descriptive, integrative review type study of articles published between 2011 and 2021 in the LILACS, SciELO, BDENF, SCOPUS, and PubMed databases, using the descriptors “Neurogenic Bowel”; “Constipation”; “Nursing”; “Neurogenic Bowel”; “Constipation” and “Nursing”. The analysis was performed through reflective and careful reading about the theme of the study.

Results:

it was perceived that the most frequently performed nursing care in patients with neurogenic bowel included: bowel massage, abdominal press, vessel training, digit-anal stimulation, transanal irrigation, and use of suppositories, contributing positively to the institution of an effective and safe Bowel Re-education Program.

Conclusion:

the present study contributes to the nursing care actions of patients with NB and to the dissemination of findings on the benefits of the Bowel Reeducation Program.

DESCRIPTORS:
Health Care; Nursing Care; Nursing; Neurogenic Bowel; Rehabilitation

Main Author Year/ Country	Journal/ Qualis/ Type of Study/ Level of Evidence	Objetive	Results/ Conclusion
Engler⁹9 Engler TMN de M, Farage L, Mello PA de. Cons2dctipação intestinal em pacientes admitidos em Programa de Reabilitação Neurológica. Acta Paul. Enferm. (Online). [Internet]. 2011 [cited in 2020 Nov. 17]; 24(6):804-9. Available in: https://doi.org/10.1590/S0103-21002011000600013. https://doi.org/10.1590/S0103-2100201100... 2011/ Brazil	Acta paul. enferm. (A2) Cohort / IV	To know the prevalence of constipation in patients admitted for rehabilitation and to verify the results of two models of conduct instituted for bowel re-education during hospitalization.	Increased fluid intake, respect for the gastrocolic reflex, abdominal massage, and stimulation of defecation daily after breakfast improve functional capacity, bowel frequency, and have been shown to play an important role in improving bowel habit.
Mcclurg¹⁰10 McClurg D, Hagen S, Hawkins S, Lowe-Strong A. Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study. Int. MS j. [Internet]. 2011 [cited in 2020 Dec. 25]; 17(2):223-33. Available in: https://doi.org/10.1177/1352458510384899. https://doi.org/10.1177/1352458510384899... 2011/ Ireland	Int. MS j. (C) Randomized Clinical Trial/ II	To determine the feasibility of performing abdominal massage in people with Multiple Sclerosis.	The results suggested a positive effect of the abdominal massage intervention in improving constipation symptoms.
Faleiros¹¹11 Faleiros F, Paula EDR de. Paralisia cerebral tetraplégica e constipação intestinal: avaliação da reeducação intestinal com uso de massagens e dieta laxante. Rev. Esc. Enferm. USP. [Internet]. 2013 [cited in 2020 Dec. 26]; 47 (04). Available in: https://www.scielo.br/j/reeusp/a/PxhxsShqjGsMgqg8jWmMmrs/abstract/?lang=pt. https://www.scielo.br/j/reeusp/a/PxhxsSh... 2013/ Brazil	Rev. Esc. Enferm. USP. (A2) Prospective and Comparative/ IV	To evaluate outcomes of nursing interventions in the treatment of constipation associated with cerebral palsy.	The patient was advised to consume laxative foods and vegetable oils on a daily basis, increase water intake, and perform daily bowel maneuvers. There was total or partial relief of constipation in 90%, improved sleep, decreased irritability, rectal bleeding, anal fissure, voluntary retention of stool, crying, and pain when defecating.
Engkasan¹²12 Engkasan JP, Sudin SS. Neurogenic bowel management after spinal cord injury: Malaysian experience. J. Rehabil. Med. [Internet] 2013 [cited in 2020 Nov. 11]; 45(2): 141-4. Available in: https://doi.org/10.2340/16501977-1074. https://doi.org/10.2340/16501977-1074... 2013/ Malaysia	J. rehabil. med. (A2) Transversal/ VI	To describe the bowel programs used by individuals with spinal cord injury; and to determine the association between the outcome of bowel programs and various interventions to facilitate defecation.	Digito-anal stimulation techniques, suppository use, manual evacuation, stimulation of the skin around the anus, dietary modifications, and abdominal massages increased evacuation satisfaction in patients with neurogenic bowel.
Ozisler¹³13 Ozisler Z, Koklu K, Ozel S, Unsal-Delialioglu S. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regen. Res. [Internet]. 2015 [cited in 2020 Nov. 05]; 10(7): 1153-8. Available in: https://doi.org/10.4103/1673-5374.160112. https://doi.org/10.4103/1673-5374.160112... 2015 Turkish	Neural Regen Res (B1) Randomized Clinical Trial/ II	To determine gastrointestinal problems associated with neurogenic bowel and dysfunction in patients with spinal cord injury, and to evaluate the effectiveness of the bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction.	The institution of a Bowel Reeducation Program with digit-anal stimulation maneuvers, abdominal massage, and Valsalva maneuvers reduced the need for the patient to use enemas and laxative medications frequently. In addition, they reduced symptoms of constipation, incontinence and abdominal distension.
Emmanuel²2 Emmanuel A, Kumar G, Christensen P, Mealing S, Storling Z, Andersen F, et al. Long-term cost-effectiveness of transanal irrigation in patients with neurogenic bowel dysfunction. PLoS One. [Internet]. 2016 [cited in 2020 Nov. 25]; 11 (8): e0159394. Available in: https://doi.org/10.1371/journal.pone.0159394. https://doi.org/10.1371/journal.pone.015... 2016 England	PLoS One (A2) Deterministic Study/ IV	Investigate the long-term cost-effectiveness of initiating transanal irrigation in patients with neurogenic bowel who have failed standard bowel treatment.	Transanal irrigation was found to be a treatment strategy that provided cost savings, reduced the risk of stoma surgery, urinary tract infections, episodes of fecal incontinence, and improved bowel dysfunction in cases of conservative treatment failure.
Campoy⁴4 Campoy LT, Rabeh SAN, Castro FFS, Nogueira PC, Terçariol CAS. Bowel rehabilitation of individuals with spinal cord injury: video production. Rev. Bras. Enferm. [Internet]. 2018 [cited in 2020 Sept 03]; 71(5): 2376-82. Available in: https://doi.org/10.1590/0034-7167-2017-0283. https://doi.org/10.1590/0034-7167-2017-0... 2018 Brazil	Rev. bras. enferm. (A2) Methodological study/ VII	Produce and validate an educational video on bowel emptying maneuvers to empower individuals with neurogenic bowel in the process of bowel rehabilitation.	The video contributes to the education of individuals with neurogenic bowel by teaching abdominal massage, abdominal press, rectal stimulation, vessel training, and Valsalva maneuver.
Burns¹⁴14 Burns AS, St-Germain D, Connolly M, Delparte JJ, Guindon A, Hitzig SL, Craven BC. Phenomenological study of neurogenic bowel from the perspective of individuals living with spinal cord injury. Arch. phys. med. rehabil. [Internet]. 2015 [cited in 2020 Nov. 07]; 96(1):49-55. Available in: https://www.sciencedirect.com/science/article/abs/pii/S000399931400968X#!. https://www.sciencedirect.com/science/ar... 2018 Canada	Arch. phys. med. rehabil. (A1) Phenomenological study/ IV	To gain a greater understanding of the life experience of individuals with spinal cord injury and neurogenic bowel dysfunction.	Use of suppositories, transanal irrigation, digital stimulation, health education support, and the flexibility of work schedules presented themselves as the main outcomes of the positive experience.
Todd¹⁵15 Todd C, Woodward S. Experience of nurses caring for patients with neurogenic bowel dysfunction: A qualitative study. J. wound. ostomy continence nurs. [Internet]. 2018 [cited in 2020 Nov. 10]; 45(2): 163-167. Available in: https://doi.org/10.1097/WON.0000000000000413. https://doi.org/10.1097/WON.000000000000... 2018 England	J. wound ostomy cont. nurs. (A2) Qualitative study/ VI	To explore the experience and perceptions of nurses providing bowel care to patients after spinal cord injury.	Despite performing digital stimulation and using suppositories, many nurses reported not feeling confident about the Bowel Reeducation Program due to lack of training, the training of which may help to decrease the stigma surrounding care delivery.
Rodrigues¹⁶16 Rodrigues BD e S, Buzatti KC de LR, Quintão NPD, Oliveira GM, Pinheiro MM, Rodrigues, FP, et al. Standardization of the technique to perform the transanal therapeutic irrigation. J. coloproctol. (Rio J., Impr.). [Internet]. 2018 [cited in 2020 Nov. 20]; 38(4): 351-355. Available in: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-93632018000400351&lng=en. http://www.scielo.br/scielo.php?script=s... 2018 Brazil	J. coloproctol. (Rio J., Impr.). (B3) Methodological study/ VII	To present a standardization of the therapeutic transanal irrigation technique.	Transanal therapeutic irrigation is an effective, well-tolerated and safe procedure, which is more suitable when compared to standard clinical treatment.
Zhang¹⁷17 Zhang Y, Xia X, Zhuang X. Effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. J. Clin. Nurs. [Internet]. 2018 [cited in 2020 Nov. 15]; 27(5-6); e1146-e1151. Available in: https://doi.org/10.1111/jocn.14198. https://doi.org/10.1111/jocn.14198... 2018 China	Journal of Clinic Nursing (B1) Randomized Clinical Trial/ II	To study and compare between two groups, the effect of nursing intervention based on quantitative assessment on bowel function and quality of life in patients with neurogenic bowel dysfunction after spinal cord injury.	Nurse guidance for diet, abdominal massage, potty training, abdominal press, Valsalva maneuver and rectal stimulation decreased bloating, constipation, prolonged defecation, fecal incontinence, and use of evacuation drugs in the patients in the intervention group.
Yin¹⁸18 Yin, Q; Wang, C; Yu, J; Zhang, Q. Quantitative assessment-based nursing intervention improves bowel function in patients with neurogenic bowel dysfunction after spinal cord injury. Medicine. [Internet]. 2020 [cited in 2021 Jan. 10]; 99(51): e23354. Available in: https://doi.org/10.1097/MD.0000000000023354. https://doi.org/10.1097/MD.0000000000023... 2020 China	Medicine (A2) Randomized Clinical Trial/ II	To implement a program to evaluate the impact of nursing interventions based on quantitative assessment on quality of life and bowel function in patients with neurogenic bowel dysfunction after spinal cord injury.	Nurse guidance for diet, abdominal massage, potty training, abdominal press, Valsalva maneuver and rectal stimulation decreased bloating, constipation, prolonged defecation, fecal incontinence, and use of evacuation drugs in the patients in the intervention group.
Azevedo¹⁹19 Azevedo MAR, Lisboa LL, Medeiros CEB de, Almeida VA de, Gonçalves RP. Terapia comportamental associada a neuromodulação no tratamento da bexiga e intestino em indivíduos com Parkinson: um estudo piloto. Rev. Pesqui. Fisioter. [Internet]. 2021 [cited in 2021 Apr. 13]; 11(1):50-58. Available in: https://doi.org/10.17267/2238-2704rpf.v11i1.3313. https://doi.org/10.17267/2238-2704rpf.v1... 2021 Brazil	Rev. Pesqui. Fisioter. (B5) Randomized Clinical Trial/ II	To evaluate the effects of behavioral therapy associated with neuromodulation on neurogenic bladder and bowel in Parkinson’s Disease.	Positioning when evacuating, diaphragmatic breathing. diaphragmatic breathing technique, adequate fluid intake, therapeutic abdominal massage, and regular practice of physical exercises related to neuromodulation were associated with improved frequency of bowel movements, greater stool consistency, and elimination of straining to evacuate.

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[1] Corresponding author: Geyslane Pereira Melo de Albuqueruque Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP-USP) Av. Bandeirantes, 3900, CEP 14040-902 - Ribeirão Preto, SP, Brasil. E-mail: lanninha_pereira@hotmail.com

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NURSING CARE IN BOWEL RE-EDUCATION PROGRAMS FOR PATIENTS WITH NEUROGENIC BOWEL* * Article extracted from the master’s/PhD thesis “Construção e validação de Protocolo de Reabilitação Intestinal do Intestino Neurogênico”, Universidade de Pernambuco, Recife, PE, Brasil, 2022.

HIGHLIGHTS

ABSTRACT

Objective:

Method:

Results:

Conclusion:

NURSING CARE IN BOWEL RE-EDUCATION PROGRAMS FOR PATIENTS WITH NEUROGENIC BOWEL^* * Article extracted from the master’s/PhD thesis “Construção e validação de Protocolo de Reabilitação Intestinal do Intestino Neurogênico”, Universidade de Pernambuco, Recife, PE, Brasil, 2022.