Neurogenic Bowel Dysfunction Changes after Osteopathic Care in Individuals with Spinal Cord Injuries: A Preliminary Randomized Controlled Trial

Abstract

Background: Neurogenic bowel dysfunction (NBD) indicates bowel dysfunction due to a lack of nervous control after a central nervous system lesion. Bowel symptoms, such as difficulties with evacuation, constipation, abdominal pain and swelling, are experienced commonly among individuals with spinal cord injury (SCI). Consequentially, individuals with SCI experience a general dissatisfaction with the lower perceived quality of life (QoL). Several studies have demonstrated the positive effects of manual therapies on NBD, including Osteopathic Manipulative Treatment (OMT). This study aimed to explore OMT effects on NBD in individuals with SCI compared with Manual Placebo Treatment (MPT).

Methods: The study was a double-blind randomized controlled trial composed of three phases, each one lasting 30 days (i: NBD/drugs monitoring; ii: four OMT/MPT sessions; iii: NBD/drug monitoring and follow-up evaluation).

Results: the NBD scale, the QoL on worries and concerns sub-questionnaire, and the perception of abdominal swelling and constipation significantly improved after treatments compared to baseline only for individuals who underwent OMT.

Conclusion: These preliminary results showed positive effects of OMT on bowel function and QoL in individuals with SCI, but further studies are needed to confirm our results.

Keywords: constipation; enteric nervous system; neurogenic bowel dysfunction; osteopathic manipulative treatment; spinal cord injury; swelling.

Figure 1

Flow chart of the study.

Figure 2

Neurogenic Bowel Dysfunction (NBD) scale results collected at E0, E1, E2, E3 were reported for both Osteopathic Manipulative Treatment (OMT) (red lines) or Manual Placebo Treatment (MPT) (green lines) groups; * = p < 0.05.

Figure 3

Knowles Eccersley Scott Symptom (KESS) scale and the Individual Assessment of Constipation–Quality of Life (PAC–QOL) questionnaire results collected at E0, E1, E2, E3 were reported for both OMT (red lines) or MPT (green lines) groups; * = p < 0.05.

Figure 4

Visual Analogue Scales (VAS) results about individuals’ perception of pain, swelling and constipation before (pre) and after (post) each OMT or MPT session were reported for both OMT (red lines) or MPT (green lines) groups; * = p < 0.05.

Figure 5

Daily bowel diary data. (a) Spontaneous bowel movements (%—grey columns) or bowel movements after administering enema (%—black columns) are reported with the related Bristol Stool Chart (BSC) score; (b) % of incontinence episodes variation during the treatment period compared to the observational period before OMT or MPT sessions and to the follow-up one for the OMT group (OMTg) (red columns) and MPT group (MPTg) (green columns). “-“ refers to a reduction into faecal incontinence, while “+”refers to an increment into faecal incontinence.

Figure 6

Localization of treated and assessed somatic dysfunctions reported for the different body regions according to somatic dysfunction classifications in OMTg.

Figure 7

Techniques selected for the treatment of the different somatic dysfunctions in OMTg (%).