The effect of neuromuscular electrical stimulation on bowel management in people with chronic spinal cord injury-An IDEAL 2a pilot study.

Abstract

Spinal cord injury (SCI) disrupts autonomic function, often impairing bowel control. About 14% of individuals require over an hour for defaecation, limiting social participation. This trial evaluated the effect of 16 weeks of neuromuscular electrical stimulation (NMES) on defaecation time, bowel transit time, bowel and bladder function and satisfaction in individuals with chronic SCI. Participants with SCI more than 1 year post injury (AIS A-D, C5-L3) applied home-based NMES to the abdominal wall for 30 min before scheduled defaecation. Stimulation intensity was set to elicit strong but tolerable contractions. Five visits over 24 weeks assessed bowel and bladder function (Neurogenic Bowel Dysfunction Score, NBDS; Qualiveen Short Form). Defaecation time, frequency and bowel transit time (corn test) were recorded. Feasibility was assessed using two questions. The study was designed in accordance with IDEAL framework Stage 2a recommendations for surgical and device-based innovations. Twenty participants completed the study. Defaecation time was reduced by 8.0 min (95% CI 4.2-11.9, p < 0.001) and bowel transit time by 32.5 h (95% CI 4.0-61.1, p = 0.031). Satisfaction with bowel management improved (+1.5 points, p = 0.011), while NBDS and Qualiveen scores remained unchanged. Defaecation time regressed to baseline following cessation of the intervention. The participants confirmed that NEMS was convenient to use. No serious adverse events were reported. NMES significantly improved defaecation and transit times in people with chronic SCI. Though effects were not sustained post-intervention, continued NMES use suggests clinical relevance as a non-invasive bowel management strategy. The trial is registered to ClinicalTrials.gov under NCT04914975.