Bowel Function

Afferent Stimulation to Evoke Recto-colonic Reflex for Colonic Motility

Background

The investigators are testing the effect of electrical stimulation of the rectum on colonic motility. Most individuals with spinal cord injury develop neurogenic bowel dysfunction, which includes slowed colonic motility, which means that stools take longer than normal to pass through the colon. This slowed movement may result in chronic constipation and difficulty emptying the bowels. Individuals typically (without or without caregiver assistance) insert a gloved finger into the rectum and gently stretch it to improve colonic motility for a brief period to empty the bowels. The investigators hypothesize that electrically stimulating the rectum, instead of mechanically stretching it, will produce the same beneficial effect of improving colonic motility. Therefore, this study will compare the two methods. If electrical stimulation effectively improves colonic motility, then the investigator shall develop the approach as a therapeutic intervention in future studies.


About This Study

Objective/Specific Aims: Compare changes in colonic pressure (cmH2O) over baseline in response to electrical rectal stimulation versus mechanical rectal distension (control) [ Time Frame: 1 month ] [ Designated as safety issue: No ] Two interventions will be tested, including the clinical standard of digital rectal stimulation and a novel approach using electrical stimulation of rectal sensory afferents, to determine the effect on colonic pressure. Increased colonic pressure will indicate successful modulation of neural pathways to increase bowel activity and thereby facilitate defecation in individuals with neurogenic bowel dysfunction.

Study Information: Electrical stimulation of the rectum will be applied to activate sensory afferent neurons of the rectum and evoke a recto-colonic reflex to improve colonic motility. This intervention will be compared to participants’ usual mechanical intervention of the digital rectal stimulation. Study participants will act as their own controls, first providing data using their usual digital rectal stimulation intervention for bowel care, then providing data using electrical stimulation for bowel care.


Detailed program information and criteria available at: https://clinicaltrials.gov/ct2/show/NCT02641483?term=%22bourbeau%22+%22cleveland%22&rank=1