Case Report: Effects of Lower Thoracic Spinal Cord Stimulation on Bowel Management in a Person with Spinal Cord Injury

Background: Disturbances in bowel function occur in over 80% of persons with spinal cord injury (SCI). Some of the challenges relate to their dependence on caregiver support, need for medications, and extensive time requirements of bowel management (BM). Lower thoracic spinal cord stimulation (SCS) has been shown to restore an effective cough. Participants also reported an improvement in bowel function, as well. However, this was not studied prospectively. Objective: To determine whether usage of SCS to restore cough may improve BM in individuals with SCI. Methods: In a participant with C6 AIS A tetraplegia, SCS was applied at home, 2-3times/day, on a chronic basis and as needed for secretion management and to facilitate BM. Stimulus parameters were set at values resulting in near maximum airway pressure generation (P) (30-40 V, 50 Hz, 0.2 ms). P was measured at total lung capacity as an index of expiratory muscle strength. Questionnaires related to BM, were collected. Results: P during spontaneous effort was 21 cmH2O. Following a period of reconditioning, SCS resulted in P of 144 cmH2O and 172 cmH2O, at functional residual capacity (FRC) and total lung capacity (TLC) respectively. Over the course of 20 ± 1 week, BM time was reduced from 120 minutes (Pre-Implant) to 25 minutes. A mechanical method for BM (digital rectal stimulation and/or manual evacuation) was no longer needed. The number and dosages of medications required for BM was also reduced. This subject also reported marked subjective improvement in their BM routine. No complications of SCS were noted. Conclusion: Our results suggest that SCS to restore cough may be a useful method to improve BM for both SCI individuals and their caregivers.