The Effect of Abdominal Functional Electrical Stimulation On Bowel Function In Spinal Cord Injury

Colorectal, anal and pelvic floor complications are common in people with spinal cord injury (SCI). The abdominal muscles are one of the major muscle groups used during expiratory and expulsive manoeuvres such as defecation and coughing. We have shown that surface Functional Electrical Stimulation (FES) of the abdominal muscles, termed Abdominal FES, can improve respiratory function. Furthermore, there is evidence that abdominal FES may also improve bowel function in people with SCI via increased intra-abdominal pressure. However, there is a lack of data from randomised, controlled trials to substantiate this evidence and there is no standard Abdominal FES protocol for improving bowel function. 34 people will be recruited to this prospective cohort trial. Participants will be recruited who are greater than 1 year post SCI. Abdominal FES will be applied to the abdominal muscles for eight week day bowel management (BM) sessions (which will last for the duration of the bowel routine for an estimated 30-60 minutes) over an estimated period of three to four weeks. This will be delivered by the participant pressing a button (where able) to trigger the FES when required, and by a carer or researcher when this is not possible Specifically, Abdominal FES will be delivered, via electrodes placed over the posterolateral surface of the abdomen. The stimulation amplitude will initially be set to cause a strong visible muscle contraction (typically 60 - 80 mA). In addition, the stimulation amplitude will be evaluated every five minutes to ensure that stimulation is still tolerable and causing a suitable muscle contraction. A patient diary will also be used to monitor bowel management time for six sessions, prior to and also after the intervention period.