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A 48-year-old man, suffering from incomplete tetraplegia with preserved neurological level C4 and AIS grade D, comes to our ambulatory because he was not satisfied with his current bowel management, with enemas and digital stimulation - a maneuver that he was unable to perform independently.
We Are What We Eat
He reports also meteorism and obstinate constipation, with numerous missed evacuations, long periods (>1 hour) when he manages to evacuate and denies fecal incontinence.
He is prescribed a colonoscopy, which shows no changes in the bowel wall, and is therefore trained in the use of transanal irrigation with the Navina Smart device, which he can handle independently.
Three weeks after the end of the training he returns to the outpatient clinic and reports a marked reduction in his failure to evacuate, but he is not fully satisfied and complains of persistent meteorism and long (although reduced compared to previous management) times to complete evacuation.
Based on these symptoms, the anamnesis is deepened, detecting inadequate eating habits: in particular, simple sugars and fats are consumed in excess, often outside main meals. Involving a dietician, personalized guidance is then provided to adopt correct eating habits.
At the subsequent outpatient check-up, he reports that he has followed the indications given and now shows full satisfaction with the use of transanal irrigation: in addition to a clear reduction in meteorism, objectively observable on inspection of the abdomen, the time needed to complete evacuation has also been almost halved
Method of use of Navina:
Every other day
400 mL per irrigation
Balloon inflation 3
Conclusions:
- Proper nutrition plays a key role in ensuring the well-being of people with neurological bowel disease
- Before considering a patient as a non-responder to transanal irrigation, it is necessary to verify that he or she has appropriate eating habits and that laxative therapy has been optimized, if necessary
author is Dr Gabriele Righi - AOU Careggi, Firenze.