NS: Since paraplegia results from damage to the spinal cord, how does it affect the quality of life?

T: A good example of that is the anorectal disorders, which concern almost all paraplegic patients. In this sense, their management is unavoidable and requires special nursing care.

NS: What are the principal symptoms of this condition?

T: Basically, they are related to voluntary and reflex motor skills; superficial and deep sensory disorders; sphincter, bladder and bowel disorders; and neurovegetative disorders.

NS: But since patients are completely paralyzed, they don’t feel any pain, do they?

T: Well, they do, and this can be supra-lesional pain of muscular, articular or osseous origins in an area where sensitivity is a priori normal; lesional pain that is due to damage to the roots secondary to the vertebral injury (radiculalgia) or to reflex; and sublesional pain that is visceral, vascular or muscular. And, therefore, pain control involves total or partial inhibition of the pain message which is exerted at the level of the spinal cord for pain in the trunk and limbs.

NS: And what does anorectal disorders care consist in?

T: From a neurological point of view, the functioning of the colorectal system depends on the autonomic nervous system, which controls the colon, the rectum and the internal anal sphincter, but also the somatic nervous system which controls defecation, and more precisely the striated perineal muscles.

NS: What does that exactly mean?

T: It means that constipation is the most common symptom, which also manifests as bloating and/or abdominal discomfort and/or fecal incontinence. This is mainly due to alterations in the nervous control of the anorectal system, but loss of mobility and autonomy, medication and the age of the patients are also involved.

NS: How do we manage this, as healthcare professionals?

T: It depends on how this impacts the patient’s quality of life; the type of neurological lesion; the type of constipation (transit or distal); its severity; the physical capacities of the patient; and the lifestyle of the patient and his or her family.

NS: But then again, what’s the link between patient care and the quality of their life?

T: Well, it’s that they cause a major social, emotional, sexual and psychological handicap, sometimes even more important than the loss of motor skills; and can increase a dysfunction of the vesico-sphincter system (incontinence, retention or urinary infections).

NS: So, what kind of treatment or care should be advised?

T: There are many, among which are medical treatments like laxatives, hygienic and dietary measures; stimulatory or evacuating rectal touch which are poorly understood care practices as they involve intimacy but then trust relationship between carer and patient. There’s also the abdominal massage; and finally, surgical procedures should be considered in case of failure of transanal irrigations and medical treatments, in particular if there is fecal incontinence; or colostomy which can be a potential second-line treatment when other treatments fail.