A. Estin Comarr, M.D.
JAMA. 1958;167(1):18-21. doi:10.1001/jama.1958.02990180020004.
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The function of defecation in patients with lesions of the spinal cord requires constant attention, especially during the first few months after injury. The vast majority of spinal cord injury patients lose voluntary control of the rectal sphincter and are usually constipated; however, during the stage of spinal shock and areflexia, they may have involuntary evacuations. These latter accidents should not be inhibited but should be provided for by protective pads about the anus. A regular regimen of water and food intake is established early; suppositories, abdominal massage, digital stimulation, and digital removal of scybala are usually necessary; the latter method is used with due caution. Mild laxatives and enemas are used only sparingly. When the patient can be safely out of bed, the regular use of the water closet is begun. The vast majority of patients maintain more or less scybalous stools and practice either digital stimulation or digital evacuation; they learn a combination of procedures that give the desired results and remove the fear of involuntary evacuations. Special problems, such as episodes of diarrhea, appearance of hemorrhoids, and the persistence of mass reflexes in response to stimulation of the anorectal area, can be solved by methods here described.


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