Le Spina Bifida est une maladie congénitale rare due à anomalie de fermeture du tube neural ayant des conséquences physiques et fonctionnelles multiples. La prise en charge des séquelles digestives du Spina Bifida ne fait l’objet d’aucun consensus national ou international. Les objectifs de cette thèse translationnelle étaient de caractériser les plaintes anorectales des patients adultes ayant un Spina Bifida, d’en préciser les mécanismes physiopathologiques sous-jacents à partir des données de la manométrie anorectale et du barostat rectal et en étudiant les fonctions de la barrière épithéliale intestinale. Les plaintes anorectales des patients adultes ayant un Spina Bifida représentent leur deuxième plainte en terme de fréquence et sont l’incontinence fécale, et la constipation. Ces troubles peuvent évoluer au cours du temps ce qui justifie un suivi digestif au long cours. Le niveau lésionnel neurologique n’est ni associé aux troubles digestifs ni à à leur évolution. Les patients ayant un Spina Bifida ont une atteintede la fonction anale (défaut de contraction) et des fonctions rectales (diminution du tonus et de la compliance rectale). Ils ont également une hyperperméabilité paracellulaire et une diminution de la densité du tissu conjonctif; ces 2 anomalies étant corrélées entre elles. L’augmentation de la perméabilité paracellulaire était négativement corrélée avec la compliance rectale. Enfin, les patients ayant un Spina Bifida ont une augmentation de l’expression de TGFBeta1. Les anomalies des fonctions anorectales et de la barrière épithéliale intestinale pourraient être des cibles thérapeutiques potentielles dans la prise en charge des troubles anorectaux des patients adultes ayant un Spina Bifida. / Spina Bifida is a rare congenital disorder caused by an abnormal neural tube closure with multiple physical and functional consequences. The management of the digestive disorders of Spina Bifida is not consensual. The objectives of this present work were to characterize the anorectal complaints of adult patients with Spina Bifida, to specify the underlying pathophysiological mechanisms from the data of anorectal manometry and rectal barostat and to study the functions of the intestinal epithelial barrier. The anorectal complaints of adult patients with Spina Bifida represent their second complaint and are faecal incontinence and constipation. These disorders can change over time which justifies long-term digestive follow-up. The level of neurological lesion is neither associated with digestive disorders nor with their evolution. Patients with Spina Bifida have impaired anal function (lack of contraction) and rectal function (decreased tone and rectal compliance). They also have paracellular hyperpermeability and decreased connective tissue density ; these 2 anomalies are interrelated. The increase in paracellular permeability was negatively correlated with rectal compliance. Finally, patients with Spina Bifida have an increased expression of TGFBeta1. Abnormalities of anorectal function and intestinal epithelial barrier may be potential therapeutic targets in the management of anorectal disorders in adult patients with Spina Bifida.

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - Irritable bowel syndrome (IBS) is a poorly understood functional gastrointestinal disorder and is a major cause of abdominal discomfort and gut dysfunction. IBS symptoms encompass abdominal pain, bloating, flatulence and irregular bowel movements such as constipation, diarrhoea and alternating bowels, bloating, flatulence and irregular bowel movements. Physiological studies have shown that manipulation of the intestinal microbiota by antibiotics, prebiotics or probiotics can affect intestinal functions in the pathogenesis of IBS. The probiotic concept suggests that supplementation of the intestinal microbiota with the right type and number of live microorganisms can improve gut microbiota composition and promote health in IBS sufferers. Aim - The aim of the main clinical trial is to determine whether ingestion of fermented milk containing Bifidobacterium animalis DN-173010 is associated with improved defecation frequency, stool consistency and quality of life in black South African females with constipation-predominant IBS (IBS-C). Methods - A pilot and process evaluation approach was employed during the current study to examine and understand the feasibility of implementing the study and to explore the facilitating implementation of the main clinical trial. Twenty black female participants, aged 18-60, with IBS-C were recruited from the practices of gastroenterologists, specialist physicians and medical doctors in Soweto. Participants fulfilling the Rome III criteria for IBS-C and inclusion criteria were randomized into two groups to participate in a 4-week, double blind, placebo controlled study. The placebo group received unflavoured sweetened, white base yoghurt and the intervention group received similar yoghurt with the probiotic, Bifidobacterium animalis DN-173010 [>3,4X10⁷ CFU/g]. Participants were required to record their bowel movements daily and IBS symptoms weekly in questionnaires during the four-week study period. Quality of life was assessed at baseline and at the end of the treatment period. Participants visited the study unit weekly to collect the placebo or probiotic study products and return the completed questionnaires during the study period. Results - Seventeen participants completed the study (eight intervention and nine placebo). There were not significant differences in IBS symptoms between the two groups, but differences were observed overtime within groups. The severity of abdominal pain score within both groups was statistically significant (p=0.004), and the number of days with pain was also statistically significant (p=0.00001). The frequency of normal stools reported was statistically significant different compared to all the other stool types (constipation and loose stools) throughout the four-week study period in both the intervention and placebo group. There was no significant difference in the quality of life between the intervention group compared to the placebo group. Conclusion - Process evaluation allows for the monitoring of a programme and corrections of problems as they occur. The intervention is feasible to implement, acceptable and safe to participants. The study indicates that consumption of the probiotic Bifidobacterium animalis DN-173010 for four weeks is not superior to the placebo in relieving IBS symptoms. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

L'objectif de la présente étude vise à déterminer si la présence de constipation dyssynergique durant la grossesse est un facteur de risque des déchirures du troisième et du quatrième degré lors d'un premier accouchement vaginal. Un dispositif de recherche cas-témoin rétrospectif a été utilisé. La population était constituée de femmes primipares recrutées à l'aide du registre de la salle des naissances selon leur degré de déchirure périnéale. Les participantes ont ensuite été classées en deux groupes. Le premier groupe, les cas, était constitué de femmes ayant eu une déchirure du troisième ou du quatrième degré. Le deuxième groupe, les témoins, était composé de femmes présentant un périnée intact ou une déchirure du premier ou du deuxième degré. La variable dépendante, soit le degré de déchirure périnéale, a été identifiée à l'aide du dossier obstétrical. La variable indépendante principale, soit la présence de constipation dyssynergique, a été documentée à l'aide du questionnaire Knowles-Eccersley-Scott-Symptom (KESS) envoyé par la poste aux femmes primipares. Les autres facteurs de risque des déchirures périnéales ont été documentés à l'aide du dossier obstétrical et d'un questionnaire maison postal. Un modèle de régression logistique, avec le rapport de cote comme mesure d'association et un intervalle de confiance de 95%, a été utilisé afin de déterminer les facteurs influençant les déchirures du troisième et du quatrième degré. Au total, 549 femmes primipares ont participé à l'étude ; 140 étaient dans le groupe des cas et 409 dans le groupe témoin. Dix-sept pourcent des femmes du groupe des cas et 7,6% des femmes du groupe témoin souffraient de constipation dyssynergique (p=0,001). Une régression logistique multiple a démontré que la présence de constipation dyssynergique est associée à 2,94 fois (95%Cl : 1,47 - 5,88) plus de risque de déchirure du troisième et du quatrième degré. En conclusion, cette étude a démontré que la présence de constipation dyssynergique durant la grossesse augmente le risque de subir une déchirure du troisième et du quatrième degré. Une étude prospective devra cependant être conduite afin d'établir la relation de cause à effet entre la présence de l'incoordination des muscles du plancher pelvien rencontrée dans la constipation dyssynergique et les déchirures du troisième et du quatrième degré."--Résumé abrégé par UMI.

Idag lider cirka 70 procent av populationen inom äldrevården av obstipation. Leva med obstipation är relaterat till obehag, en sänkt livskvalitet och kan dessutom leda till obehagliga konsekvenser. Obstipation är ett medicinskt tillstånd som påverkar patienters liv och ytterligare kunskap är nödvändigt för att kunna vidta omvårdnadsåtgärder som underlättar för patienten. Syftet med studien var att belysa sjuksköterskans omvårdnadsåtgärder för att lindra och förebygga obstipation hos vuxna och äldre patienter. Studien grundades på 11 vetenskapliga artiklar och genomfördes som en litteraturstudie. Fyra teman framkom i resultatet; ”Rådgivning, motion, kost och vätska”, ”Omvårdnadsåtgärder i form av massage, akupressur och heta kompresser”, ”Information och dokumentation om toalettrutiner samt ”Laxantia en omvårdnadsåtgärd med för- och nackdelar”. Alternativa omvårdnadsåtgärder som massage, akupressur och heta kompresser visade på uppskattade och positiva förbättringar och ett individuellt träningsprogram med rätt kost- och vätskeintag, minskade patienternas obehag. Sjuksköterskor redogjorde för att regelbundna toalettvanor är viktiga omvårdnadsåtgärder vid obstipation. Ytterligare framkom att laxantia i samband med opioidbehandling minskade risken att utveckla obstipation. Elimination är en livsviktig fysiologisk funktion som måste fungera, därmed är detta ett omvårdnadsområde som kräver sjuksköterskans uppmärksamhet. Det krävs vidare forskning för att förebygga och lindra för patienter med obstipation. / About 70 percent of the elderly population is suffering from constipation. Living with constipation is related to discomfort, reduced quality of life and can lead to unpleasant consequences. Constipation is a medical condition that affects the lives of patients and additional knowledge is necessary for caring out nursing interventions that facilitate the patient. The aim of the study was to elucidate nursing interventions to alleviate and prevent constipation in adults and elderly patients. The study was based on 11 scientific articles and was conducted as a literature study. Four themes emerged in the results; "Consulting, exercise, diet and liquid", "Nursing intervention such as massage, acupressure and hot compresses", "Information and documentation of toilet routines” and “Laxative a nursing intervention with advantages and disadvantages”. It was found that with an individual exercise program with proper diet and liquid intake, decreased patient discomfort. Alternative nursing interventions such as massage, acupressure and hot compresses, showed positive improvements. Regular toilet habits are important nursing interventions to prevent constipation. Further results showed that laxatives in conjunction with opioid therapy reduced the risk of developing constipation. Elimination is a vital physiological function which is essential. Further research is needed to prevent and relieve patients with constipation.

Occupational therapists are concerned with individuals´ abilities to engage in daily occupations. When a daily activity such as bowel management is problematic, participation in key occupations can be limited. Retentive fecal incontinence is a common disorder in children. Behavior seems to be partly responsible for this condition. Occupational therapists have hypothesized that some behaviors could be related to sensory over-responsivity. This study investigated the relationship between retentive fecal incontinence and sensory over-responsivity and examined the Toileting Habit Profile Questionnaire, a tool designed to screen for toileting difficulties. The study showed that a group of children (n=16) with retentive fecal incontinence presented with significantly more behaviors related to sensory over-responsivity than a group of typically developing children (n=27) as measured by the Short Sensory Profile. The study also revealed that the Toileting Habit Profile Questionnaire effectively discriminates between children with retentive fecal incontinence and those without toileting difficulties.

Orientador: Nilton Carlos Machado / Resumo: Introdução: A Constipação Funcional (CF) constitui um distúrbio de alta prevalência em crianças, associada ao comprometimento na Qualidade de Vida Relacionada à Saúde (QVRS), apesar de existirem poucos instrumentos específicos para avaliar este problema, e nenhum no português brasileiro. Objetivos: Desenvolver e validar um questionário específico de QVRS para crianças com CF, aplicado aos pais ou cuidadores. Métodos: Estudo observacional, transversal, em uma amostra de pais ou cuidadores de crianças de 5 a 15 anos de idade, com diagnóstico de CF, segundo os Critérios de Roma IV. O processo de desenvolvimento do questionário foi realizado em 10 fases, iniciando com geração dos itens relativos à constipação funcional, desenvolvimento de questionários preliminares, apreciação por 11 profissionais da saúde com atuação na área pediátrica, até o desenvolvimento de um questionário preliminar. Após identificar problemas ou incoerências pelos pesquisadores, as questões foram corrigidas, obtendo-se um questionário final (PedFCQuest-PR) com 26 perguntas, divididos em 4 domínios, cada uma com 4 opções de resposta tipo Likert, baseado nos acontecimentos das últimas 4 semanas. O PedFCQuest-PR foi aplicado simultaneamente ao questionário genérico Pediatric Quality of Life Inventory Versão 4.0 (PedsQL 4.0) a pais/cuidadores das crianças elegíveis para o estudo, assim como foram colhidos dados sociodemográficos, antropométricos e clínicos. Todos os dados foram compilados utilizando-se o progr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Functional Constipation (FC) is a disorder of high prevalence in children, associated with impairment in Health-Related Quality of Life (HRQoL). There are few specific instruments to assess this problem and none at all Brazilian Portuguese. Objectives: To develop and validate a specific HRQoL questionnaire for children with FC, applied to parents or caregivers. Methods: Observational, cross-sectional study in a sample of parents or caregivers of children from 5 to 15 years of age, diagnosed with CF according to the Rome IV Criteria. The process of developing the questionnaire was carried out in 10 phases, starting with the Items generation concerning functional constipation, the development of questionnaires, assessment by 11 health professionals, and development of a preliminary questionnaire. After identifying problems or inconsistencies by the researchers, the questions were corrected, obtaining a final questionnaire named (PedFCQuest-PR) with 26 questions divided into four domains, each with 4 Likert type response options, based on the events of the last four weeks. The PedFCQuest-PR was applied simultaneously to the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) to parents/caregivers of children eligible for the study, as well as sociodemographic, anthropometric and clinical trials. All data were compiled using the program GraphPad Prism version 7.0. The statistical tests were bicaudals and the level of significance considered at p <0.05. Results: The... (Complete abstract click electronic access below) / Mestre

Bakgrund: Två vanligt förekommande smärtsamma procedurer på barn i sjukvården är insättning av perifer venkateter (PVK) och behandling med lavemang (KLYX). För att lindra procedursmärta hos barn är det viktigt med en välgenomtänkt planering som gör barn och föräldrar trygga och lugna inför proceduren. Syfte: Studiens syfte var att undersöka hur föräldrar upplevde förberedelser på sjukhus inför insättning av perifer venkateter eller givande av lavemang på deras barn. Metod: Studien var en kvantitativ enkätstudie, där frågorna besvarades av 71 föräldrar med barn upp till 12 års ålder som genomgått PVK-insättning eller lavemangbehandling. Joyce Travelbees omvårdnadsteori användes som teoretiskreferensram för att beskriva vikten av information och god kommunikation i vården. Resultat: Resultatet visade att 91% av föräldrarna fick information om barnets behandling och 78% av föräldrarna var nöjda med informationen de fick inför proceduren på barnet. En större andel av barnen som fick PVK (88%) fick smärtlindring jämfört med barnen som fick KLYX (5%) (p = 0,001). Sjutton föräldrar (24%) i studien upplevde att deras barn inte hade möjlighet att stoppa proceduren om den blev för jobbig. Av föräldrarna blev 36,6% tillfrågade om sina önskemål inför barnets procedur. Slutsats: Denna enkätstudie visade att en stor andel av föräldrarna inte blev tillfrågade om sina önskemål inför proceduren som barnet skulle genomgå. Den belyser också att en grupp föräldrar upplevde att barnet vid de smärtsamma procedurerna inte kunde säga stopp om behandlingen blev för jobbig. Studien belyser vikten av att fråga föräldrar om önskemål för delaktighet i barnets vård samt att barnet måste ges möjlighet till att kunna sätta stopp om behandlingen blir för jobbig. / Background: Two commonly occurring painful procedures for children in healthcare are the insertion of peripheral vein catheters (PVK) and treatment with enema (KLYX). In order to ease the pain for the children during the procedure, it is important to have a well planning that makes children and parents safe and calm before starting the procedure. Purpose: The aim of the study was to investigate how parents experienced preparations in hospitals prior to inserting peripheral vein catheters or giving enema to their children. Method: The study was a quantitative survey, which the questionnaire was answered by 71 parents with children up to 12 years of age who had experienced PVK insertion or enema treatment. Joyce Travelbees nursing theory was chosen as theoretical referencefram to describe the importance of information and good communication in healthcare. Result: The result showed that 91% of the parents got information about the child's treatment and 78% of the parents were satisfied with the information they received before the procedure for the child. A larger proportion of the children who got PVK (88%) received pain relief compared to the children who got KLYX (5%) (p = 0,001). Seventeen parents (24%) in the study found that their children hadn’t possibility to stop the procedure if it became too difficult. 36,6% of the parents were asked about their wishes before the initiating the procedure. Conclusion: This survey showed that a large proportion of the parents were not asked about their wishes before the starting the procedure which the child would undergo. It also highlights that a group of parents felt that the child hadn’t possibility to stop the procedures if the treatment becomes too painful. The study highlights the importance of asking parents about the wishes for participation in the child's care and that the child must be given the opportunity to be able to stop the treatment if it becomes too painful.

Introdução: Complicações gastrointestinais na terapia nutricional enteral são frequentes e podem afetar negativamente o desfecho de pacientes hospitalizados. Entre os principais problemas gastrointestinais observados na terapia nutricional enteral destacam-se a diarreia e a constipação intestinal, tema principal do presente estudo. Variáveis relacionadas aos pacientes, terapia medicamentosa e a própria terapia nutricional podem ser fatores predisponentes de diarreia e constipação intestinal. O objetivo do presente estudo foi identificar a frequência de diarreia e constipação intestinal em pacientes em terapia nutricional enteral exclusiva internados em hospital geral no Brasil e estudar os fatores associados a estes eventos. Método: Estudo monocêntrico, sequencial de inclusão aleatória e observacional que avaliou, de forma prospectiva e diária, a ocorrência de diarreia e constipação intestinal em pacientes em terapia nutricional enteral exclusiva durante 21 dias. Estudou-se o comportamento de variáveis relacionadas aos pacientes, a influência da terapia medicamentosa e o tipo de fórmula de nutrição enteral. Os pacientes foram categorizados retrospectivamente quanto a evacuação diária em: grupo D (diarreia; definida como três ou mais evacuações no período de 24h); grupo C (constipação intestinal, definida como menos do que uma evacuação em três dias) e grupo N (ausência de diarreia e constipação intestinal). Analisou-se a terapia medicamentosa administrada aos pacientes de acordo com cada classe terapêutica e quantidade recebida. Também se avaliou a presença de fibras na composição de fórmulas de nutrição enteral. Resultados: Dos 110 pacientes analisados, observou-se constipação intestinal em 70,0% (77), diarreia em 12,7% (14) e em apenas 17,3% (19) dos pacientes houve ausência de diarreia e constipação intestinal. A única variável associada à frequência de diarreia foi a terapia medicamentosa. Houve associação entre os medicamentos anti-inflamatórios não esteroidais e diarreia em pacientes que fizeram uso de fórmula de nutrição enteral sem fibras (p=0,021). No grupo constipação intestinal, a internação na UTI e insuficiência respiratória foram variáveis significativas (p=0,036 e p=0,003277, respectivamente). Houve associação também entre os medicamentos antagonistas H2 e constipação intestinal em pacientes que fizeram uso de fórmula de nutrição enteral sem fibras (p=0,013). Fórmula de nutrição enteral com fibra esteve associada à prevenção da constipação intestinal. A classe terapêutica de antidopaminérgico mostrou efeito benéfico na prevenção da diarreia (p=0,023) e de constipação intestinal (p=0,022) quando comparados com grupo N. Conclusão: A constipação intestinal foi mais frequente que diarreia em pacientes em TNE exclusiva, principalmente quando foi usada fórmula de nutrição enteral sem fibras. A classe terapêutica de medicamentos anti-inflamatórios não esteroidais associou-se à diarreia em pacientes que fizeram uso de fórmula de nutrição enteral sem fibras. A constipação intestinal esteve associada à internação na UTI, à indicação de TNE por necessidade de ventilação mecânica e a classe terapêutica de medicamentos antagonistas H2 em pacientes que fizeram uso de fórmula de nutrição enteral sem fibras. A prescrição de medicamentos pró-cinéticos se mostrou benéfica na prevenção de diarreia e constipação intestinal, assim como o acréscimo de fibras na fórmula de nutrição enteral associou-se à prevenção de diarreia e constipação intestinal influenciados pela terapia medicamentosa / Introduction: Digestive complications in enteral nutrition (EN) are frequent and can affect negatively in the clinical outcome of hospitalized patients. Diarrhea and constipation are the main gastrointestinal problems presented in these cases. Variables related to patients, drug therapy and nutritional therapy itself might be predisposing factors for diarrhea and constipation. The aim of this study was to analyze and assess the frequency and risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital. Method: The authors performed a monocentric study, sequential with random inclusion that evaluated prospectively by observation the daily occurrence of diarrhea and constipation in hospitalized adult patients fed exclusively by EN through a feeding tube for 21 days. Variables related to patients, the influence of drug therapy and type of enteral formula were studied too. Patients were categorized retrospectively as evacuation daily: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula. Results: Among the 110 patients included in the study, patients classified in group C represented 70.0% (77) of the study population; group D comprised 12.7% (14), and group N represented 17.3% (19). The only variable associated with frequency of diarrhea was drug therapy. There was an association between anti-inflammatory drugs and diarrhea in patients who used formula for enteral nutrition without fiber (p=0.021). In the constipation group, the ICU admission and orotracheal intubation as the indication for EN were significant variables (p=0.036 and p=0.003277, respectively). There was also an association between H2 drugs antagonists and constipated patients who used formula for enteral nutrition without fiber (p=0.013). Enteral nutrition formula with fiber was associated to prevention of constipation. The antidopaminergic therapeutic class showed beneficial effect in the prevention of diarrhea (p=0.023) and constipation (p=0.022) when compared with group N. Conclusion: Constipation was more frequent than diarrhea in patients fed exclusively by EN through a feeding tube, especially when it was used enteral nutrition formula without fiber. The therapeutic class of anti-inflammatory drugs was associated with diarrhea in patients who used formula for enteral nutrition without fiber. Constipation was associated with ICU admission, TNE indication for mechanical ventilation and therapeutic class of H2 drugs antagonists in patients who used formula for enteral nutrition without fiber. The prescription of prokinetic drugs seems to be beneficial in the prevention of diarrhea and constipation, as well as the addition of fiber in enteral nutrition formula was associated with prevention of diarrhea and constipation influenced by drug therapy

O trauma raquimedular (TRM) é uma agressão na medula espinhal e pode acarretar severas alterações físicas e psíquicas ao paciente, refletindo na família e sociedade. Com a inexistência de terapêutica que reverta o quadro de TRM, é necessário investimento na reabilitação para melhorar a qualidade de vida destes pacientes. Através de um estudo exploratório-descritivo, com metodologia quantitativa foi investigada as práticas de autocuidado intestinais e complicações em 27 indivíduos com TRM. Todos os participantes eram do sexo masculino e predominância da faixa etária de 18 a 30 anos, solteiros, com até 1º grau incompleto, com renda familiar entre 2 e 5 salários mínimos, tendo o ferimento por arma de fogo como principal etiologia da lesão. As práticas de autocuidado intestinal mais utilizadas foram a massagem abdominal (32%), seguida da dieta rica em fibras (24%), uso de laxante (15%), toque dígito anal (15%), extração manual das fezes (7%) e outros (7%). Quanto às complicações intestinais, houve predomínio de constipação/impactação (50%), seguido de incontinência fecal (23%), sangramento anal (21%) e outras (6%). Em relação às internações hospitalares, consideradas oportunidades para o enfermeiro orientar sobre as alterações decorrentes do TRM, 59,3% dos pacientes apresentaram mais de uma internação, porém a transmissão de informação sobre alterações intestinais ocorreu em somente 22% dos casos. Diante do número reduzido de centros especializados em reabilitação, julgamos de grande importância a presença de enfermeiros com formação específica em reabilitação para atuarem na assistência, na educação dos pacientes e no ensino nas instituições formadoras de profissionais. / Spinal cord injury (SCI) is an aggression to the spinal cord and can bring physical and psychological alterations to patients lives, reflecting upon family and society. So far, there is no therapeutic to revert the injury of the spinal cord; thus, it is necessary to invest on rehabilitation to improve the patient´s quality of life. Practices of self care for bowel functioning and complications were studied in 27 individuals with SCI, through a descriptive-exploratory study with a quantitative methodology. All participants were men, mostly between 18 and 30 years of age, single, with low education level, family income between 1 to 5 minimal wages; and wounded by gun shots. Practices of self care mostly used were abdominal massage (32%), high fiber diet (24%), use of laxatives (15%), anal digital stimulation (15%), stool manual removal (7%) and others (7%). Related to complications, constipation/impactation was the most frequent (50%), followed by fecal incontinence (23%), bleeding (21%) and others (6%). Hospitalization is considered an opportunity for nurses to teach patients about SCI alterations and 59,3% of patients had more then one episode of hospitalization. However, only in 22% of the cases they received any information about alterations in bowel functioning. With so few rehabilitation centers in our region it is important to have nurses at terciary and general hospitals, educated in rehabilitation to deliver adequate nursing care and patient teaching. It is also necessary, in nursing educational institutions, to prepare profissionals with focus in rehabilitation.