Doctor greeting patient before starting treatment in hospital

While people with spinal cord injury (SCI) are not at greater risk for colon cancer than able-bodied people, studies have shown the people with SCI are less likely to get routine screenings due to apprehension about colonoscopy preparation and the risk of autonomic dysreflexia.1

“When I was nearing 50 years of age, I knew that one of those procedures I had been putting off that I could no longer be put off was now staring me in the face…a colonoscopy, “said Scott Chesney, a Thrive Advocate, who has been paraplegic for nearly 36 years.  “Having had a few pressure sores on my buttocks over the years, I was very reluctant to have anything done in that area.  It is just too sensitive,” Chesney continued.

What is a Colonoscopy?

A colonoscopy is a routine screening for colorectal cancer. It’s important to schedule colonoscopies with a Gastroenterologist (GI) who has specific training performing this procedure on people with SCI. A colonoscopy requires a thorough cleanse of the colon beforehand, as the GI uses a scope with a camera on the end that allows the doctor to view the gastrointestinal tract and screen for any polyps (pre-cancerous growths) or other abnormalities.

“When I began my research into getting a GI doctor who was familiar with SCI, I immediately contacted my SCI/rehab doctor who had a couple of reputable recommendations,” Chesney stated.

Who is at Risk for Colon Cancer? 

People at increased risk for colon cancer include 

  • A family history of colon cancer
  • People age 45+
  • People with bowel inflammation due to Ulcerative Colitis or Crohn’s disease
  • Polyps in the bowel
  • A high fat diet
  • Smoking (including chewing tobacco and vaping)

Colon Cancer and SCI

Some of the symptoms of colon cancer can be easy to miss for people with SCI, as they are similar to symptoms associated with spinal cord injury. This underscores the need for people with SCI to get routine screening by a qualified GI. Common symptoms include:

  • Diarrhea or constipation
  • Frequent gas pains, cramps, and/or bloating
  • Nausea or vomiting
  • Feeling the bowel is not completely empty
  • Narrower stools than usual
  • Bright red or very dark blood in the stool
  • Weight loss with no obvious cause
  • Frequent fatigue

Due to the disruption of the signals sent between the brain and bowel caused by SCI, it may be harder to detect sensations of cramps, pain, bloating, and/or incomplete evacuation of the bowel. 

It’s important to establish a routine screen schedule with a GI to increase the likelihood of detecting any colorectal cancer early. For people who do not have a regular GI, seeking a referral from a rehabilitation doctor is advised.

Colonoscopy Preparation for People with SCI

There is no difference in the methods used to prepare for a colonoscopy for people with SCI. A GI will prescribe the medication(s) that are best suited for each patient based on the level of injury, risk of autonomic dysreflexia, and overall health. 

Spending more than 30 minutes on the commode increases the risk of skin breakdown and frequent transfers increases the risk of falls and/or accidents. Some people with SCI prefer the convenience of in-patient preparation the night before the procedure due to these risks. 

Colonoscopy and Risk of Autonomic Dysreflexia

Autonomic dysreflexia (AD) can be a risk during both the preparation and colonoscopy procedure. Typically, AD occurs with injuries above T6, however it has occurred in people with injury levels as low as T10.2

While AD is rare during the preparation and colonoscopy procedure3, even a person who has never had an episode of AD could still be at risk, making constant attendant care during the preparation advisable. 

Steps for Preparing for a Colonoscopy

Common methods of preparation are the same for people with SCI as they are for able-bodied individuals, but it’s important to have the oversight and advice of a GI before deciding on the method that is right for you.

Complete evacuation of the bowel is important to ensure proper screening of the bowel. Polyps are difficult to detect if stool remains in the bowel during the procedure.

While there is no single recommendation for how to prepare for a colonoscopy, common steps are as follows: 

A few days before: commence a low-fiber diet and avoid whole grains, raw fruits/vegetables, nuts, seeds, and dried fruit

The day before: Avoid solid foods and consume only clear liquids, such as white grape juice, clear soft drinks, and/or clear broth.

The afternoon/evening before: Consume the first dose of the GI-recommended preparation. Be sure to follow the exact instructions depending on needed bowel preparation and the time of the colonoscopy.

The day of the procedure: Continue to consume only clear liquids and avoid solid foods. Do not eat or drink anything less than two hours beforehand. 

Six hours before: Consume the second dose of the prescribed preparation. The American Gastroenterological Association recommends splitting this dose as the stomach and pancreas continue to create fluids that flow into the colon. The more time between your last dose and the procedure the more likely it is that fluid will be present in the colon.

Throughout the preparation process drink lots of non-diuretic fluids. This helps to clear the colon and maintain a healthy electrolyte balance.

 

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Disclaimer: The material contained is for reference purposes only. Quest Products, LLC does not assume responsibility for patient care. Consult a physician prior to use. Copyright 2021 Quest Products, LLC.

 

Sources: 

1. A safe and effective multi–day colonoscopy bowel preparation for individuals with spinal cord injuries (nih.gov)

2. Bowel management – Reeve Foundation (christopherreeve.org)

3. A safe and effective multi–day colonoscopy bowel preparation for individuals with spinal cord injuries (nih.gov)

Colonoscopy – Craig Hospital

How you can make colonoscopy prep easier – Harvard Health