Gastro-intestinal tract

All patients with spinal cord injury are at risk of developing delayed paralytic ileus. It is therefore advisable to avoid oral fluids for 24-48 hours. At the end of this period, commencement of oral fluids should be gradual and guided by abdominal girth and bowel sounds. Paralytic ileus and abdominal distension could cause splinting of the diaphragm resulting in respiratory difficulties particularly in the tetraplegic patients.

Contemporary medical practice advocates the use of appropriate antacids/proton pump inhibitors such as Ranitidine to reduce the incidence of gastric bleed/stress ulcerations.

A PR check after 48 hours followed by once a day insertion of a suppository (Glycerine/Bisacodyl) should be carried out until regular bowel evacuations occur. This will avoid unexpected faecal soiling.

If prolonged paralytic ileus occurs (in ventilated patients, or patients who have undergone abdominal surgery) there may be an indication for parentral feeding.