Bowel Care and Cardiovascular Function After Spinal Cord Injury

• Blood pressure change during bowel care [ Time Frame: Measured continuously during bowel care (approximately one hour) on two occasions within 28 days. ] [ Designated as safety issue: No ]
  Beat-to-beat blood pressure will be recorded using a finger blood pressure cuff (Finometer) on two occasions within 28 days, for up to one hour on each occasion.
  
  

• Duration of bowel care routine [ Time Frame: The exact duration of bowel care will be noted on two days within a 28 day period ] [ Designated as safety issue: No ]
  The duration of bowel care routine will be recorded on two occasions within 28 days.
  
  
• Cardiovascular symptoms during bowel care [ Time Frame: Measured by questionnaire (approximately 15 minutes) after bowel care on two occasions within 28 days. ] [ Designated as safety issue: No ]
  Cardiovascular symptoms will be recorded using a questionnaire on two occasions within 28 days. The questionnaire takes approximately 15 minutes to complete.
  
  
• Heart beat abnormalities during bowel care [ Time Frame: Measured continuously during bowel care (approximately one hour) on two occasions within 28 days. ] [ Designated as safety issue: No ]
  3-lead electrocardiogram will be recorded throughout the duration of bowel care on two occasions within 28 days, for up to one hour on each occasion.
  
  

The primary purpose of this study is to investigate the effects of topical anesthesia on cardiovascular changes triggered by bowel care in people with spinal cord injury.

In people with spinal cord injury, episodes of high blood pressure are common during strong sensory stimuli such as those present during routine bowel care. These episodes of high blood pressure can be dangerous due to the magnitude of blood pressure increase and because they can be accompanied by irregular heart beats. This condition, known as autonomic dysreflexia, is most common in individuals with high-level injuries.

The experience of autonomic dysreflexia can vary widely between individuals: some have goosebumps, sweating, facial flushing or headaches, while others have no symptoms at all, despite their changes in heart rate and blood pressure.

The use of a lubricant gel containing an anesthetic, lidocaine lubricant, is the standard of care in many hospital facilities when performing bowel care for individuals with spinal cord injury; however, it is not often used in the home setting. It is thought that using anaesthetic might reduce the cardiovascular effects of bowel care after spinal cord injury. However, it is not known whether this is the case. We do not yet know the long-term consequences of these short-term elevations in blood pressure during autonomic dysreflexia, but given that they are often associated with discomfort, and have been known to be associated with more severe events such as stroke, it would be beneficial to reduce their occurrence.

Therefore, we will test whether lidocaine lubricant improves the symptoms and signs of autonomic dysreflexia during bowel care in people with spinal cord injury.