Bowel management experiences of individuals with spinal cord injury: A meta-synthesis study

BACKGROUND: Bowel dysfunction is a common and distressing consequence of spinal cord injury (SCI), with profound effects on physical, psychological, and social well-being. Despite its high prevalence, there is limited consolidated evidence regarding patients' lived experiences, which are essential for improving care. OBJECTIVE: To synthesize qualitative research findings on the experiences of individuals with SCI regarding bowel management. METHODS: A qualitative meta-synthesis was conducted following PRISMA guidelines. Systematic searches were performed in Google Scholar, MEDLINE, CINAHL, PubMed, Web of Science, and Springer Nature Journals between June 3 and June 28, 2024. Studies were appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data were analyzed through Sandelowski and Barroso's two-stage meta-synthesis method. The review was prospectively registered in PROSPERO (CRD420250578291). RESULTS: Twelve qualitative studies involving 210 participants from seven countries were included. Three overarching themes emerged: (1) Challenges in bowel management, encompassing physical complications, emotional burden, and social restrictions; (2) Perceived shortcomings and expectations, reflecting inadequate professional support and a strong desire for independence; and (3) Managing the difficult process, highlighting self-care adjustments, social support, and consideration of invasive interventions such as colostomy. CONCLUSION: Bowel management is a central yet challenging aspect of life for individuals with SCI, affecting all domains of quality of life. Findings underscore the need for patient-centered strategies, enhanced professional education, and early discussion of all management options to improve care outcomes.