Chronic constipation significantly impacts the quality of life of individuals with spinal cord injuries (SCI), affecting up to 80% of this population. Current management strategies, including lifestyle modifications and pharmaceutical interventions, often prove ineffective. Manual colon massage offers a viable alternative but lacks practicality for home use. This study investigated the long-term efficacy and tolerability of a novel home-based solution: the MOWOOT device, which employs intermittent colonic exoperistalsis (ICE) to mimic natural colonic contractions. Previous studies demonstrated the safety and efficacy of ICE in patients with chronic constipation, but research specifically focusing on the SCI population and long-term home use was lacking. This study aimed to address this gap by evaluating the real-world effectiveness and user experience of the MOWOOT device in SCI individuals with chronic constipation within their home environment.

The literature extensively documents the high prevalence of chronic constipation among individuals with SCI, often associated with incontinence, fecal impaction, and hemorrhoids. While guidelines suggest a sequential approach starting with lifestyle changes and progressing to pharmaceutical interventions and, finally, invasive procedures, these methods often yield limited success in this population. The limitations of conventional treatments underscore the need for alternative, effective, and patient-friendly management strategies. Manual colon-specific massage, a non-invasive method with proven efficacy, has been highlighted, but its dependence on daily professional administration restricts its feasibility and affordability for home use. Therefore, the development and evaluation of self-administered devices like MOWOOT are crucial.

This structured patient feedback survey involved 11 SCI individuals with chronic constipation recruited from four specialized German hospitals between February 2019 and September 2020. Participants were provided with the MOWOOT-II device and instructed to use it for 10–20 minutes daily. Data were collected via a self-administered questionnaire at baseline (F1) and after at least 10 months of use (F2). The questionnaire assessed device usage, bowel function (number of bowel movements, time per evacuation, stool consistency, failed attempts), constipation symptoms (difficulty/strain, abdominal pain, bloating, cramps, spasms), use of laxatives and evacuation aids, and overall satisfaction with bowel function and management. The MOWOOT-II system, a CE-certified medical device, utilizes an exoperistaltic belt that inflates and deflates consecutively to simulate natural peristaltic contractions. Data analysis involved comparing F1 and F2 responses for various parameters using appropriate statistical tests (Student's t-test, Wilcoxon matched-pairs test, Chi-squared/Fisher's exact test).

Eleven participants (63.6% male) completed the survey, using the device for a mean (SD) of 13.27 (4.03) months. From baseline (F1) to the follow-up (F2), a statistically significant reduction was observed in the mean time per evacuation (–24.5 min, p = 0.0076) and the number of failed evacuation attempts per week (–1.05, p = 0.0354). There was a trend towards increased bowel movements and softer stool consistency, along with a decrease in incomplete bowel movements. Participants reported significant improvements in difficulty/strain (p = 0.0055), abdominal pain (p = 0.0230), bloating (p = 0.0010), abdominal cramps (p = 0.0019), and spasms (p = 0.0198). Concomitant use of laxatives and evacuation aids did not change significantly. Importantly, satisfaction with bowel function and management improved significantly (p = 0.0095), with more participants reporting high levels of satisfaction (p = 0.0300). The majority of participants rated the device's tolerability, efficacy, and ease of use as very good or good.

The results demonstrate the long-term efficacy and tolerability of the MOWOOT ICE device in improving bowel function and reducing chronic constipation symptoms in individuals with SCI. The significant improvements observed across various bowel function parameters and constipation symptoms, coupled with increased patient satisfaction, highlight the clinical benefits of this home-based intervention. The lack of significant change in laxative and evacuation aid usage suggests that MOWOOT provides a viable alternative or supplement to these interventions, potentially leading to reduced reliance on pharmaceutical treatments. The findings support the potential of MOWOOT as a valuable addition to the management of chronic constipation in the SCI population, offering a significant improvement in their quality of life by promoting autonomy and self-management of bowel function.

This study provides robust evidence supporting the long-term effectiveness and acceptability of the MOWOOT ICE device for managing chronic constipation in SCI individuals. The device offers a significant improvement in bowel function, reduces various associated symptoms, and enhances patient satisfaction. Further research could explore the cost-effectiveness of MOWOOT compared to traditional treatments, and larger, multicenter trials are warranted to further validate these findings and assess its generalizability across diverse SCI populations.

The relatively small sample size limits the generalizability of the findings. The study's design, relying on self-reported data, introduces the potential for recall bias. The lack of a control group prevents a direct comparison with alternative treatments. Future studies should address these limitations by including a larger, more diverse sample, employing objective measures alongside self-reported data, and incorporating a control group for robust comparative analysis.