Bowel dysfunction following spinal cord injury: A description of bowel function in a spinal cord-injured population and comparison with age and gender matched controls

Abstract

Study design: A controlled, descriptive and comparative, questionnaire based study. Objectives: To describe the bowel function of spinal cord injured (SCI) patients and compare this with a general community control group. Setting: Christchurch, New Zealand. Methodology: A postal questionnaire was sent out to past SCI patients of the Burwood Spinal Injuries Unit, Christchurch, New Zealand, and age/gender matched with controls randomly selected from the electoral roll. Permission was obtained from SCI participants to retrieve data relating to their injury from hospital case notes. The questionnaire detailed general bowel function, influence of bowel problems on everyday life, incidence of incontinence and methods of defecation. A Faecal Incontinence Score was generated according to an established incontinence grading scheme. Results: Questionnaires were sent out to 1200 SCI patients and 1200 control subjects. Of these, 467 completed questionnaires were returned from SCI patients and age/gender matched from the 668 returned control questionnaires. Mean Faecal Incontinence Score was higher for SCI patients than controls (P<0.0001), and for complete compared with incomplete injury (P=0.0023). Age or time from injury did not affect Faecal Incontinence Score. Incontinence affected quality of life for 62% of SCI patients, compared with 8% of controls. Faecal urgency and time spent at the toilet were also significantly higher for the SCI group (39% of SCI patients use laxatives, compared with 4% of controls (P<0.0001)). Haemorrhoidectomy was more common (P<0.001) in the SCI population (9% vs 1.5%), particularly among those requiring manual evacuations. Conclusion: SCI has a significant effect on bowel function in terms of faecal incontinence, urgency, and toileting methods. This results in a marked impact on quality of life. While bowel function may deteriorate with time, most patients with poor function can be identified early implying a role for early intervention in those with potential bowel problems, such as colostomy or ACE procedure. Sponsorship: Dr AC Lynch had a Royal Australian College of Surgeons Foundation Research Scholarship and a grant for expenses was provided by The Burwood International Spinal Trust.