Bowel Dysfunction after Spinal Injury

Overview

Bladder and bowel controls are affected in significant ways after spinal cord injury. With increasing time intervals post-injury the incidence of further bowel problems grows. The aims of this study are:

1. To understand the clinical effects of spinal cord injury on bowel function
2. To document the methods participants use for managing bowel dysfunction
3. To relate the changes to the level of injury, its completeness and the time since injury
4. To compare bowel dysfunction with bladder dysfunction

Method

Research question:
Can bowel function after a SCI be predicted from the level of cord injury, in the same was as for bladder function?

A postal survey was used to collect data from 2 groups of people who had graduated from the Burwood Spinal Unit: one between 2 and 3 years post admission, and the second between 20 and 21 years post-injury.  Some were uncontactable, some declined, some had died. This left us with a total of 54 people to evaluate. Responses were stratified according to level of spinal cord injury and AIS status. Urodynamic study results were used to determine any relationship with bowel function.

Status of Research

Completed.

Outputs

Results:

We found no correlation of spinal level or its completeness, with bowel symptoms including incontinence, methods of bowel management, time taken on bowel cares. Manual evacuation was needed in about 80%, and about half of these used suppositories to supplement.
Bowel function can cause considerable bother, in some taking between 30 and 60 minutes, and a few where the time was more than an hour. For half of the patients, over time there were changes in bowel function with care taking longer, or having more accidents.
Bowel function did not correlate with bladder function on urodynamics.

Conclusions:

Changes in bowel function can occur over time, so continuing surveillance is warranted.
Manual evacuation was used on most patients regardless of level, and half of the patients used suppositories
Advice on bowel management needs to be on an empirical basis, as it cannot be predicted from the level of injury or from somatic functions like the tone of the pelvic floor.
The numbers were small, so no statistical significance could be established.

Acknowledgements

We are grateful to the people with Spinal injury who agreed to participate in the study, to the Spinal Unit Trust and the Urological Research Foundation for funding and to BAIL for supporting the organisation of the study.