Abstract
Study design:
Cross-sectional study.
Objective:
To analyze the predictors of severe neurogenic bowel dysfunction (NBD) in persons with spinal cord injury (SCI).
Setting:
The Kaohsiung Medical University Hospital, Taiwan.
Methods:
Two questionnaires—the NBD score and the Beck Depression Inventory second edition—were sent to 232 persons with SCI by mail. The demographic factors and injury-related factors were recorded to evaluate any relationships with severe NBD. The associations between the severity of NBD and psychological condition were also measured.
Results:
In all, 39.4% of the respondents suffered from severe NBD. Multiple logistic regression analysis showed that those with a cervical injury (odds ratios (OR)=10.5, 95% confidence interval (CI) 1.6–67.7) or a thoracic injury (OR=7.1, 95% CI 1.2–40.3) had a higher risk of severe NBD than those with a lumbar injury. Persons with American Spinal Injury Association (ASIA) A had a 12.8-fold higher risk of severe NBD than persons with ASIA D (OR=12.8, 95% CI 3.3–50.1). Longer duration of injury (⩾10 years) was another risk factor of severe NBD. Moderate-to-severe depression was associated with reduced bowel function.
Conclusions:
This study showed that high level of cord lesion, completeness of cord injury and longer duration of injury (⩾10 years) could predict the severity of NBD in patients with SCI.
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References
Krogh K, Nielsen J, Djurhuus JC, Mosdal C, Sabroe S, Laurberg S . Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 1997; 40: 1233–1239.
Faaborg PM, Christensen P, Finnerup N, Laurberg S, Krogh K . The pattern of colorectal dysfunction changes with time since spinal cord injury. Spinal Cord 2008; 46: 234–238.
Gore RM, Mintzer RA, Calenoff L . Gastrointestinal complications of spinal cord injury. Spine 1981; 6: 538–544.
Glickman S, Kamm MA . Bowel dysfunction in spinal-cord-injury patients. Lancet 1996; 347: 1651–1653.
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA . Prospective comparison of fecal incontinence grading systems. Gut 1999; 44: 77–80.
Agachan F, Chen T, Pfeiffer J, Reisman P, Wexner SD . A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39: 681–685.
Krogh K, Christensen P, Sabroe S, Laurberg S . Neurogenic bowel dysfunction score. Spinal Cord 2006; 44: 625–631.
Liu CW, Huang CC, Yang YH, Chen SC, Weng MC, Huang MH . Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury. J Rehabil Med 2009; 41: 35–40.
Krause JS, Kjorsvig JM . Mortality after spinal cord injury: a four-year prospective study. Arch Phys Med Rehabil 1992; 73: 558–563.
Furlan JC, Urbach DR, Fehlings MG . Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis. Br J Surg 2007; 94: 1139–1150.
Steer RA, Ball R, Ranieri WF, Beck AT . Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. J Clin Psychol 1999; 55: 117–128.
Ditunno JF, Young W, Donovan WH, Creasey G . The international standards booklet of neurological and functional classification of spinal cord injury. Paraplegia 1994; 32: 70–80.
Fajardo NR, Pasiliao RV, Modeste-Duncan R, Creasey G, Bauman WA, Korsten MA . Decreased colonic motility in persons with chronic spinal cord injury. Am J Gastroenterol 2003; 98: 128–134.
De Looze D, Van Laere M, De Muynck M, Beke R, Elewaut A . Constipation and other chronic gastrointestinal problems in spinal cord injury patients. Spinal Cord 1998; 36: 63–66.
Lynch AC, Antony A, Dobbs BR, Frizelle FA . Bowel dysfunction following spinal cord injury. Spinal Cord 2001; 39: 193–203.
Brading AF, Ramalingam T . Mechanisms controlling normal defecation and the potential effects of spinal cord injury. Prog Brain Res 2006; 152: 345–358.
Kirshblum SC, Gulati M, O’Connor KC, Voorman SJ . Bowel care practices in chronic spinal cord injury patients. Arch Phys Med Rehabil 1998; 79: 20–23.
Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M . Effects on age on spinal cord lesion patients′ rehabilitation. Spinal Cord 2003; 4: 457–464.
Madsen JL, Graff J . Effects of ageing on gastrointestinal motor function. Age Ageing 2004; 33: 154–159.
Ng C, Prott G, Rutkowski S, Li Y, Hansen R, Kellow J et al. Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors. Dis Colon Rectum 2005; 48: 1562–1568.
Acknowledgements
We thank the National Science Council for their financial support. We also thank Mr James Fenton for his assistance with editing.
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Liu, CW., Huang, CC., Chen, CH. et al. Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury. Spinal Cord 48, 554–559 (2010). https://doi.org/10.1038/sc.2009.181
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DOI: https://doi.org/10.1038/sc.2009.181
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