Bowel dysfunction in spinal-cord-injury patients.

BACKGROUND: This study aimed to determine the prevalence, nature, and effects--both physical and psychological--of spinal-cord-injury (SCI) on bowel function.

METHODS: 115 consecutive hospital outpatients (89 male, median age 38 years) with chronic SCI (median duration 62 months, range 9-491 months, 48% cervical, 47% thoracic, 5% lumbar) completed a questionnaire about pre and post injury bowel function, the Hospital Anxiety and Depression Scale (HADS), and self assessment of the impact of their disabilities and symptoms.

FINDINGS: Nausea, diarrhoea, constipation, and fecal incontinence were all much more common (p<0.0001) after SCI. 95% of patients required at least one therapeutic method to initiate defaecation. Half the patients became dependent on others for toileting. 49% took more than 30 min to complete their toilet procedure. Bowel function was a source of distress in 54% of patients and this was significantly (p=0.005) associated with the time required for bowel management and frequency of incontinence (p=0.001). There was a highly significant correlation between the HADS scores and the time taken for bowel management. On a scale of 0 (for no perceived problem) to 10 (maximum perceived problem), patients rated their loss of mobility as a mean of 6.8 (SD 3.3) and their bowel management as 5.1 (SD 3.6).

INTERPRETATION: Bowel function is a major physical and psychological problem in SCI patients.