Early Colostomy Formation Can Improve Independence Following Spinal Cord Injury and Increase Acceptability of Bowel Management

Abstract

Background: Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. Objectives: To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable. Methods: Medical and nursing records of patients with SCI who chose to have a colostomy during the period 2005-2016 were examined retrospectively. Data were gathered concerning reasons for choosing a colostomy, early and later complications, the need for further surgery, and independence with bowel care before and after surgery. Patients were divided into two groups: those who chose a colostomy "early" during inpatient rehabilitation and those who chose it "later" as is traditional. Results: Reasons for choosing colostomy differed. Reducing reliance on caregiver and independence were of more importance to the early group; the later group chose colostomy to solve bowel care problems. Early complication rates in both groups were low. Longer term complications were higher in the early group, with the most common complication being rectal discharge. Parastomal hernia rates were low in both groups, as was the need for further surgery. Colostomy formation led to 20.8% of all patients gaining independence with bowel care. Conclusion: This study found colostomy to be a safe and effective option when performed early after SCI and demonstrates colostomy can be a means of gaining independence and making bowel care easier and more acceptable to the newly injured patient.

Colostomy and quality of life after spinal cord injury: systematic review

“…Bowel dysfunction develops fairly rapidly after SCI 31,34 , and colostomy formation within 12 months of SCI could be a safe and effective way of gaining independence and making bowel care easier 35 .…”

Spinal cord injuries and bowel stomas: timing and satisfaction with stoma formation and alterations in quality of life

“…Other studies reported higher percentages of rectal discharge in individuals with SCI. Boucher et al retrospectively studied 72 participants with SCI with either early colostomy formation (in the first few months after onset SCI; 20 participants) or late colostomy formation (after at least one year; 52 participants) [ 16 ]. Early complication rates did not differ between both groups.…”

Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury

“…The optimal timing of instituting the colostomy is open for discussion. In a retrospective study, Boucher et al 224 evaluated patients who were identified as having a colostomy "early, " in the first few months after SCI, and those who chose "later, " usually more than a year after injury and being discharged home. Early complication rates in both groups were low.…”

“…Overall, 20.8% of the individuals in this study who had previously been reliant on caregivers gained independence. 224 Co-management with an enterostomal therapist prior to surgery and in follow-up optimizes outcome. Colostomy has been compared with conservative management bowel programs and found to have equivalent or superior QOL outcomes.…”