Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury

Branagan, Graham; Tromans, A M; Finnis, D

doi:10.1038/sj.sc.3101529

Cited by 87 publications

(66 citation statements)

References 16 publications

(16 reference statements)

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“…Nine studies (aggregate N ¼ 590) examined the effect of colostomy after SCI (Table 11). [60][61][62][63][64][65][66][67][68] Given the ethical nature of this treatment (that is few safe options once they reach the point of [60][61][62][63][64] and Level 5 evidence (from one study) 68 that colostomy reduces the number of hours spent on bowel care. There is Level 4 evidence (from one retrospective pre-post study) 60 that colostomy greatly simplifies bowel care routines.…”

Section: Resultsmentioning

confidence: 99%

“…However, it is of importance to note that colostomy is a safe, effective method of managing severe and chronic GI problems, and perianal pressure ulcers in persons with SCI. Our systematic review shows that colostomies reduce the number of hours spent on bowel care, [60][61][62][63][64] reduce the number of hospitalizations caused by GI problems 63 and bowel care-related complaints, 60 simplify bowel care routine, 60 and improve quality of life. 62,63,67 In addition, many patients wished to have the colostomy performed earlier.…”

mentioning

confidence: 99%

“…62,63,67 In addition, many patients wished to have the colostomy performed earlier. 64 As described by Safadi et al, 68 the left colostomy may be preferred because it preserves colic surfaces to absorb water and prevent dehydration; thus, feces are less liquid and discharges less frequently than with right colostomies. Using a decision analysis to examine the optimal treatment for chronic refractory constipation in SCI, Furlan et al 76 found that the MACE procedure had the best long-term outcomes (reduced complication rates, lower incidence of autonomic dysreflexia, and fitted with patient preferences).…”

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confidence: 99%

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Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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Study design: Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. Objective: To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. Setting: Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Methods: Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. Results: A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Conclusions: Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

et al. 2010

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“…More invasive treatments for NBD, such as elective colonic surgery and creation of a stoma, are associated with far greater morbidity and mortality than TAI. 44 Other reported unwanted effects, including rectal burn, stricture and inflammation (chemical colitis), have been associated with non-recommended extensions of the irrigation technique, such as using hot water or enema additives. In addition, comorbidity such as hyponatraemia 45,46 and gut lesions 47 increase the likelihood of perforation that is not attributed specifically to TAI.…”

Section: Safety Of Taimentioning

confidence: 99%

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

Emmanuel

2010

Spinal Cord

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Study design: Neurogenic bowel dysfunction (NBD) is a common occurrence after spinal cord injury (SCI) and in patients with spina bifida or multiple sclerosis. The impact of NBD on well-being is considerable, affecting both physical and psychological aspects of quality of life. Transanal irrigation (TAI) of the colon promotes the evacuation of faeces by introducing water into the colon and rectum through a catheter inserted into the anus. Regular and controlled evacuation in this manner aims at preventing both constipation and faecal soiling. Objectives: The aim of this study was to review current evidence for the efficacy and safety of TAI in patients with NBD. Materials and methods: A literature search was conducted in PubMed. All identified papers were assessed for relevance based on the title and abstract; this yielded 23 studies that were considered to be of direct relevance to the topic of the review. Results: A multicentre, randomized, controlled trial has supported observational reports in demonstrating that TAI offers significant benefits over conservative bowel management in patients with SCI, in terms of managing constipation and faecal incontinence, reducing NBD symptoms and improving quality of life. Among other populations with NBD, TAI shows the greatest promise in children with spina bifida; however, further investigation is required. The overall safety profile of TAI is good, with few, and rare, adverse effects. Conclusions: Building on the positive data reported for patients with SCI, continued evaluation in the clinical trial setting is required to further define the utility of TAI in other populations with NBD.

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“…11 One individual reported an antegrade continence enema; these are common in spina bifida children and have been performed successfully in SCI adults. 12 Colostomy for bowel management after SCI has been found to be effective, 13 but was reported by only 2.4% of respondents (excluded from analysis). The low level of surgical intervention merits exploration as it is possible that some potentially helpful operations are currently under used.…”

Section: Pp0001mentioning

confidence: 99%

Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

2008

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Study design: Postal survey. Objectives: To describe bowel management in community-dwelling spinal cord-injured (SCI) individuals and to explore associations between age, injury, dependency, problems, interventions and satisfaction. Setting: Outpatients of a single SCI unit, in the United Kingdom. Methods: Postal questionnaire to all outpatients with SCI for at least 1 year, of any level or density, aged 18 years or more. Results: Response rate was 48.6% (n ¼ 1334). Median age was 52 years, median duration of injury 18 years. The most common intervention was digital evacuation (56%). Up to 30 min was spent on each bowel care episode by 58% of respondents; 31-60 min by 22%; 14% spent over 60 min. Reported problems included constipation (39%), haemorrhoids (36%) and abdominal distension (31%). Reduced satisfaction with bowel function was associated with longer duration of each bowel care episode, faecal incontinence, greater number of interventions used and more problems reported (all Pp0.001); 130 (9.7%) had undergone any type of surgical bowel intervention. Impact of bowel dysfunction on the respondent's life was rated as significantly greater than other aspects of SCI (Pp0.001). Conclusions: Managing SCI bowel function in the community is complex, time consuming and remains conservative. Despite potential for bias from a low response, for this large group of responders, bowel dysfunction impacted most on life compared with other SCI-related impairments. The study findings demand further exploration of bowel management to reduce impact, minimize side effects and increase the choice of management strategies available.

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Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury

Cited by 87 publications

References 16 publications

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Neurogenic bowel management after spinal cord injury: a systematic review of the evidence

Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction

Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

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