Gastrointestinal Symptoms in Spinal Cord Injury: Relationships With Level of Injury and Psychologic Factors

Ng, Clinton; Prott, Gillian; Rutkowski, Sue; Li, Yueming; Hansen, Ross; Kellow, John; Malcolm, Allison

doi:10.1007/s10350-005-0061-5

Cited by 80 publications

(43 citation statements)

References 23 publications

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“…This suggests that there is a significant correlation between NBD and the patient's psychological condition. Moderate-to-severe depression may have an effect on bowel function in patients with an SCI, 20 and support for their psychological state may potentially lead to a decrease in their bowel-related symptoms.…”

Section: Discussionmentioning

confidence: 99%

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Liu

Huang

et al. 2010

Spinal Cord

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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 questionnairesFthe NBD score and the Beck Depression Inventory second editionFwere 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) ¼ 10.5, 95% confidence interval (CI) 1.6-67.7) or a thoracic injury (OR ¼ 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 ¼ 12.8, 95% CI 3.3-50.1). Longer duration of injury (X10 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 (X10 years) could predict the severity of NBD in patients with SCI.

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Section: Discussionmentioning

confidence: 99%

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Liu

Huang

et al. 2010

Spinal Cord

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“…Nevertheless, the study shows a significant reduction in symptoms of constipation and fecal incontinence and it is well-documented that constipation and fecal incontinence are socially debilitating and that any improvement in these symptoms has a great impact on the patient's quality of life. 15 Furthermore, the reduction of time spent on bowel management for the patients as well as their increased independence from carers also contribute to a higher quality of life for these patients. We therefore assume that the reported increase in quality of life for patients using transanal irrigation 9,10 would compensate for the increased product costs of the method and thus result in a higher costeffectiveness for transanal irrigation.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

2008

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Study design: Cost-effectiveness analysis following international guidelines and taking the societal viewpoint. Objectives: To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management. Setting: A randomized clinical trial was conducted at five spinal centres situated in Denmark, Germany, Italy, United Kingdom and Sweden. Estimates of resources and unit costs were made for the German health care system. Methods: Efficacy outcomes were drawn from a randomized controlled trial conducted in [2003][2004][2005]. Adult spinal cord-injured patients with neurogenic bowel dysfunction were randomized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management. Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany. Unit costs were obtained from the Federal Statistical Office Germany and product list prices. Results: When comparing outcome measures at termination, transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction. Product-related costs were higher for transanal irrigation using the self-administered system; however, costs for a carer to help with bowel management and changes/washing due to leakage were lower. For transanal irrigation, costs associated with urinary tract infections and patient time spent were reduced. Thus, the total cost to society is lower when patients use transanal irrigation. The results were shown to be robust in the sensitivity analysis. Conclusion: Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management. Sponsorship: The study was supported by Coloplast A/S.

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“…Bowel management and associated problems have been increasingly recognized as important factors in post-injury community reintegration and quality of life. [3][4][5] The purpose of this study was to describe bowel management in community-dwelling individuals with an SCI in the United Kingdom and to explore associations between age, injury characteristics, dependency, problems, interventions and satisfaction.…”

Section: Introductionmentioning

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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Gastrointestinal Symptoms in Spinal Cord Injury: Relationships With Level of Injury and Psychologic Factors

Cited by 80 publications

References 23 publications

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

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

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