Pathophysiology of Bowel Dysfunction in Patients with Motor Incomplete Spinal Cord Injury: Comparison with Patients with Motor Complete Spinal Cord Injury

Vallès, Margarita; Mearin, Fermı́n

doi:10.1007/dcr.0b013e3181a873f3

Cited by 52 publications

(40 citation statements)

References 29 publications

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“…Cecum/ascending colon 6.0 (3.5-12.0) [7] 6.8 with healthy subjects and in accordance with previous studies, most spinal cord injured subjects had prolonged gastrointestinal and segmental colonic transit times. Baseline GITT in group A was 1 year after injury and in group B, the median was 19 years after injury.…”

Section: Table 3 Maximum Colonic Diameters In Centimeters (Shown As Msupporting

confidence: 90%

“…6 Constipation is usually evaluated by symptom scores or, objectively, by radio-opaque markers or scintigrafy. Colonic or gastrointestinal transit times (GITTs) after SCI have previously been described in cross-sectional studies [7][8][9][10][11] and in a single follow-up study within the first year after injury. 12 However, long-term results are not available.…”

Section: Introductionmentioning

confidence: 99%

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Do gastrointestinal transit times and colonic dimensions change with time since spinal cord injury?

et al. 2010

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Study design: Long-term follow-up study. Objectives: To determine whether gastrointestinal transit times (GITTs) and colonic dimensions change during the first or subsequent decades after spinal cord injury (SCI). Setting: Aarhus University Hospital, Denmark. Methods: GITT and colonic dimensions were evaluated by means of radio-opaque markers. Group A (n ¼ 12) was investigated 1 year after SCI and again 13 (range 11-14) years later. Group B (n ¼ 10) was studied 19 (range 9-36) years after injury and again 12 (range 11-12) years later. All had been treated with conservative bowel management. Results: In group A, the median GITT 1 year after injury was 4.3 (range 1.1-6.5) days and 13 years later, it was 3.2 (range 1.3-6.5) days, P ¼ 0.96. In group B, the median GITT 19 year after injury was 3.4 (range 0.6-5.9) days and 12 years later, it was 3.2 (range 1.9-5.5) days, P ¼ 0.77. None of the two groups experienced a significant change in the diameter of the caecum/ascending colon, transverse colon, descending colon or the sigmoid during long-term follow-up. Megacolon was present in four patients at baseline and in five at follow-up. Conclusion: GITTs and colonic dimensions did not change, neither during the first decade nor long after SCI.

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Section: Table 3 Maximum Colonic Diameters In Centimeters (Shown As Msupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Do gastrointestinal transit times and colonic dimensions change with time since spinal cord injury?

et al. 2010

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“…Those with an incomplete injury may retain the sensation of rectal fullness and ability to evacuate bowels, so no specific bowel program may be required; however, the pathophysiologic mechanisms of fecal incontinence and constipation in subjects with incomplete SCI are similar to subjects with complete SCI and preserved spinal sacral reflexes. 9 Further, individual variations in bowel routing before SCI and preexisting conditions may also influence the pattern of bowel evacuation post-injury. Careful evaluation and individual approaches are, therefore, important for accurate diagnoses and prescription of treatments for bowel management after SCI.…”

Section: Introductionmentioning

confidence: 99%

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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“…Patients with neurogenic bowel may have many severe deficits such as weak abdominal muscles, impaired rectal sensation and delayed colonic transit time resulting in obstructed defecation, whereas impaired external anal sphincter contraction and uninhibited rectal contractions result in incontinence for stools. 19 It is hard to tell if anticholinergic treatment for urge incontinence or treatments with laxatives in some patients might have worsened the patients' bowel function. A large proportion of patients were bothered by bowel dysfunction, suggesting the importance of a thorough evaluation of the patients' discomforts at follow-up.…”

Section: Discussionmentioning

confidence: 99%

Mid-term follow-up of patients with permanent sequel due to spinal cord ischemia after advanced endovascular therapy for extensive aortic disease

2014

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Study design: Observational study. Objectives: Thoraco-abdominal endovascular aortic aneurysm repair (TAEVAR) can be used to treat patients with extensive and complex aortic disease, however, at the risk of spinal cord ischemia (SCI). The aim of this follow-up study was to evaluate the life satisfaction in patients with SCI after TAEVAR. Setting: Among 83 patients undergoing TAEVAR between 2009 and 2012 at the Vascular Centre, Malmö, Sweden, 29 developed SCI in-hospital and at follow-up (median 26 months), eight had died and three had no complaints. Methods: Patients diagnosed with permanent (n = 10) and transient (n = 8) SCI were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were compared with reference samples. Results: Mid-term mortality in patients with permanent SCI (7/17) was higher than those with transient SCI (1/12) (P = 0.035). Ten patients had permanent T1-S5 SCI, two were classified as ASIA Impairment Scale (AIS) A, one as AIS B and seven as AIS D at hospital discharge. Patients diagnosed with transient SCI had residual neurological deficits in the legs (n = 8), urge incontinence (n = 3) and fecal leakage (n = 2) at follow-up. Patients with SCI had lower self-rated life satisfaction in terms of 'life as a whole', 'sexual life', 'somatic health' and 'psychological health' but better in the 'economy' domain. Conclusion: Assessment of life satisfaction at mid-term follow-up suggests that all patients with SCI in-hospital, whether permanent or transient, should have a multi-disciplinary follow-up regime. Most patients diagnosed with transient neurological deficits had an overlooked permanent, less severe, SCI.

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Pathophysiology of Bowel Dysfunction in Patients with Motor Incomplete Spinal Cord Injury: Comparison with Patients with Motor Complete Spinal Cord Injury

Cited by 52 publications

References 29 publications

Do gastrointestinal transit times and colonic dimensions change with time since spinal cord injury?

Do gastrointestinal transit times and colonic dimensions change with time since spinal cord injury?

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

Mid-term follow-up of patients with permanent sequel due to spinal cord ischemia after advanced endovascular therapy for extensive aortic disease

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