Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury

Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988–2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.

“Bowel Management” program for children with congenital malformations and neurogenic bowel after surgery

BACKGROUND: After the surgical treatment of children for anorectal malformations, spinal pathology, and Hirschsprungs disease, their quality of life is significantly reduced due to fecal incontinence. For patients with persistent defecation disorders, the Bowel Management program is offered. AIM: This study analyzes the Bowel Management program implemented in the clinic. MATERIALS AND METHODS: A prospective analysis of the program used in children after surgical correction of malformations was conducted. The program comprised the following components: lectures for patients/parents, hospitalization, irrigography with water-soluble contrast, teaching patients/parents about cleansing enemas, keeping a bowel movement diary, plain abdominal X-ray, changing the recipe for enema solution, monitoring the effectiveness, and correcting recommendations. RESULTS: A total of 66 children from 1.5 to 17 years old were treated. Three groups were identified: (I) anorectal malformations (n = 26), (II) spinal pathology (n = 30), and (III) Hirschsprungs disease (n = 10). The results were considered satisfactory if the bowel cleansing procedure was painless for the child and did not cause stress reactions; the parents were satisfied with the result of the prescribed program if after the enema a sufficient amount of stool was removed within 45 minutes, there were no episodes of defecation during the day. With the help of the Rome IV revision criteria, fecal incontinence was noted in all cases against the background of stool retention. In 11 (16.7%), there was no fecal incontinence even in cases of prolonged stool retention. A correlation was found between high lesions (in the lumbar spine) in spinal hernias with the absence of fecal incontinence with prolonged stool retention compared with the low sacral localization of the hernia. In group I, 91.7% had spinal cord fixation. In group II, 86.7% had it, and none were present in group III. The effectiveness of the program was 83.3%. CONCLUSION: The Bowel Management is easy to use and effective in 83% of patients. It can be recommended for the rehabilitation of children with defecation disorders, fecal incontinence after surgical correction of congenital malformations (anorectal malformations, spinal pathology and Hirschsprung's disease).

Addressing Bowel Dysfunction in Men Aging With Spinal Cord Injury

Objectives: Spinal Cord Injury (SCI) increases the frequency and severity of bowel problems, especially for those who age with this injury. The present study aimed to investigate the effectiveness of a bowel management training program in patients aged with SCI. Methods: A multiple-baseline single-case design of concurrent type was employed. Three male married patients with SCI whose ages ranged between 48 and 53, with a mean duration of 32 years after the injury, were recruited for this study from a rehabilitation center in Isfahan City, Iran, in 2020. An individualized 8-week bowel management training program was conducted. The patients’ bowel dysfunction was evaluated by Neurogenic Bowel Dysfunction (NBD) score. Results: The results were provided by the six features of single-case designs, namely immediacy of the effect, overlap, variability consistency of data patterns across similar phases, trend, and level, revealed the efficacy of the program in decreasing bowel dysfunction problems in men aging with SCI. Discussion: Health care providers should know about the changes that might happen as an individual gets old with SCI to take preventive measures and reduce the harmful effects of aging, especially bowel dysfunction.

Bladder and bowel management in multiple sclerosis

Jane Young and Joan Bradley discuss the impact and management of neurogenic bladder and bowel dysfunction in multiple sclerosis.

External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury

Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.