Chronic Bowel Dysfunction Research Articles

Transanal irrigation: a review of indications, key assessments, benefits, contraindications, complications, efficacy and safety

Transanal irrigation (TAI) is a therapeutic procedure designed to manage chronic bowel dysfunction, including constipation and faecal incontinence, particularly in individuals with neurogenic bowel dysfunction. TAI offers symptom relief and improves quality of life by providing autonomy in bowel management. This article explores the benefits, clinical indications and contraindications of TAI. The article also emphasises the importance of thorough patient assessments before initiating TAI, such as evaluating bowel function, manual dexterity and motivation. Furthermore, the review discusses the role of structured education programmes in ensuring long-term adherence and safety, particularly within the first 3 months. In addition, it covers the complications associated with TAI, such as bowel perforation and autonomic dysreflexia, and offers management strategies. Finally, the review outlines the conditions under which TAI should be discontinued and provides guidance on ensuring patient safety throughout the treatment.

T3 Transection as a Mouse Model of Bowel Dysfunction after Spinal Cord Injury

Bowel dysfunction, in the form of constipation and/or incontinence, is one of the most prevalent and life-impacting co-morbidities associated with spinal cord injury (SCI) with no long- term treatment available. The extent to which SCI-induced changes in the colon (e.g. inflammation, fibrosis, and reduced enteric neuron density) cause progressive dysfunction is understudied. There remains a significant unmet need to develop strategies to prevent or reverse bowel dysfunction after SCI. This need remains, in part, due to the lack of a mouse model which recapitulates the human condition. We hypothesized that a T3 spinal transection in mice would trigger bowel dysfunction alongside early colonic inflammation and downstream remodeling of the colon musculature as seen in both humans and rats after SCI. Bowel dysfunction was defined as increased number of fecal pellets within the colon, smaller pellet size, and decreased water content in the stool. The number of fecal pellets within the colon increased significantly in animals receiving SCI compared to sham (laminectomy only) injuries by 4 days post injury (dpi) and persisted to 21dpi. Furthermore, fecal pellet size was significantly decreased in the SCI animals at 21dpi and trended toward decreased water content. Together, these functional measurements are indicative of chronic bowel dysfunction after T3 transection. We next molecularly interrogated whole colon tissue for inflammatory cytokine levels and found increased levels of IFN-γ at 4 dpi but not at 21dpi and found increased collagen deposition in the colonic musculature at both 4 and 21 dpi in the SCI versus sham animals. The acute spike in INF-γ and deposition of collagen after injury are consistent with our hypothesis that T3 transection causes acute inflammation followed by remodeling of the colon wall. Establishing this mouse model will enable further interrogation of cell-type specific responses and signaling pathways using transgenic models. T32 Fellowship in Physiology (GM118292) and T32 Fellowship Neurobiology of CNS Injury & Repair (5T32 NS077889) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study.

Background and AimBecause acute infectious gastroenteritis may cause post‐infection irritable bowel syndrome and functional dyspepsia and the severe acute respiratory syndrome coronavirus‐2 affects gastrointestinal (GI) tract, coronavirus disease‐19 (COVID‐19) may cause post‐infection‐functional GI disorders (FGIDs). We prospectively studied the frequency and spectrum of post‐infection‐FGIDs among COVID‐19 and historical healthy controls and the risk factors for its development.MethodsTwo hundred eighty patients with COVID‐19 and 264 historical healthy controls were followed up at 1 and 3 months using translated validated Rome Questionnaires for the development of chronic bowel dysfunction (CBD), dyspeptic symptoms, and their overlap and at 6‐month for IBS, uninvestigated dyspepsia (UD) and their overlap. Psychological comorbidity was studied using Rome III Psychosocial Alarm Questionnaire.ResultsAt 1 and 3 months, 16 (5.7%), 16 (5.7%), 11 (3.9%), and 24 (8.6%), 6 (2.1%), 9 (3.2%) of COVID‐19 patients developed CBD, dyspeptic symptoms, and their overlap, respectively; among healthy controls, none developed dyspeptic symptoms and one developed CBD at 3 months (P < 0.05). At 6 months, 15 (5.3%), 6 (2.1%), and 5 (1.8%) of the 280 COVID‐19 patients developed IBS, UD, and IBS‐UD overlap, respectively, and one healthy control developed IBS at 6 months (P < 0.05 for all except IBS‐UD overlap). The risk factors for post‐COVID‐19 FGIDs at 6 months included symptoms (particularly GI), anosmia, ageusia, and presence of CBD, dyspeptic symptoms, or their overlap at 1 and 3 months and the psychological comorbidity.ConclusionsThis is the first study showing COVID‐19 led to post‐COVID‐19 FGIDs. Post‐COVID‐19 FGIDs may pose a significant economic, social, and healthcare burden to the world.

Severe gastrointestinal haemorrhage from an eroding jejuno-jejunal fistula

Abstract Children with complex needs often have limited communication which makes clinical assessment extremely difficult. They also require complex feeding regimes and are prone to chronic bowel dysfunction and dysmotility requiring frequent admissions to hospital. We present the case of an 11-year old boy with mosaic trisomy 13 and an end ileostomy (for gut dysmotility) who presented with a catastrophic gastrointestinal haemorrhage during a prolonged Paediatric Intensive Care (PICU) stay recovering from an episode of presumed sepsis. A normal upper GI endoscopy was followed by a laparoscopy which revealed a small bowel adhesion to the anterior abdominal wall which had facilitated the creation of a jejuno-jejunal fistula that had eroded through a mesenteric artery. The child recovered well after a limited laparotomy and segmental small bowel resection. This case highlights an extremely unusual cause of gastrointestinal bleeding in a child and emphasises the role of Laparoscopy in the comprehensive assessment of this presentation.

Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study.

Postinfection irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD), though reported from the temperate countries, have not been studied in the tropics; PI-malabsorption syndrome (MAS), which mimics PI-IBS, is reported from the tropics. No report till date on PI-IBS excluded PI-MAS. We studied: (i) the frequency of continuing bowel dysfunction after acute gastroenteritis (AG), (ii) its predictors, and (iii) PI-MAS among patients with PI-IBS. 345 consecutive subjects each, with AG and age- and gender-matched healthy controls were followed up 3-monthly for 12 months using a translated-validated questionnaire and functional gastrointestinal disorders (FGIDs) were diagnosed by Rome III criteria. Symptom duration >3 months but <6 months was diagnosed as chronic bowel dysfunction (CBD) and dyspeptic symptoms, respectively. MAS was diagnosed if 2/3 tests (D-xylose H2 breath test, Sudan III-stained stool microscopy, and duodenal histology) were abnormal. Fecal microbiological studies were performed in 245/345 (71%) patients. AG patients more often developed PI-IBS and PI-FD than controls (16.5 vs. 2.6% and 7.4 vs. 0.6%, respectively; p<0.001). Presence of FD was a risk factor for PI-IBS and IBS for PI-FD. On multivariate analysis, dyspeptic symptoms, CBD, and weight loss were the risk factors for PI-FGIDs. The frequency of PI-IBS following Vibrio cholera and other bacterial infection was comparable. Malabsorption was present among 2/23 (9%) patients with PI-IBS. FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS.

081 Patient Techniques Aimed at Easing Chronic Vulvar Pain Prior to Internal Assessment

Reducing abnormal tension in pelvic floor muscles (PFMs) in women with vulvar vestibulitis (provoked vestibulodynPVD) was found by Glazer in 1995 to improve sexual function and decrease complaints of chronic vulvar pain. Multiple studies since have confirmed the presence of abnormal tension in PFMs in women with PVD when compared to matched, asymptomatic controls. Though its pathophysiology remains unclear, PVD may be caused by inciting events in patients’ histories. Histories that includes recurrent yeast or bacterial infections, urinary or bladder infections, endometriosis, or chronic bowel dysfunction can have a lasting, negative impact, causing PFM dysfunction as well as elevated tension in the affected viscera. Though this may not occur in all, many women with PVD present with both elevated PFM tone and residual abnormal visceral tension. Though PFM dysfunction appears to be a primary driver of chronic vulvar pain, it is possible that the muscular dysfunction is secondary to abnormal tension in the surrounding abdominal and pelvic viscera, fascia, and muscle. Together, these abnormal physical findings make internal assessment, whether digital or with a speculum, painful, difficult at best, or often impossible.

Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction.

The purpose of this review is to critically analyze the relationship between symptoms of abnormal emptying of the bladder, urgency, pelvic pain, anorectal dysfunction and pelvic organ prolapse (POP) and to present evidence in order to show how many of the above mentioned symptoms can be cured or substantially improved by repair of specific pelvic ligaments. In this review, we provide evidence to show how often these dysfunctions occur and how they can be cured in 42-94% by appropriate pelvic floor surgery in the longer term, up to 2 years. Laxity in ligaments and/or vaginal membrane due to damaged connective tissue may prevent the normal opening and closure mechanism of urethra and anus, because muscles need finite lengths to contract properly. Hypermobility of the apex can irritate the pelvic plexus causing chronic pelvic pain. In consequence, dysfunctions as abnormal emptying of the bladder, urgency, pelvic pain, fecal incontinence and obstructed defecation can occur in women with different degrees of POP. In conclusion, it has to be recognized that women bothered by these symptoms should be examined for POP and appropriately advised for possibility of cure by pelvic floor surgery after careful selection. VIDEO ABSTRACT.

Is overactive bladder in the female surgically curable by ligament repair?

IntroductionOveractive bladder (OAB) symptoms (urge, frequency, nocturia) are not generally considered surgically curable by learning institutions. The Integral Theory hypothesizes that OAB is a prematurely activated, but normal micturition reflex caused by loose suspensory ligaments and potentially curable surgically by repairing such ligaments.To test this hypothesis by surgical repair of loose cardinal and uterosacral ligaments in patients with 2nd degree or greater uterine/apical prolapse.Material and methodsMulticenter prospective case control audit.611 females, mean age 70. Inclusions: symptomatic apical prolapse of 2nd or greater degree, (POPQ stages 2–4), and at least two pelvic symptoms. Exclusions: Comorbid medical problems known to cause chronic pelvic pain (e.g., infection), sphincter tears, neurological bladder conditions. Surgery: minimally invasive cardinal/uterosacral ligament repair using the TFS (Tissue Fixation System). Primary outcome: Uterine prolapse cure; Secondary outcomes; bladder, bowel, and pain symptoms improvement.Results90% prolapse cure in 611 patients. Symptom incidence (% Cure at 12 months in brackets) was: urge incontinence: n = 310 (85%); frequency: n = 317 (83%); nocturia: n = 254 (68%); chronic pelvic pain (CPP): n = 194 (77%); fecal incontinence: n = 93 (65%). Statistics: McNemar x2-tests to test for significant changes in the symptoms’ incidence-frequency from baseline (preoperative) to the postoperative phase. For each symptom the null hypothesis H0: P(baseline) = P(12 months after surgery) versus H1: P(baseline) ≠ P(12 months after surgery) was tested, with P indicating prevalence or incidence rate.ConclusionsBladder & bowel incontinence and chronic pelvic pain occur in predictable groupings and are associated with apical prolapse. OAB symptom improvement with the TFS ligament repair provides a good alternative to anticholinergics, especially when considering their association with dementia causation. Application of the Integral Theory System has the potential to significantly improve clinical practice, QoL for ageing women, delaying entry into Nursing Homes and creating new scientific research directions. The take home message is that symptoms of chronic pelvic pain, bladder and bowel dysfunction occur in relatively predictable groups, caused by lax suspensory ligaments and can be cured or improved by TFS mini sling ligament repair.

Hyperbaric oxygen therapy for radiation-induced injury: evidence is needed

Hyperbaric oxygen therapy for radiation-induced injury: evidence is needed

Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): a randomised, double-blind, sham-controlled phase 3 trial

SummaryBackgroundHyperbaric oxygen has been used as a therapy for patients experiencing chronic intestinal syndromes after pelvic radiotherapy for decades, yet the evidence to support the use of this therapy is based almost exclusively on non-randomised studies. We aimed to provide conclusive results for the clinical benefits of hyperbaric oxygen in patients with chronic bowel dysfunction after radiotherapy for pelvic malignancies.MethodsHOT2 was a double-blind, sham-controlled, phase 3 randomised study of patients (≥18 years) with chronic gastrointestinal symptoms for 12 months or more after radiotherapy and which persisted despite at least 3 months of optimal medical therapy and no evidence of cancer recurrence. Participants were stratified by participating hyperbaric centre and randomly assigned (2:1) by a computer-generated list (block size nine or 12) to receive treatment with hyperbaric oxygen therapy or sham. Participants in the active treatment group breathed 100% oxygen at 2·4 atmospheres of absolute pressure (ATA) and the control group breathed 21% oxygen at 1·3 ATA; both treatment groups received 90-min air pressure exposures once daily for 5 days per week for a total of 8 weeks (total of 40 exposures). Staff at the participating hyperbaric medicine facilities knew the allocated treatment, but patients, clinicians, nurse practitioners, and other health-care professionals associated with patients' care were masked to treatment allocation. Primary endpoints were changes in the bowel component of the modified Inflammatory Bowel Disease Questionnaire (IBDQ) score and the IBDQ rectal bleeding score 12 months after start of treatment relative to baseline. The primary outcome was analysed in a modified intention-to-treat population, excluding patients who did not provide IBDQ scores within a predetermined time-frame. All patients have completed 12 months of follow-up and the final analysis is complete. The trial is registered with the ISRCTN registry, number ISRCTN86894066.FindingsBetween Aug 14, 2009, and Oct 23, 2012, 84 participants were randomly assigned: 55 to hyperbaric oxygen and 29 to sham control. 75 (89%) participants received 40 pressure exposures, all participants returned the IBDQ at baseline, 75 (89%) participants returned the IBDQ at 2 weeks post-treatment, and 79 (94%) participants returned the IBDQ at 12 months post-start of treatment. Patients were excluded from analyses of co-primary endpoints if they had missing IBDQ scores for intestinal function or rectal bleeding at baseline or at 12 months. In an analysis of 46 participants in the active treatment group and 23 participants in the control group, we found no significant differences in the change of IBDQ bowel component score (median change from baseline to 12 months of 4 (IQR −3 to 11) in the treatment group vs 4 (−6 to 9) in the sham group; Mann-Whitney U score 0·67, p=0·50). In an analysis of 29 participants in the active treatment group and 11 participants in the sham group with rectal bleeding at baseline, we also found no significant differences in the change of IBDQ rectal bleeding score (median change from baseline to 12 months of 3 [1 to 3] in the treatment group vs 1 [1 to 2] in the sham group; U score 1·69, p=0·092). Common adverse events in both groups were eye refractive changes (three [11%] of 28 patients in the control group vs 16 [30%] of 53 patients in the treatment group), increased fatigue (three [11%] vs two [4%]), and ear pain (six [21%] vs 15 [28%]). Eight serious adverse events were reported in eight patients: two were reported in two patients in the control group (tonsillitis requiring surgery [grade 3]; recurrent cancer of the vulva [grade 4]) and six serious adverse events were reported in six patients in the treatment group (malignant spinal cord compression requiring surgery [grade 3]; malignant paraortic lymph node involvement requiring surgery [grade 3]; recurrence of vomiting and dehydration [grade 3]; diarrhoea and fever associated with Campylobacter infection [grade 3]; recurrence of abdominal pain, bloating, diarrhoea, and urinary tract infection [grade 3]; aneurysm [grade 4]), none of which were deemed treatment-related.InterpretationWe found no evidence that patients with radiation-induced chronic gastrointestinal symptoms, including those patients with rectal bleeding, benefit from hyperbaric oxygen therapy. These findings contrast with evidence used to justify current practices, and more level 1 evidence is urgently needed.FundingCancer Research UK and National Health Service (NHS) funding to the National Institute of Health Research Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research.

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a "skin-CNS-bladder" reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2-3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data. Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions. This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.

Electroacupuncture Improves Bladder and Bowel Function in Patients with Traumatic Spinal Cord Injury: Results from a Prospective Observational Study

In order to explore the effect of electroacupuncture (EA) for chronic bowel and bladder dysfunction after traumatic spinal cord injury, 14 patients were treated with electroacupuncture once a day, five times a week for the first four weeks, and once every other day, three times a week for the following four weeks. The patients were then followed up for six months. After treatment, four (4/14, 28.57%) patients resumed normal voiding; six (6/14, 42.86%) resumed normal voiding for no less than half of all micturition behaviors; four (4/14, 28.57%) required supplementary urination methods for higher than half of all micturition behaviors. These effects persisted during followup. Mean postvoid RUV decreased by 190.29 ± 101.87 mL (P < 0.01) after treatment and by 198.86 ± 112.18 mL (P < 0.01) during followup. Patients' weekly urinary incontinence frequency decreased 7.14 ± 46.34 times/week (P = 0.036) after treatment and decreased 49.86 ± 44.38 times/week during followup. After treatment, four (4/14, 28.57%) patients resumed normal bowel movements (P = 0.025); five (5/14, 35.71%) reduced the dependence on supplementary defecation methods; five (5/14, 35.71%) had no changes. In patients with chronic bowel and bladder dysfunction after traumatic SCI, EA may provide a valuable alternative tool in improving patients' self-controlled bowel and bladder functions with minimal side effects.

The Relationship between Chronic Bowel Dysfunction and the Small Bowel Dose Volume Histogram of Rectal Cancer Survivors

Materials/Methods: Billing records and tumor registry were used to identify all living patients treated with RT for rectal cancer between January 1996 and January 2009. After exclusions for stomas, active metastatic disease, no 3D treatment planning, inadequate small bowel contrast, unrecoverable treatment data, repeat pelvic RT, wide local excision/no surgery, lost to follow-up, incapacitation from other disease, or declining participation, the remaining patients answered a validated 18 item questionnaire (Temple, et al. Diseases Colon Rectum 2005;48:1353-65). This resulted in a frequency score, a dietary score, an urgency/soilage score, and four scores from independent questions. These seven scores were tested using linear regression to evaluate the correlation the absolute small bowel volume for each dose at 5 Gy increments. The Student’s unpaired t test and Pearson chi-square/Fisher’s Exact test were used to compare continuous and categorical variables between preoperative and postoperative groups, respectively. A p value of 0.05 was considered statistically significant. Statistical analyses were performed with SPSS Version 17.0 (SPSS Inc., Chicago, IL), and all statistical tests were two-sided.

Suspected epidural morphine analgesia induced chronic urinary and bowel dysfunction in a cat

A 12-year-old male castrated domestic shorthair developed chronic urinary retention, constipation and a decreased perineal reflex following a single lumbo-sacral epidural injection of morphine during general anesthesia. Similar adverse effects have been reported in humans following epidural analgesia, but this is the first reported case of both urinary and bowel dysfunction in a cat purportedly from an epidural. The cat was medically managed with manual bladder expressions, intermittent enemas, and various medications including bethanechol, cisapride and stool softeners. The cat continues to have long-term neurologic dysfunction 15 months post-onset. This case report describes a rare but serious potential risk of lumbo-sacral epidural injections in cats.

Late onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of gastroenterologists

Introduction17 000 patients receive treatment with radical pelvic radiotherapy annually in the UK. Up to 50% develop significant gastrointestinal (GI) symptoms. The Department of Health estimates that £40 million is...

Changes in bowel function after stoma closure

Much of the evidence related to bowel dysfunction after stoma closure has been written from a medical oncological or surgical oncological perspective. Due to advances in surgical technique, most stomas formed are temporary or ′defunctioning′. Stoma closure can cause the common symptoms of frequency, urgency and incontinence, which are largely under−reported. Existing literature points to the fact that chronic bowel dysfunction is multi−factorial, and often related to a combination of damaged anal sphincters, shorter transit time, radiation damage and psychological issues relating to bowel function. There is very little evidence written from a nursing perspective on the quality of life of these patients after stoma closure. This article aims to show evidence−based and consensus theory regarding the subject from the current sources available.

Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis

When conservative management fails in patients with chronic spinal cord injury (SCI) and neurogenic bowel dysfunction, clinicians have to choose from a variety of treatment options which include colostomy, ileostomy, Malone anterograde continence enema (MACE) and sacral anterior root stimulator (SARS) implantation. This study employed a decision analysis to examine the optimal treatment for bowel management of young individuals with chronic refractory constipation in the setting of chronic SCI. A decision analysis was created to compare the four surgical strategies using baseline analysis, one-way and two-way sensitivity analyses, 'worst scenario' and 'best scenario' sensitivity analyses, and probabilistic sensitivity analyses. Quality-adjusted life expectancy (QALE) was the primary outcome. The baseline analysis indicated that patients who underwent the MACE procedure had the highest QALE value compared with the other interventions. Sensitivity analyses showed that these results were robust. The MACE procedure may provide the best long-term outcome in terms of the probability of improving bowel function, reducing complication rates and the incidence of autonomic dysreflexia, and being congruent with patients' preferences. The analysis was sensitive to changes in assumptions about quality of life/utility, and thus the results could change if more specific estimates of utility became available.

The Effects Of Colostomy On The Quality Of Life In Patients With Spinal Cord Injury: A Retrospective Analysis

Purpose: The purpose of this study was to evaluate the effects of colostomy on the quality of life (QOL) in patients with spinal cord injury (SCI) by designing a questionnaire that used self-reported data and correlating these data with the clinical information obtained from patients' medical records.Materials and methods: A comprehensive QOL questionnaire was designed to specifically address the following 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure. This questionnaire was completed during a telephone or an in-person interview. The subjective data derived from the questionnaire were correlated with objective medical information obtained from a review of medical records.Results: The QOL improved significantly (t = 9.128, P < .0001) after colostomy. All 27 (100%) patients were “satisfied,” and 16 (59%) of them were “very satisfied” with colostomy. Nineteen (70%) patients would have preferred to have the colostomy done earlier, and only 3(11%) patients wished it reversed. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (t = 7.964, P < .0001). All patients stated that colostomy simplified bowel care routine and increased independence. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy. Stoma prolapse and wound dehiscence were the most common complications of stomal surgery. When compared with medical data, patients were able to reliably recall average time with bowel problems (r = .881, P < .0001) and stomal surgery complications (r = .810, P < .0001).Conclusion: Colostomy is a safe and effective treatment for chronic bowel dysfunction in patients with spinal cord injury. It is well accepted by the patients and significantly improves QOL and bowel management procedures. Correlation analysis indicates that subjective patient-reported data are consistent with objective data obtained from the medical records.

Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury.

Amongst complications arising from spinal cord injury (SCI), chronic gastrointestinal (G-I) problems and bowel dysfunction have not received as much research attention as many other medical and rehabilitation problems, even although their incidence is not negligible. We therefore investigated chronic G-I problems and bowel dysfunction in SCI patients where the degree of these was such that activities of daily living (ADL) were significantly affected and/or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The history of SCI was longer than 6 months, bowel habits had settled, and neurological recovery was completed. The incidence of chronic G-I problems was very high (62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL, and in particular, restricted diet (80%), restricted outdoor ambulation (64%) and caused unhappiness with bowel care (62%). Bowel care was performed once per 2.85 +/- 1.96 days and occupied an average of 42.1 +/- 28.7 min. To improve bowel habits, 43% of the patients took oral medication, and 36.1% controlled their diet. The usual methods of bowel care were anal massage (34.7%), unaided self-defecation with or without oral medication and abdominal massage (29.2%), finger enema (18.1%), rectal suppository (15.2%) and in two patients a colostomy tube had been inserted because of rectal cancer and traumatic colorectal injury. These chronic G-I symptoms were vague and very subjective, but significant enough to affect the quality of life. Bowel dysfunction was not related to age, duration of, or the neurological level of injury, ASIA score of ADL level, and bowel habits had generally settled within 6 months of SCI. With regard to frequency, time, and method of defection, bowel care habits varied considerably amongst individuals, and in relation to the extent to which practical results matched the level of expectation generated by physicians' recommended care program. Individual satisfaction was also very subjective. We therefore suggest that during the early stage of rehabilitation, an appropriate bowel program should be properly designed and adequate training provided.