CHRONIC GASTROINTESTINAL PROBLEMS AND BOWEL DYSFUNCTION IN PATIENTS WITH SPINAL-CORD INJURY

Amongst complications arising from spinal cord injury (SCI), chronic g astointestinal (G-I) problems and bowel dysfunction have not received as much research attention as many other medical and rehabilitation pr oblems, even although their incidence is not negligible. We therefore investigated chronic G-I problems and bowel dysfunction in SCI patient s where the degree of these was such that activities of daily living ( ADL) were significantly affected and/or long-term medical management w as required. Detailed semi-structured individual interviews were condu cted with 72 traumatic SCI patients. The history of SCI was longer tha n 6 months, bowel habits had settled, and neurological recovery was co mpleted. The incidence of chronic G-I problems was very high (62.5%), most were associated with defecation difficulties such as severe const ipation, difficult with evacuation, pain associated with defecation, o r urgency with incontinence. These problems had an extensive impact on ADL, and in particular, restricted diet (80%), restricted outdoor amb ulation (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 o ral 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 (1 8.1%), rectal suppository (15.2%) and in two patients a colostomy tube had been inserted because of rectal cancer and traumatic colorectal i njury. These chronic G-I symptoms were vague and very subjective, but significant enough to affect the quality of life. Bowel dysfunction wa s not related to age, duration of, or the neurological level of injury , ASIA score of ADL level, and bowel habits had generally settled with in 6 months of SCI. With regard to frequency, time, and method of defe cation, bowel care habits varied considerably amongst individuals, and in relation to the extent to which practical results matched the leve l of expectation generated by a physicians' recommended care program. Individual satisfaction was also very subjective. We therefore suggest that during the early stage of rehabilitation, an appropriate bowel p rogram should be properly designed and adequate training provided.