Megacolon in patients with chronic spinal cord injury

Purpose: To investigate the clinical and functional correlates of megacolon in individuals with chronic spinal cold injury (SCI). Patients and methods: This is a cross-sectional study of 128 patients conse cutively admitted to a SCl in-patient service in a US Veterans Administrati on Medical Centre (mean age 57 +/- 15 years, mean years since injury 20 +/- 13, 97% male) who underwent plain abdominal radiography for study purposes . Participants were characterised by radiological findings. 'Megacolon' was defined as colonic dilatation of >6 cms in one or more colonic segment(s). Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews were conducted with study parti cipants regarding bowel-related symptoms and treatment over the previous 1- month period. Results: Seventy-three per cent of subjects (n = 94) had megacolon, and 52% of these individuals had associated radiological constipation. Subjects wi th megacolon were compared with those without colonic dilatation (n = 34). Factors significantly associated with megacolon were older age, longer dura tion of injury, symptom of abdominal distension, radiological constipation, urinary outlet surgery, laxative use at least once weekly, use of antichol inergic drugs, and use of calcium-containing antacids. These factors were s imultaneously included in a multiple logistic regression model. Independent correlates of megacolon were more than 10 years elapsed since acute injury , age over 50 years, and use of 34 laxative doses per month. Conclusion: Megacolon is a highly prevalent disorder in individuals with ch ronic spinal cord injury. Out findings suggest that the presence of megacol on may be predicted in older individuals, and in those who are more than 10 years post-SCI. We also found that clinical constipation was frequently pr esent in individuals with megacolon, despite their significantly greater us e of laxatives. Sponsorship: This work was supported by a grant from the Claude D Pepper Ge riatric Research and Training Center from the National Institute of Ageing- AG08812-05, and a grant from the Education and Training Foundation of the P aralyzed Veterans Association in the USA. Dr Harari is currently recipient of a grant from Action Research (UK).