Chronic Gastrointestinal Problems and Bowel Dysfunction in Spinal Cord Injury Patients

ABSTRACT

Among complications arising from spinal cord injury (SCI), chronic gastrointestinal(G-I) problems and bowel dysfunction have not received as much attention as the other fields of medical and rehabilitation research, even though their incidence is not negligible. Among SCI patients, we therefore investigated chronic G-I problems and bowel dysfunction, where the degree of these was such that activities of daily living(ADL) were significantly affected or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. 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 in particular, they restricted diet (80%), restricted out door ambulation(64%), and caused unhappiness with bowel care(62%). These chronic G-I symptoms were vague and very subjective, but significant enough to affect quality of life. Bowel dysfunction was not related to severity of injury, and bowel habits had generally settled within six months of SCI. With regard to frequency, time, and method of defecation, bowel care habits varied very considerably among individuals, and in relation to the extent to which practical results matched the level of expectation generated by a physician's recommended care program, individual satisfaction was also very subjective. We therefore suggest that an appropriate bowel program should be properly designed and adequate training provided during the early stage of rehabilitation.