title: Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom.
abstract: METHODS
  Postal survey.
  
  
  OBJECTIVE
  To describe bowel management in community-dwelling spinal cord-injured (SCI) individuals and to explore associations between age, injury, dependency, problems, interventions and satisfaction.
  
  
  METHODS
  Outpatients of a single SCI unit, in the United Kingdom.
  
  
  METHODS
  Postal questionnaire to all outpatients with SCI for at least 1 year, of any level or density, aged 18 years or more.
  
  
  RESULTS
  Response rate was 48.6% (n=1334). Median age was 52 years, median duration of injury 18 years. The most common intervention was digital evacuation (56%). Up to 30 min was spent on each bowel care episode by 58% of respondents; 31-60 min by 22%; 14% spent over 60 min. Reported problems included constipation (39%), haemorrhoids (36%) and abdominal distension (31%). Reduced satisfaction with bowel function was associated with longer duration of each bowel care episode, faecal incontinence, greater number of interventions used and more problems reported (all P<or=0.001); 130 (9.7%) had undergone any type of surgical bowel intervention. Impact of bowel dysfunction on the respondent's life was rated as significantly greater than other aspects of SCI (P<or=0.001).
  
  
  CONCLUSIONS
  Managing SCI bowel function in the community is complex, time consuming and remains conservative. Despite potential for bias from a low response, for this large group of responders, bowel dysfunction impacted most on life compared with other SCI-related impairments. The study findings demand further exploration of bowel management to reduce impact, minimize side effects and increase the choice of management strategies available.
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK. maureen.coggrave@buckshosp.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Coggrave
authors.forename: C
authors.initials: C
authors.lastname: Norton
authors.forename: J
authors.initials: J
authors.lastname: Wilson-Barnett
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000209:etiology* / Q000628:therapy*; D011788:Quality of Life; D012111:Residence Characteristics; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult