Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury.
OBJECTIVE
To compare symptoms of neurogenic bowel dysfunction in patients with spinal cord injury (SCI) at baseline and after 10 weeks of treatment with transanal irrigation and to identify possible factors that could predict outcome of the treatment.


METHODS
Sixty-two patients with SCI (45 men and 17 women; mean age, 47.5 +/- 15.5 [SD] years) from 5 specialized European SCI centers were offered treatment with transanal irrigation for a 10-week period. Bowel function was assessed at baseline and at termination using the Cleveland Clinic Constipation Scoring System (CCCSS; 0-30, 30 = severe symptoms), St. Mark's Fecal Incontinence Grading System (FIGS; 0-24, 24 = severe symptoms), and the Neurogenic Bowel Dysfunction score (NBD; 0-47, 47 severe symptoms). Factors predicting improvement in bowel function scores were identified using a general linear model.


RESULTS
Severity of symptoms at termination was significantly reduced compared with baseline values (CCCSS: -3.4; 95% confidence interval [CI], -4.6 to -2.2; FIGS: - 4.1; 95% CI, -5.2 to -2.9; NBD: -4.5; 95% CI, -6.6 to -2.4; all P < 0.0001). Although several factors were associated with positive outcome, no consistent and readily explainable pattern could be identified. Surprisingly, hand function, level of dependency, predominant symptom, and colonic transit time were not associated with outcome.


CONCLUSIONS
Transanal irrigation in patients with SCI reduces constipation, improves anal continence, and improves symptom-related quality of life. No readily obtainable factors could predict outcome, which might be because of the relatively low number of patients. This supports the use of trial and error as a strategy in deciding on a bowel management method for neurogenic bowel dysfunction.
Christensen
Peter
P
Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark. piz@webspeed.dk
Bazzocchi
Gabriele
G
Coggrave
Maureen
M
Abel
Rainer
R
Hulting
Claes
C
Krogh
Klaus
K
Media
Shwan
S
Laurberg
Søren
S
D000328:Adult; D001913:Bowen's Disease / Q000209:etiology* / Q000628:therapy*; D004311:Double-Blind Method; D005242:Fecal Incontinence; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
D005765:Gastrointestinal Agents