title: Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury.
abstract: 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.
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark. piz@webspeed.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Christensen
authors.forename: Gabriele
authors.initials: G
authors.lastname: Bazzocchi
authors.forename: Maureen
authors.initials: M
authors.lastname: Coggrave
authors.forename: Rainer
authors.initials: R
authors.lastname: Abel
authors.forename: Claes
authors.initials: C
authors.lastname: Hulting
authors.forename: Klaus
authors.initials: K
authors.lastname: Krogh
authors.forename: Shwan
authors.initials: S
authors.lastname: Media
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
mesh_terms: 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
chemical_list: D005765:Gastrointestinal Agents