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Neuberger L, Braude P, Weeks K, Braude P, Halliday R, McCarthy K, Carter B. A new stoma for an older person-An association with quality of life and physical function: A systematic review. J Am Geriatr Soc 2022; 70:2415-2425. [PMID: 35506939 DOI: 10.1111/jgs.17803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/22/2022] [Accepted: 03/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Older people are more likely to have a stoma postabdominal surgery than younger people. Few studies have examined the effect of a stoma on older people. The aim of this review was to explore the effect of a stoma on functional independence of an older person. We explored secondary outcomes of poststoma formation length of hospital stay, quality of life and factors affecting stroma independence. METHODS An exploratory systematic review was developed by our multidisciplinary group including an expert patient, colorectal surgeon, stoma nurse, physiotherapist, geriatrician, and methodologist. Four databases were searched including studies with participants 60 years old or older, who had undergone abdominal surgery for any pathology resulting in an abdominal stoma. RESULTS We identified 857 studies, of which we included 25 in the final review incorporating 6972 participants (average age 67.4 years). There was a strong association between presence of stoma and (1) worse physical function (standardized MD = 0.7; 95% CI 0.21-1.19; I2 = 95) and (2) worse quality of life (standardized MD = 1.61; 95% CI 0.5-2.72, I2 = 98). The same effect was seen in fecal ostomy and urinary diversion. Few studies measured stoma independence and only one examined factors affecting this. No studies examined length of stay. CONCLUSIONS Stoma have a negative association with the physical function and quality of life of older people. Future studies should focus on identifying modifiable factors that may affect physical function, quality of life, and stoma independence.
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Affiliation(s)
- Lydia Neuberger
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Philip Braude
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Kayleigh Weeks
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Peter Braude
- Division of Women's Health, King's College London, London, UK
| | - Ruth Halliday
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Kathryn McCarthy
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK
| | - Ben Carter
- Medicine for Older People, CLARITY (Collaborative Ageing Research) Group, North Bristol NHS Trust, Bristol, UK.,Biostatistics and Health informatics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Cochrane Skin Group, Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Waddell O, McCombie A, Frizelle F. Colostomy and quality of life after spinal cord injury: systematic review. BJS Open 2020; 4:1054-1061. [PMID: 32852897 PMCID: PMC7709367 DOI: 10.1002/bjs5.50339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) has a significant impact on the quality of life (QoL) of affected patients. The aim of this review was to determine whether colostomy formation improves QoL in patients with SCI. METHODS The Cochrane Register, MEDLINE, Embase and CINAHL were searched using medical subject headings. The search was extended to the reference lists of identified studies, ClinicalTrials.gov and the WHO International Clinical Trials Registry. All clinical trials that included spinal injury and QoL, time spent on bowel care, and patient satisfaction with stoma were assessed. RESULTS A total of 15 studies were found (including 488 patients with a stoma), of which 13 were retrospective cross-sectional studies and two were case-control studies, one of which was prospective research. Nine of 11 studies focusing on QoL reported that patients' QoL was improved by the stoma, whereas the remaining two studies found no difference. Time spent on bowel care was significantly reduced in all 13 studies that considered this outcome, with patients reducing the average time spent on bowel care from more than 1 h to less than 15 min per day. All 12 studies assessing patient satisfaction with their stoma reported high patient satisfaction. CONCLUSION Stoma formation improves QoL, reduces time spent on bowel care, and increases independence. Stoma is an option that could be discussed and offered to patients with spinal cord injury.
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Affiliation(s)
- O. Waddell
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
| | - A. McCombie
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
| | - F. Frizelle
- Department of SurgeryUniversity of Otago Christchurch2 Riccarton Avenue, Christchurch Central CityChristchurch8011New Zealand
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Abstract
The symptoms of neurogenic bowel dysfunction (NBD) comprise constipation and fecal incontinence. These have a major impact on quality of life and dignity. Bowel symptoms occur in the majority of patients with chronic neurological diseases like multiple sclerosis, spinal cord injury, and Parkinson’s disease. Management relies on obtaining a careful bowel history, including assessment of bowel function prior to the onset of neurological symptoms. Objective measures of NBD are available and important in terms of monitoring response for what are often intensely personal and difficult-to-elicit symptoms. Conservative management begins by establishing an effective and regular bowel regime by optimizing diet and laxative use. If this is insufficient, as seen in about half of patients, transanal irrigation has been shown to reduce NBD symptoms and improve quality of life. Failing that, there are more invasive surgical options available. This review aims to provide practical guidance for the clinician who encounters these patients, focusing on a stepwise approach to assessment, interventions, and monitoring.
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Affiliation(s)
- Anton Emmanuel
- GI Physiology Unit, University College London Hospital, Euston Road, London, WC1E 6DB, UK
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4
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Pontell ME, Kucejko R, Scantling D, Weingarten M, Stein D. Morbidity and mortality in patients undergoing fecal diversion as an adjunct to wound healing: a NSQIP comparison study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Choukou MA, Best KL, Craven BC, Hitzig SL. Identifying and Classifying Quality of Life Tools for Assessing Neurogenic Bowel Dysfunction After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 25:1-22. [PMID: 30774286 DOI: 10.1310/sci18-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives: To identify and classify tools for assessing the influence of neurogenic bowel dysfunction (NBD) on quality of life (QoL) after spinal cord injury (SCI). Methods: In this systematic review, MEDLINE/PubMed, CINAHL, and PsycInfo were searched to identify studies assessing the influence of NBD on QoL (or related construct) after SCI. Two independent reviewers screened titles and abstracts, and both reviewers classified tools as subjective or objective according to Dijkers' theoretical QoL framework. Results: Seventy-two studies were identified, and 35 studies met the inclusion criteria. Five objective measures assessed the influence of NBD on QoL, which were validated for use in SCI, but no measure was condition-specific to NBD. Eight measures were classified as subjective tools; two had an established reliability and validity for SCI while six had some psychometric evidence for use in the SCI population. Five subjective measures (NBD score, Burwood QoL Questionnaire, Impediments to Community Integration [ICI] Scale, SCI-QoL Bowel Management Difficulties, and Survey of Neurogenic Bowel Characteristics) were developed specifically for SCI. The NBD score showed sensitivity to the influence of NBD on QoL in experimental trials. Conclusion: Thirteen tools assessed the influence of NBD on QoL in SCI. Although not developed specifically for SCI, the Health Utility Index (HUI-III) was the only tool identified that provided data on "QoL as utility" on the impact of NBD. The validated NBD score was the only condition-specific tool to assess QoL as "subjective well-being." Further validation of existing tools could help to inform practice and policy related to resource allocation for bowel care post SCI.
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Affiliation(s)
- Mohamed-Amine Choukou
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - Krista L Best
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - B Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, Faculty ofHealth, York University, Toronto, Ontario, Canada
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Ageing with neurogenic bowel dysfunction. Spinal Cord 2017; 55:769-773. [PMID: 28290468 DOI: 10.1038/sc.2017.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 12/19/2022]
Abstract
STUDY DESIGN Longitudinal study with postal survey. OBJECTIVES To describe changes in the patterns of neurogenic bowel dysfunction and bowel management in a population of people with spinal cord injury (SCI) followed for two decades. SETTING Members of the Danish SCI Association. METHODS In 1996, a validated questionnaire on bowel function was sent to the members of the Danish SCI Association (n=589). The same questionnaire was sent to all the surviving members in 2006 (n=284) and in 2015 (n=178). A total of 109 responded to both the 1996 and 2015 questionnaires. RESULTS Comparing data from 2015 with those from the exact same participants in 1996, the proportion of respondents needing more than 30 min for each defaecation increased from 21 to 39% (P<0.01), the use of laxatives increased (P<0.05) and the proportion considering themselves very constipated increased from 19 to 31% (P<0.01). In contrast, the proportion suffering from faecal incontinence remained stable at 18% in 1996 and 19% in 2015. During the 19-year period, there had been no significant change in the methods for bowel care, but 22 (20%) had undergone surgery for bowel dysfunction, including 11 (10%) who had some form of stoma. CONCLUSION Self-assessed severity of constipation increased but quality of life remained stable in a cohort of people with SCI followed prospectively for 19 years. Methods for bowel care remained surprisingly stable but a large proportion had undergone stoma surgery.
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Bølling Hansen R, Staun M, Kalhauge A, Langholz E, Biering-Sørensen F. Bowel function and quality of life after colostomy in individuals with spinal cord injury. J Spinal Cord Med 2016; 39:281-9. [PMID: 25738657 PMCID: PMC5073766 DOI: 10.1179/2045772315y.0000000006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN Cross-sectional descriptive study. SETTING Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet. PARTICIPANTS Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. INTERVENTIONS Questionnaires and measurement of gastrointestinal transit time (GITT). OUTCOME MEASURES Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. RESULTS Seventy-two percent significantly reduced their use of time on bowel emptying after the colostomy. All but one reported being content with the colostomy. Thirty-nine percent reported one or more problems related to the colostomy. Seventy-five percent had a GITT within normal range for able-bodied populations. When disregarding the physical component, QoL was not significantly lower in the total study group compared to a Danish norm group, but significantly lower when compared the subgroup of persons with tetraplegia. CONCLUSION A colostomy reduces the time necessary for bowel management. The majority of individuals with SCI and a colostomy did not perceive bowel management as being a problem. The results indicate that colostomy is a favourable option for individuals with SCI, who spend long hours on bowel management and for whom non-invasive procedures did not improve the situation enough.
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Affiliation(s)
- Rikke Bølling Hansen
- Department for Spinal Cord Injuries, Glostrup Hospital, University of Copenhagen, Hornbæk, Denmark,Correspondence to: Rikke Bølling Hansen, Department for Spinal Cord Injuries, Glostrup Hospital, University of Copenhagen, Havnevej 25, DK-3100 Hornbæk, Denmark. E-mail:
| | - Michael Staun
- Department of Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Kalhauge
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ebbe Langholz
- Department of Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Department for Spinal Cord Injuries, Glostrup Hospital, University of Copenhagen, Hornbæk, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Boucher M. Early elective colostomy following spinal cord injury. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S4, S6, S8-10. [PMID: 26973012 DOI: 10.12968/bjon.2016.25.5.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elective colostomy is an accepted method of bowel management for patients who have had a spinal cord injury (SCI). Approximately 2.4% of patients with SCI have a colostomy, and traditionally it is performed as a last resort several years after injury, and only if bowel complications persist when all other methods have failed. This is despite evidence that patients find a colostomy easier to manage and frequently report wishing it had been performed earlier. It was noticed in the author's spinal unit that increasing numbers of patients were requesting colostomy formation during inpatient rehabilitation following SCI. No supporting literature was found for this; it appears to be an emerging and untested practice. This article explores colostomy formation as a method of bowel management in patients with SCI, considers the optimal time for colostomy formation after injury and examines issues for health professionals.
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Affiliation(s)
- Michelle Boucher
- Stoma Care Clinical Nurse Specialist, Salisbury NHS Foundation Trust
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9
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Pan Y, Liu B, Li R, Zhang Z, Lu L. Bowel dysfunction in spinal cord injury: current perspectives. Cell Biochem Biophys 2015; 69:385-8. [PMID: 24549854 DOI: 10.1007/s12013-014-9842-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Permanent disruptions of gastrointestinal function are very common sequel of spinal cord injury (SCI). When motor and sensory nervous integrity are severely affected, neurogenic gastrointestinal dysfunction is an inevitable consequence. Autonomic nervous system miss function has significantly diminished or lost sensory sensations followed with incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone all of those predisposing to increased risk of fecal incontinence (FI). The FI is, beside paralysis of extremities, one of the symptoms most profoundly affecting quality of life (QOL) in patients with SCI. We are reviewing current perspectives in management of SCI, discussing some pathophysiology mechanisms which could be addressed and pointing toward actual practical concepts in use for evaluation and improvements necessary to sustain SCI patients QOL.
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Affiliation(s)
- Yuehai Pan
- Department of Hand Surgery, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130021, People's Republic of China
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10
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West JR, Mohiuddin SA, Hand WR, Grossmann EM, Virgo KS, Johnson FE. Surgery for constipation in patients with prior spinal cord injury: the Department of Veterans Affairs experience. J Spinal Cord Med 2013; 36:207-12. [PMID: 23809590 PMCID: PMC3654446 DOI: 10.1179/2045772312y.0000000078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Patients with spinal cord injury (SCI) typically have difficulty with constipation. Some undergo surgery for bowel management. We predicted that SCI patients would have higher mortality and/or morbidity rates following such surgery than neurally intact patients receiving the same procedures. We sought to evaluate this using a large population-based data set. METHODS Patients receiving care at Department of Veterans Affairs Medical Centers (DVAMCs) with computer codes for SCI and constipation who later underwent colectomy, colostomy, or ileostomy during fiscal years 1993-2002 were identified. Charts were requested from the VAMCs where the surgery had been performed and a retrospective chart review of these charts was done. We collected data on patient demographics, six specific pre-operative co-morbidities, surgical complications, and post-operative mortality. Comparisons were made to current literature evaluating a population receiving total abdominal colectomy and ileorectal anastomosis for constipation but not selected for SCI. RESULTS Of 299 patients identified by computer search, 43 (14%) had codes for SCI and 10 of 43 (24%) met our inclusion criteria. All were symptomatic and had received appropriate medical management. Co-morbid conditions were present in 9 of 10 patients (90%). There were no deaths within 30 days. The complication rate was zero. The mean post-operative length of stay was 17 days. CONCLUSIONS Patients with SCI comprise about 14% of the population who receive surgery for severe constipation in the Department of Veterans Affairs system. The mortality and morbidity rates in these patients are similar to those reported in other constipated patients who have surgery for intractable constipation. Our data suggest that stoma formation ± bowel resection in patients with SCI is a safe and effective treatment for chronic constipation.
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Affiliation(s)
- Jason R. West
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA
| | - Shoeb A. Mohiuddin
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA
| | - William R. Hand
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA
| | - Erik M. Grossmann
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA
| | - Katherine S. Virgo
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA; and Surgical Service, Department of Veterans Affairs Medical Center, St Louis, MO, USA
| | - Frank E. Johnson
- Department of Surgery, Saint Louis University Health Sciences Center, St Louis, MO, USA; and Surgical Service, Department of Veterans Affairs Medical Center, St Louis, MO, USA,Correspondence to: Frank E. Johnson, Department of Surgery, Saint Louis University, 3635 Vista Avenue, PO Box 15250, St Louis, MO 63110-0250, USA.
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12
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Sigurdsen E, Tørhaug T. [Spinal cord injury and bowel function]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1107-10. [PMID: 22614313 DOI: 10.4045/tidsskr.10.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) often causes permanent disruptions of gastrointestinal function, which exacerbates functional disablement. MATERIAL AND METHOD The article is based on the authors' own clinical experience at tertiary level in the specialist health service and literature searches in PubMed. RESULTS Neurogenic gastrointestinal dysfunction is a common sequela of injury to the spinal cord. Obstipation and faecal incontinence entail treatment that is often time- and resource-consuming. It is not yet possible to treat the cause of the condition. New treatment methods with retrograde and antegrade irrigation of the rectocolon, transanally or by means of appendicostomy, result in a greater degree of self-sufficiency and faster evacuation procedures. INTERPRETATION Neurogenic gastrointestinal dysfunction following a spinal cord injury should be assessed and treated in a tertiary level rehabilitation department. The function loss is permanent, and the treatment must be systematically tested and regularly evaluated. The decision as to which treatment is appropriate has to be taken by the patient and the healthcare system. Individual and personal factors must be taken into account. The newly established international consensus, with standardised data sets for evaluating function loss due to spinal cord injuries, paves the way for new and greater possibilities for multi-centre cooperation on quality assurance and research.
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Affiliation(s)
- Erik Sigurdsen
- Avdeling for ryggmargsskader, Klinikk for fysikalsk medisin og rehabilitering, St. Olavs hospital.
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Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord 2010; 48:718-33. [PMID: 20212501 PMCID: PMC3118252 DOI: 10.1038/sc.2010.14] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Randomized-controlled trials (RCTs), prospective cohort, case-control, pre-post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the management of the neurogenic bowel after spinal cord injury (SCI) were included. OBJECTIVE To systematically review the evidence for the management of neurogenic bowel in individuals with SCI. SETTING Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. METHODS Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. RESULTS A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. CONCLUSIONS Often, more than one procedure is necessary to develop an effective bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.
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Affiliation(s)
- A Krassioukov
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada.
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14
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Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of the pathophysiology of various specific impairments including bowel dysfunction' and 'management approaches for specific impairments including bowel dysfunction'.
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Affiliation(s)
- Anton Emmanuel
- Department of Gastroenterology, University College Hospital and National Hospital for Neurology & Neurosurgery, London, UK.
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15
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Cesaretti IUR, Santos VLCG, Vianna LAC. [Quality of life of the colostomized person with or without use of methods of bowel control]. Rev Bras Enferm 2010; 63:16-21. [PMID: 20339749 DOI: 10.1590/s0034-71672010000100003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 12/12/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate and to compare the quality of life (QoL) of colostomy people, using or not using the bowel control methods (BCM), in other words, the colostomy irrigation and the plug system, considering the hypothesis that people who used them had better QoL. METHOD This study was carried out in the Heliópolis Hospital Outpatient Department, after the project approval for the Ethical and Research Committee, using the WHOQoL-bref. The sample was constituted of two groups: 50 colostomy people with BCM and 50, without BCM. RESULTS The Group with BCM had a QoL significantly higher, being this observed in all the Domains and in the Overall QoL, than those of the Group without BCM. CONCLUSION The study confirmed the hypothesis that the QoL of the Group with BCM is better than the Group without BCM.
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16
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Preziosi G, Emmanuel A. Neurogenic bowel dysfunction: pathophysiology, clinical manifestations and treatment. Expert Rev Gastroenterol Hepatol 2009; 3:417-23. [PMID: 19673628 DOI: 10.1586/egh.09.31] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bowel dysfunction (e.g., fecal incontinence, infrequent or difficult defecation) are both frequent and severely troubling problems for patients with spinal cord injury, multiple sclerosis and Parkinson's disease. The etiology of these symptoms is complex; there may be autonomic and pelvic nerve dysfunction (with attenuation of voluntary motor function and impaired anorectal sensation and anorectal reflexes), or generalized systemic factors (e.g., altered diet and behavior, impaired mobility, psychological disturbances or drug adverse effects). The mainstay of current treatment is adapting a conservative approach towards reversing the systemic effects and optimizing the mechanics of defecation through the use of laxatives and irrigation approaches. When successful, this approach improves both evacuation and incontinence symptoms, with associated improvements in quality of life and independence. Future therapies may be directed at modulating pelvic innervation through electrical stimulation. Stoma formation remains an option for patients refractory to other approaches.
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Affiliation(s)
- Giuseppe Preziosi
- Research Fellow in Neurogastroenterology, GI Physiology Unit, University College Hospital, London, NW1 2BU, UK
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17
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Abstract
Constipation and faecal incontinence are common symptoms among patients with spinal cord injury (SCI), myelomeningocoele (MMC), multiple sclerosis (MS), Parkinson's disease (PD) and stroke. Faecal incontinence in SCI, MMC and MS is mainly due to abnormal rectosigmoid compliance and rectoanal reflexes, loss of rectoanal sensibility and loss of voluntary control of the external anal sphincter. Constipation in SCI, MMC and MS is probably due to immobilisation, abnormal colonic contractility, tone and rectoanal reflexes or side effects from medication. In PD, dystonia of the external anal sphincter causes difficult rectal evacuation and the loss of dopaminergic neurons in the enteric nervous system probably causes slow-transit constipation. Changes after stroke remain to be studied. Though dietary adjustments, oral laxatives, suppositories and other conservative treatment modalities are commonly used, evidence for their use in patients with central neurological disorders is scarce. For patients with severe symptoms trans-anal irrigation, the Malone appendicostomy or a colostomy can be recommended.
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Affiliation(s)
- Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology V, Aarhus University Hospital, Norrebrogade 2, 8000 Aarhus C, Denmark.
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18
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Affiliation(s)
- Maureen Coggrave
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire and the Burdett Institute of Gastrointestinal Nursing, St Mark’s Hospital, Harrow, and Lecturer, King’s College London
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19
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Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury. J Wound Ostomy Continence Nurs 2008; 35:159-66. [PMID: 18344790 DOI: 10.1097/01.won.0000313638.29623.40] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. OBJECTIVES 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. SEARCH STRATEGY A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. RESULTS Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. IMPLICATIONS FOR PRACTICE 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.
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Furlan JC, Urbach DR, Fehlings MG. Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis. Br J Surg 2007; 94:1139-50. [PMID: 17535012 DOI: 10.1002/bjs.5781] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND When conservative management fails in patients with chronic spinal cord injury (SCI) and neurogenic bowel dysfunction, clinicians have to choose from a variety of treatment options which include colostomy, ileostomy, Malone anterograde continence enema (MACE) and sacral anterior root stimulator (SARS) implantation. This study employed a decision analysis to examine the optimal treatment for bowel management of young individuals with chronic refractory constipation in the setting of chronic SCI. METHODS A decision analysis was created to compare the four surgical strategies using baseline analysis, one-way and two-way sensitivity analyses, 'worst scenario' and 'best scenario' sensitivity analyses, and probabilistic sensitivity analyses. Quality-adjusted life expectancy (QALE) was the primary outcome. RESULTS The baseline analysis indicated that patients who underwent the MACE procedure had the highest QALE value compared with the other interventions. Sensitivity analyses showed that these results were robust. CONCLUSION The MACE procedure may provide the best long-term outcome in terms of the probability of improving bowel function, reducing complication rates and the incidence of autonomic dysreflexia, and being congruent with patients' preferences. The analysis was sensitive to changes in assumptions about quality of life/utility, and thus the results could change if more specific estimates of utility became available.
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Affiliation(s)
- J C Furlan
- Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada.
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Soler JM, Denys P, Game X, Ruffion A, Chartier-Kastler E. Chapitre B - L’incontinence anale et les troubles digestifs et leurs traitements en neuro-urologie. Prog Urol 2007; 17:622-8. [PMID: 17622100 DOI: 10.1016/s1166-7087(07)92378-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anal incontinence and gastrointestinal disorders are one of the major causes of impaired quality of life in patients with neurological disease. Patients are very often too embarrassed to spontaneously talk about these problems and problems of chronic constipation can lead to microbial maceration, a known risk factor for urinary tract infection. In this article, the authors review the physiology of defecation and describe the main disorders observed in the various neurological diseases and their management.
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Affiliation(s)
- J M Soler
- Centre de médecine physique et de réadaptation du cap Peyrefitte, Cerbère, France.
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Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, Media S, Laurberg S. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 2006; 131:738-47. [PMID: 16952543 DOI: 10.1053/j.gastro.2006.06.004] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 05/18/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Bowel dysfunction in patients with spinal cord injury often causes constipation, fecal incontinence, or a combination of both with a significant impact on quality of life. Transanal irrigation improves bowel function in selected patients. However, controlled trials of different bowel management regimens are lacking. The aim of the present study was to compare transanal irrigation with conservative bowel management (best supportive bowel care without irrigation). METHODS In a prospective, randomized, controlled, multicenter trial involving 5 specialized European spinal cord injury centers, 87 patients with spinal cord injury with neurogenic bowel dysfunction were randomly assigned to either transanal irrigation (42 patients) or conservative bowel management (45 patients) for a 10-week trial period. RESULTS Comparing transanal irrigation with conservative bowel management at termination of the study, the mean (SD) scores were as follows: Cleveland Clinic constipation scoring system (range, 0-30, 30 = severe symptoms) was 10.3 (4.4) versus 13.2 (3.4) (P = .0016), St. Mark's fecal incontinence grading system (range, 0-24, 24 = severe symptoms) was 5.0 (4.6) versus 7.3 (4.0) (P = .015), and the Neurogenic Bowel Dysfunction Score (range, 0-47, 47 = severe symptoms) was 10.4 (6.8) versus 13.3 (6.4) (P = .048). The modified American Society of Colorectal Surgeon fecal incontinence scores (for each subscale, range is 0-4, 4 = high quality of life) were: lifestyle 3.0 (0.7) versus 2.8 (0.8) (P = .13), coping/behavior 2.8 (0.8) versus 2.4 (0.7) (P = .013), depression/self perception 3.0 (0.8) versus 2.7 (0.8) (P = .055), and embarrassment 3.2 (0.8) versus 2.8 (0.9) (P = .024). CONCLUSIONS Compared with conservative bowel management, transanal irrigation improves constipation, fecal incontinence, and symptom-related quality of life.
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Affiliation(s)
- Peter Christensen
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
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Affiliation(s)
- Marca L Sipski
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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Lynch AC, Frizelle FA. Colorectal motility and defecation after spinal cord injury in humans. PROGRESS IN BRAIN RESEARCH 2006; 152:335-43. [PMID: 16198711 DOI: 10.1016/s0079-6123(05)52022-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following spinal cord injury, colorectal problems are a significant cause of morbidity, and chronic gastrointestinal problems remain common with increasing time after injury. Although many cord-injured patients achieve an adequate bowel frequency with drugs and manual stimulation, the risk and occurrence of fecal incontinence, difficulties with evacuation, and need for assistance remain significant problems. The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested. There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.
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Affiliation(s)
- A C Lynch
- Colorectal Unit, Department of Surgery, Christchurch Hospital and Burwood Spinal Unit, Christchurch, New Zealand
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Chung EAL, Emmanuel AV. Gastrointestinal symptoms related to autonomic dysfunction following spinal cord injury. PROGRESS IN BRAIN RESEARCH 2006; 152:317-33. [PMID: 16198710 DOI: 10.1016/s0079-6123(05)52021-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The impact of spinal cord injury on an individual's gastrointestinal tract function is often poorly understood by the general public and also by those involved with persons with spinal cord injury. This chapter reviews the anatomy, physiology and function of the gastrointestinal tract, with particular emphasis on neurological control mechanisms. In turn, it relates the effect that spinal cord injury has on the neurological control of the gastrointestinal tract. The symptoms that are encountered by patients in the acute phase following injury, and by individuals in the months/years after injury, with particular reference to the effect of altered autonomic nervous system control of the gastrointestinal tract, are discussed. Together with a following summary of current bowel management regimens and techniques, this chapter aims to provide an overall view of the effect that autonomic dysfunction due to spinal cord injury has on gastrointestinal function.
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Affiliation(s)
- Eric A L Chung
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
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Damphousse M, Beuret-Blanquart F, Denis P. [Assessment of anorectal disorders with paraplegia]. ACTA ACUST UNITED AC 2005; 48:231-9. [PMID: 15914258 DOI: 10.1016/j.annrmp.2005.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Accepted: 02/28/2005] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Functional anorectal disorders in paraplegia are frequent; few studies evaluate the effect of these disorders on quality of life. OBJECTIVE Assessment of the functional anorectal disorders in a homogeneous group of patients with total paraplegia in terms of quality of life. METHODS During a global follow-up consultation, patients answered questions on a systematic questionnaire about anorectal disorders and a specific quality-of-life autoquestionnaire about functional digestive disorders: Functional Digestive Disorders Quality of Life (FDDQL) questionnaire; score 0 to 100 (100 corresponding to no effect on quality of life). RESULTS Twenty-three patients with a mean age of 44.3 years who had been paraplegic for 10 years participated. Two had a colostomy because of bedsores. Fourteen underwent daily rectal examination, 10 with an evacuation aim; the time given to defecation was, on average, 36 minutes. One patient had clinical constipation. Twelve had had one or more episodes of incontinence. The mean global FDDQL score was 69.7. This score was not related to incontinence; only the "comfort" domain among the 8 domains was related to incontinence. DISCUSSION Anorectal disorders are frequent in paraplegia; the duration and the methods of defecation represent a great worry to patients. More than half of the patients already had faecal incontinence; the effect of even occasional incontinence on quality of life is significant. Since the FDDQL scale is not specific to patients with paraplegia, its interest should be checked on a greater number of patients. For certain patients, it is important not to dismiss more complex surgical treatment methods.
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Affiliation(s)
- M Damphousse
- Centre régional de médecine physique et de réadaptation Les Herbiers, 111, rue Herbeuse, 76230 Bois-Guillaume, Rouen, France.
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Abstract
INTRODUCTION Formation of a permanent stoma often is seen as a last resort when all other interventions for fecal incontinence have failed. However, no previous study has examined patients' views of a colostomy to manage fecal incontinence. METHODS People who had a colostomy to manage fecal incontinence were recruited via an advertisement in the magazine of the British Colostomy Association or from those operated at a specialist colorectal hospital. Four questionnaires were sent, asking about the stoma, previous incontinence, anxiety and depression, and quality of life. RESULTS A total of 69 replies were received. Respondents were 11 males and 58 females with a median age of 64 years and a median of 59 months since the operation. Rating their ability to live with their stoma now on a scale of 0 to 10, the median response was 8 (range, 0-10). The majority (83 percent) felt that the stoma restricted their life "a little" or "not at all" (a significant improvement from perceived restriction from former incontinence, P = 0.008). Satisfaction with the stoma was a median of 9 on a scale of 0 to 10 (range, 0-10). Eighty-four percent would "probably" or "definitely" choose to have the stoma again. Quality of life (SF-36) was poor, but neither depression nor anxiety was a prominent feature. CONCLUSIONS The majority of previously incontinent people were positive about the stoma and the difference it had made to their life. However, a few had not adapted and disliked the stoma intensely. Health care professionals should discuss a stoma as an option with patients whose lives are restricted by fecal incontinence.
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Luther SL, Nelson AL, Harrow JJ, Chen F, Goetz LL. A comparison of patient outcomes and quality of life in persons with neurogenic bowel: standard bowel care program vs colostomy. J Spinal Cord Med 2005; 28:387-93. [PMID: 16869085 PMCID: PMC1808270 DOI: 10.1080/10790268.2005.11753838] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of this study was to compare patient outcomes and quality of life for people with neurogenic bowel using either a standard bowel care program or colostomy. METHODS We analyzed survey data from a national sample, comparing outcomes between veterans with spinal cord injury (SCI) who perform bowel care programs vs individuals with colostomies. This study is part of a larger study to evaluate clinical practice guideline implementation in SCI. The sample included 1,503 veterans with SCI. The response rate was 58.4%. For comparison, we matched the respondents with colostomies to matched controls from the remainder of the survey cohort. A total of 74 veterans with SCI and colostomies were matched with 296 controls, using propensity scores. Seven items were designed to elicit information about the respondent's satisfaction with their bowel care program, whereas 7 other items were designed to measure bowel-related quality of life. RESULTS No statistically significant differences in satisfaction or quality of life were found between the responses from veterans with colostomies and those with traditional bowel care programs. Both respondents with colostomies and those without colostomies indicated that they had received training for their bowel care program, that they experienced relatively few complications, such as falls as a result of their bowel care program, and that their quality of life related to bowel care was generally good. However, large numbers of respondents with colostomies (n = 39; 55.7%) and without colostomies (n = 113; 41.7%) reported that they were very unsatisfied with their bowel care program. CONCLUSION Satisfaction with bowel care is a major problem for veterans with SCI.
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Affiliation(s)
- Stephen L Luther
- Patient Safety Center of Inquiry and HSR&D REAP on Patient Safety Outcomes, James A Haley Veterans Hospital, Tampa, Florida 33612-5738, USA.
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Liem NR, McColl MA, King W, Smith KM. Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living. Arch Phys Med Rehabil 2004; 85:1567-77. [PMID: 15468013 DOI: 10.1016/j.apmr.2003.12.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING General community, international. PARTICIPANTS Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The need for more help with ADLs. RESULTS The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.
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Affiliation(s)
- Nathania R Liem
- Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.
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Branagan G, Tromans A, Finnis D. Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury. Spinal Cord 2004; 41:680-3. [PMID: 14639447 DOI: 10.1038/sj.sc.3101529] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Bowel management is a significant source of concern for patients with spinal cord injury (SCI) and may significantly alter quality of life. The effect of colostomy formation on both quality of life and time taken for bowel care is well recorded. We report our experience of intestinal stoma formation in SCI patients. METHODS Medical records from the spinal unit, operating theatres and stoma clinics were reviewed to identify SCI patients for whom a stoma had been formed. Patients were interviewed using a standard questionnaire. Average age at injury was 29 years (range 6-62 years). Mean time from injury to stoma formation was 17 years (range 0-36.25 years) and the mean period of poor bowel function prior to stoma was 8 years (range 1.5-25). RESULTS The average time spent on bowel care per week decreased from 10.3 h (range 3.5-45) prior to stoma formation to 1.9 h (range 0.5-7.75) afterwards (P<0.0001, paired t-test). In all, 18 patients felt that a stoma gave them greater independence and quality of life was described as much better by 25 patients. Complications occurred in 14 patients - eight described leakage of mucus and occasionally blood and pus per rectum, three developed parastomal hernias and three developed bowel obstruction. CONCLUSION Elective stoma formation is a safe and well-accepted treatment for the management of chronic gastrointestinal symptoms in patients with SCI.
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Affiliation(s)
- G Branagan
- Department of Surgery, Salisbury District Hospital, UK
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McColl MA, Arnold R, Charlifue S, Glass C, Savic G, Frankel H. Aging, spinal cord injury, and quality of life: structural relationships. Arch Phys Med Rehabil 2003; 84:1137-44. [PMID: 12917851 DOI: 10.1016/s0003-9993(03)00138-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify relationships among 3 sets of factors: demographic factors, health and disability factors, and quality of life (QOL). DESIGN Part of a program of longitudinal research on aging and spinal cord injury (SCI) involving 3 populations: American, British, and Canadian. The present analysis uses data from the 1999 interval. SETTING The Canadian sample was derived from the member database of the Ontario and Manitoba divisions of the Canadian Paraplegic Association. The British sample was recruited from a national and a regional SCI center in England. The American sample was recruited through a hospital in Colorado. PARTICIPANTS A sample of 352 participants was assembled from 4 large, well-established databases. The sample included individuals who had incurred an SCI at least 20 years earlier, were admitted to rehabilitation within 1 year of injury, and were between the ages of 15 and 55 at the time of injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A combination of self-completed questionnaires and interviews. Data included demographics, injury-related variables, health and disability-related factors, QOL, and perceptions about aging. RESULTS Using linear structural relationships modeling, we found that QOL was affected both directly and indirectly by age, health and disability problems, and perceptions of aging. Two surprising findings were as follows: those who experienced fewer disability-related problems were more likely to report a qualitative disadvantage in aging, and the younger members of the sample were more likely to report fatigue. CONCLUSIONS Fatigue is a concern because of the relationship of fatigue with perceived temporal disadvantage in aging, health problems, and disability problems. This finding highlights the need for clinical vigilance among those just beginning to experience the effects of aging.
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