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Pelizzari L, Antoniono E, Giraudo D, Ciardi G, Lamberti G. Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation? Neurol Int 2023; 15:1339-1351. [PMID: 37987457 PMCID: PMC10660697 DOI: 10.3390/neurolint15040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND In this study, we aimed to investigate the incidence of fecal incontinence (FI) after severe acquired brain injuries (sABIs) and to determine whether this symptom can lead to an inability to return home after rehabilitation. METHODS This was a retrospective observational cohort study. In total, 521 acute sABI inpatients were enrolled from the Department of Neurorehabilitation at an academic tertiary care hospital. Patients were divided into two groups, with and without FI, at the end of the rehabilitation phase. The primary and secondary endpoints were the incidence of persistent FI and any difference in the discharge destination. RESULTS Upon admission, new-onset FI was found in 443 (85%) patients, of which 38% had traumatic sABI. Moreover, 62.7% of all patients had FI upon admission. At discharge, 53.3% (264/495) of patients still had FI. Of these, 75.4% (199/264) had a Rancho Level of Cognitive Functioning Scale (LCFS) ≥3. A statistically significant correlation between FI at discharge and the presence of frontal lesions, autonomic crises, and increased LCFS scores was noted. Among the patients discharged to their homes, the proportion with persistent FI was lower (34% vs. 53.3). CONCLUSIONS FI was significantly persistent after sABI, even after recovery from unconsciousness, and must be considered as a consequence of, rather than an independent risk factor for, unfavorable outcomes.
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Affiliation(s)
- Laura Pelizzari
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
| | - Elena Antoniono
- Neurorehabilitation Unit, AUSL CN1, 12045 Fossano, CN, Italy;
| | - Donatella Giraudo
- Department of Urology, IRCCS San Raffaele Scientific Institute, 20127 Milano, MI, Italy;
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, AUSL Piacenza, 29017 Fiorenzuola d’Arda, PC, Italy; (L.P.); (G.C.)
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Zandalasini M, Pelizzari L, Ciardi G, Giraudo D, Guasconi M, Paravati S, Lamberti G, Frizziero A. Bowel dysfunctions after acquired brain injury: a scoping review. Front Hum Neurosci 2023; 17:1146054. [PMID: 37900728 PMCID: PMC10602674 DOI: 10.3389/fnhum.2023.1146054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is focused on spinal cord injury and multiple sclerosis; few studies have focused on patients with acquired brain injury (ABI). Neurogenic bowel dysfunction is related to a lifelong condition derived from central neurological disease, which further increases disability and social deprivation. The manifestations of neurogenic bowel dysfunction include fecal incontinence and constipation. Almost two out of three patients with central nervous system disorder have bowel impairment. This scoping review aims to comprehend the extent and type of evidence on bowel dysfunction after ABI and present conservative treatment. For this scoping review, the PCC (population, concept, and context) framework was used: patients with ABI and bowel dysfunction; evaluation and treatment; and intensive/extensive rehabilitation path. Ten full-text articles were included in the review. Oral laxatives are the most common treatment. The Functional Independence Measure (FIM) subscale is the most common scale used to assess neurogenic bowel disease (60%), followed by the Rome II and III criteria, and the colon transit time is used to test for constipation; however, no instrumental methods have been used for incontinence. An overlapping between incontinence and constipation, SCI and ABI increase difficulties to manage NBD. The need for a consensus between the rehabilitative and gastroenterological societies on the diagnosis and medical care of NBD. Systematic review registration Open Science Framework on August 16, 2022 https://doi.org/10.17605/OSF.IO/NEQMA.
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Affiliation(s)
- Matteo Zandalasini
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Laura Pelizzari
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Donatella Giraudo
- Department of Urology, San Raffaele Hospital, Ville Turro, Milan, Italy
| | - Massimo Guasconi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Dipartimento della Direzione delle Professioni Sanitarie, Azienda USL Piacenza, Piacenza, Italy
| | - Stefano Paravati
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Frizziero
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Abstract
Faecal incontinence (FI) is a hidden problem that is under-diagnosed, under-investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8-6.2%. Recent North American research indicates a prevalence of 8.3% in adults living in the community. This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.
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Affiliation(s)
- Linda Nazarko
- Consultant nurse, physical healthcare, West London Mental Health Trust
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Kulaklı F, Koklu K, Ersoz M, Ozel S. Relationship between urinary dysfunction and clinical factors in patients with traumatic brain injury. Brain Inj 2014; 28:323-7. [PMID: 24377376 DOI: 10.3109/02699052.2013.865268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Examination of relations between urinary dysfunction and Functional Independence Measurement (FIM) values and other clinical factors. MATERIALS AND METHODS Twenty-nine patients with TBI were included in the study. Patients' demographic values, lower urinary tract symptoms (LUTS) and urinary drainage methods were recorded. Functional assessment was performed using FIM. Urodynamic studies were carried out and maximum cystometric capacity (MCC), storage and voiding function, type of detrusor, urodynamic abnormality and post-void residual urine volume values were investigated. RESULTS Total FIM and FIM sphincter control sub-group scores were significantly lower in patients with storage dysfunction and urodynamic abnormality than patients without storage dysfunction and urodynamic abnormality (p < 0.05). In tetraparetic patients, frequency of storage dysfunction was significantly higher than hemiparetic patients (p < 0.05). Urodynamic abnormality was detected in five of nine patients with LUTS and in 12 of 20 patients without LUTS. There was no significant correlation between LUTS and urodynamic abnormality (p > 0.05). CONCLUSIONS Storage dysfunction and urodynamic abnormality is associated with poorly functional outcomes in TBI patients. There is a direct correlation between motor deficit and urodynamic abnormality. All of the TBI patients with or without LUTS should be evaluated neuro-urologically; urodynamic evaluation and treatment should be arranged if needed.
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Affiliation(s)
- Fazıl Kulaklı
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital , Ankara , Turkey
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Moody BJ, Liberman C, Zvara P, Smith PP, Freeman K, Zvarova K. Acute lower urinary tract dysfunction (LUTD) following traumatic brain injury (TBI) in rats. Neurourol Urodyn 2013; 33:1159-64. [PMID: 24038177 DOI: 10.1002/nau.22470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/03/2013] [Indexed: 01/13/2023]
Abstract
AIMS The aim of this study was to assess experimental traumatic brain injury (TBI)-induced lower urinary tract dysfunction (LUTD) by monitoring systemic and urodynamic parameters using an implantable telemetry system. METHODS A single lateral fluid percussion TBI (FP-TBI; 3.4 atm) was administered to 10 female rats. Pressure micro-catheters were implanted in the abdominal aorta and bladder dome for simultaneous data recording. Hemodynamic and urodynamic variables recorded 24 hr before and 24 hr after injury were analyzed and compared. RESULTS TBI in the acute phase resulted in LUTD affecting bladder emptying, characterized by failure of voiding reflex, high capacity bladder, increased voided volume, prolonged intermicturition intervals, and loss of compliance. The dominant symptom was urinary retention (100%) and incontinence (60%). The effects followed a pattern of initial loss of bladder function followed by either altered recovery of reflex micturition or a period of incontinence. With a moderate injury symptoms were temporary in 90% of animals and permanent in 10% of animals. Injury produced only transient hypertension (≤1 hr) with a maximum systolic pressure of 172.64 ± 14.53 mmHg (70% of animals). CONCLUSIONS The results demonstrate that experimental FP-TBI causes temporary bladder dysfunction that in more severe cases becomes permanent. Telemetry recordings revealed a sequence of events following injury that establishes moderate TBI as a risk factor for neurogenic bladder disorder. Results also suggest a correlation between lateral FP-TBI and incontinence.
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Affiliation(s)
- Benjamin J Moody
- Department of Surgery, University of Vermont, Burlington, Vermont
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Dourado CC, Engler TMNDM, Oliveira SBD. Disfunção intestinal em pacientes com lesão cerebral decorrente de acidente vascular cerebral e traumatismo craniencefálico: estudo retrospectivo de uma série de casos. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000400022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A disfunção intestinal é uma queixa comum entre pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico. Este estudo objetivou pesquisar a prevalência da disfunção intestinal (incontinência anal e constipação intestinal) em pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico, admitidos para reabilitação. Trata-se de um estudo retrospectivo de uma série de casos, a partir da análise dos dados de 138 prontuários de pacientes internados no primeiro semestre de 2009. A prevalência de disfunção intestinal foi 41%, sendo 33 (24%) incontinência anal e 37 (27%) constipação intestinal. Comprometimento motor, auxílio locomoção, alterações de memória e comunicação estiveram associados à presença de incontinência anal. A prevalência de disfunção intestinal é alta nessa população, identificá-la precocemente, bem como os fatores relacionados, e promover a reeducação intestinal, poderá contribuir para melhora na qualidade de vida dessas pessoas.
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Keller JJ, Liu SP, Lin HC. Traumatic brain injury increases the risk of female urinary incontinence. Neurourol Urodyn 2012; 32:354-8. [PMID: 22965745 DOI: 10.1002/nau.22309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 08/09/2012] [Indexed: 11/12/2022]
Abstract
AIMS According to our knowledge, no study has attempted to explore the risk of urinary incontinence (UI) after traumatic brain injury (TBI). This study aimed to examine the relationship between TBI in Taiwanese women and their risk of developing UI. METHODS The study was based on 2,416 female patients newly diagnosed with TBI together with 12,080 matched enrollees without a history of TBI as a comparison group. All patients were tracked for a 1-year period from their index date to identify those who developed subsequent UI. The stratified Cox proportional hazards models were performed to compute the risk of UI between groups. RESULTS Of 14,496 patients, 104 (4.30%) from the TBI group and 192 (1.59%) from the comparison group had a diagnosis of UI during the follow-up period. The incidence rate of UI was 4.50 (95% CI: 3.69-5.43) per 100 person-years in patients with TBI and 1.62 (95% CI: 1.40-1.86) per 100 person-years in patients without TBI. The stratified Cox proportional analysis showed that after adjusting for socioeconomic status, obesity, hypertension, diabetes, and hysterectomy, the increased UI risk of patients with TBI persisted at about the same level as in the unadjusted analysis (hazard ratio = 2.78; 95% CI = 2.16-3.53). In addition, although patients with severe and moderate TBI had higher incidence rates of UI than patients with mild TBI, the difference did not reach a statistically significant level (P = 0.090). CONCLUSIONS Our results suggest that an increased risk of UI exists at the first year follow-up in patients with a TBI diagnosis.
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Affiliation(s)
- Joseph J Keller
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Abstract
This article reviews neurogenic bladder related to traumatic injury as well as vascular lesion of brain/spinal cord. Because urological manifestations of traumatic or vascular brain/spinal cord injury are highly diversified and complex, the approaches to achieve accurate diagnosis and administer proper treatment can be complicated. The goal of primary treatment is preservation of renal function and attainment of social continence. Maintaining low intravesical pressure and adequate bladder emptying are central to the treatment strategy. Diagnosis and appropriate urological management of these disease entities should depend on urodynamic studies because of poor correlation between clinical symptoms or somatic neurologic signs and urodynamic findings.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Seongnam, 463-707, Korea
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Jordan LA, Mackey E, Coughlan K, Wyer M, Allnutt N, Middleton S. Continence management in acute stroke: a survey of current practices in Australia. J Adv Nurs 2010; 67:94-104. [DOI: 10.1111/j.1365-2648.2010.05480.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shin CW, Kim SD, Cho WY. The Prevalence and Management of Urinary Incontinence in Elderly Patients at Sanatorium in Busan Area. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.5.450] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chan Wook Shin
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Soo Dong Kim
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Won Yeol Cho
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
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