Monday, May 11, 2015

The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder.

Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT. (2015) The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder.
J Urol. 2015 May 5. pii: S0022-5347(15)03905-1. doi: 10.1016/j.juro.2015.04.100



Patients with neurological conditions often suffer from severe debilitating lower urinary and bowel dysfunction in addition to their physical disabilities. However, only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized.


This is a cross-sectional analysis of a prospective institutional Neurogenic Bladder Database from 2010-2013.


Among the 175 patients 60.6% had traumatic spinal cord injury (SCI) and 18.3% multiple sclerosis. Fecal Incontinence Severity Index (FISI) scores were a median of 18.0±1.39 (moderate). Neurogenic Bowel Dysfunction (NBD) score were a median of 11.0±0.63 (moderate). NBD Scores were worse in those patients with SCI and spina bifida compared to other diseases (P=0.020), in younger patients (p=0.020) and in the SCI group those with higher levels of injury (p=0.0046). Based on the Bristol stool scale 65% of patient had abnormal stool consistency, mostly constipation. None of the FISI, Bristol or NBD scores correlated significantly with SF-12 quality of life measures. However, both of the bladder symptom scores Michigan Incontinence Symptom Index (M-ISI)(p=0.05) and the AUA-SI (p=0.03) correlated with FISI severity and the NBD score correlated with the M-ISI (ρ=0.29, p=0.02). Those patients with abnormal stool consistency on the Bristol reported more urgency and stress incontinence on M-ISI.


Bowel dysfunction is very common among patients with neurogenic bladder. Those patients with worse bladder symptoms also suffered from worse bowel dysfunction. This highlights the importance of addressing both bowel and bladder dysfunction in this often poorly understood population.
Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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