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

Abstract

PURPOSE:

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.

MATERIALS AND METHODS:

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

RESULTS:

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.

CONCLUSIONS:

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.

A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients

Velde SV, Biervliet SV, Bruyne RD, Winckel MV. (2013). A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients.

Spinal Cord. 2013 Oct 15. doi: 10.1038/sc.2013.123. [Epub ahead of print]

Abstract

Study design:Systematic review.Objectives:To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.Setting:International literature.Method:Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.Results:Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.Conclusion:Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.Spinal Cord advance online publication, 15 October 2013; doi:10.1038/sc.2013.123.

 

PMID:24126852

Problematic aspects of faecal incontinence according to the experience of adults with spina bifida.

Johnsen V, Skattebu E, Aamot-Andersen A, Thyberg M. (2009) Problematic aspects of faecal incontinence according to the experience of adults with spina bifida.
Journal of Rehabilitation Medicine. Jun;41(7):506-11.

TRS National Resource Center for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.

OBJECTIVE: To describe problematic aspects of faecal incontinence according to the experience of adults with spina bifida.

DESIGN: Qualitative interview study.

SUBJECTS: Eleven adults with spina bifida and bowel problems.

METHOD: Semi-structured open-ended interviews and qualitative analysis.

RESULTS: Problematic aspects were related to participation in terms of time consumption, communication, social isolation, love and sexuality, and accessibility. Also, to a sense of helplessness in terms of panic and worry, to a sense of shame in terms of impurity, social acceptance and self-image, and to bowel function in terms of decisions about colostomy, voluntary constipation, and changing patterns.

CONCLUSION: The results reveal aspects relevant to supporting clinical practice and suggesting issues for questionnaire studies.

PMID: 19543660

After the honeymoon comes divorce: long-term use of the antegrade continence enema procedure.

Yardley IE, Pauniaho SL, Baillie CT, Turnock RR, Coldicutt P, Lamont GL, Kenny SE. (2009) After the honeymoon comes divorce: long-term use of the antegrade continence enema procedure. Journal of Pediatric Surgery. 2009 Jun;44(6):1274-6; discussion 1276-7.

Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.

BACKGROUND: Having reported that 18% of children discontinue use of the antegrade continence enema (ACE) after 5 years, we aimed to determine long-term use after an ACE procedure.

METHODS: A postal/telephone questionnaire was conducted. Subjects were consecutive children undergoing an ACE between 1993 and 1999. Outcome measures were use of ACE, reasons for nonuse, complications, and overall satisfaction.

RESULTS: Of 84 eligible subjects, data were available on 61 (73%) aged 22.4 years (15.5-35.1 years). Underlying diagnoses included spina bifida (n = 27), anorectal malformations (n = 18), constipation (n = 11), Hirschsprung's disease (n = 1), sacral agenesis (n = 2), and trauma/tumor (n = 2). Follow-up was 11.02 years (8.34-14.39 years). Thirty-six (59%) of 61 patients were still using their ACE. Reasons for nonuse were lack of effectiveness (n = 14), complications (n = 5), psychologic issues (n = 2), and poor compliance (n = 2). There was no association between diagnosis and nonuse (chi(2), P = .63). In those still using ACE, the overall satisfaction score was 4.1 (1-5). Several individuals reported feeling abandoned on becoming adults and losing the support they had in childhood.

CONCLUSION: There is a late "failure" rate for the ACE procedure. However, satisfaction was high among those still using the ACE. This study further emphasizes the need for robust transitional care arrangements.

PMID: 19524753

Treatment of fecal incontinence with a comprehensive bowel management program.

Bischoff A, Levitt MA, Bauer C, Jackson L, Holder M, Peña A. (2009) Treatment of fecal incontinence with a comprehensive bowel management program. Journal of Pediatric Surgery. 2009 Jun;44(6):1278-83; discussion 1283-4.

Department of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

PURPOSE: Many articles describe the antegrade continence enemas (ACEs), but few refer to a bowel management program. A successful ACE may not help a patient without such management. Valuable lessons were learned by implementation of bowel management in 495 fecally incontinent patients.

METHODS: We previously reported 201 patients. Thereafter, another 294 patients participated in our program. On the basis of a contrast enema and symptoms, they were divided as follows: (a) 220 constipated patients and (b) 74 patients with tendency toward diarrhea. Colonic stool was monitored with abdominal radiographs, modifying the management according to the patient's response and radiologic findings. For constipated patients, the emphasis was on using large enemas. For patients with tendency toward diarrhea, we used small enemas, a constipating diet, loperamide, and pectin. Diagnoses included anorectal malformation (223), Hirschsprung's (36), spina bifida (12), and miscellaneous (23).

RESULTS: The management was successful in 279 patients (95%)-higher in constipated patients (98%) and less successful in patients with tendency toward diarrhea (84%).

CONCLUSIONS: The key to a successful bowel management program rests in tailoring the type of enema, medication, and diet to the specific type of colon. The best way to determine the effect of an enema is with an abdominal film. The ACE procedures should be recommended only after successful bowel management.


PMID: 19524754