¹Division on Aging, Harvard Medical School, and the Massachusetts General Hospital/Beacon Hill Geriatric Medicine Unit and General Medicine Unit, 169 Cambridge St., 100 Charles River Plaza, 5th Floor, Boston, MA 02114, USA

²Geriatric Research Education and Clinical Center, VA Medical Center, Brockton/West Roxbury, MA

³Spinal Cord Injury Service, VA Medical Center, Brockton/West Roxbury, MA

⁴Program for the Analysis of Clinical Strategies, Gerontology Division, Brigham and Women's Hospital and Harvard Medical School, MA, USA

^aAuthor for correspondence

Purpose. To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of difficulty with evacuation. Patients and Methods. This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n=197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n=161, 82%) regarding bowel-related symptoms and treatment over the previous 1 month period. The study definition of difficulty with evacuation was spending more than 1 h per episode of bowel evacuation. Results. Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with difficulty with evacuation (n=66) were compared with those who spent less than 1 h on evacuation (n=95). Factors associated with difficulty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. Conclusion. Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable laxative use. Our findings suggest that difficulty with evacuation can be predicted on the basis of a patient's clinical profile.

spinal cord injury; constipation; bowel program; cathartics; tetraplegia