Original Article

Spinal Cord (2009) 47, 323–333; doi:10.1038/sc.2008.137; published online 18 November 2008

Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

M Coggrave1,2, C Norton2,3 and J Wilson-Barnett3

  1. 1National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK
  2. 2Burdett Institute of Gastrointestinal Nursing, King's College, London, UK
  3. 3The Florence Nightingale School of Nursing and Midwifery, King's College, London, UK

Correspondence: Dr M Coggrave, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks HP21 8AL, UK. E-mail: maureen.coggrave@buckshosp.nhs.uk

Received 23 October 2007; Revised 29 September 2008; Accepted 4 October 2008; Published online 18 November 2008.

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Abstract

Study design:

 

Postal survey.

Objectives:

 

To describe bowel management in community-dwelling spinal cord-injured (SCI) individuals and to explore associations between age, injury, dependency, problems, interventions and satisfaction.

Setting:

 

Outpatients of a single SCI unit, in the United Kingdom.

Methods:

 

Postal questionnaire to all outpatients with SCI for at least 1 year, of any level or density, aged 18 years or more.

Results:

 

Response rate was 48.6% (n=1334). Median age was 52 years, median duration of injury 18 years. The most common intervention was digital evacuation (56%). Up to 30 min was spent on each bowel care episode by 58% of respondents; 31–60 min by 22%; 14% spent over 60 min. Reported problems included constipation (39%), haemorrhoids (36%) and abdominal distension (31%). Reduced satisfaction with bowel function was associated with longer duration of each bowel care episode, faecal incontinence, greater number of interventions used and more problems reported (all Pless than or equal to0.001); 130 (9.7%) had undergone any type of surgical bowel intervention. Impact of bowel dysfunction on the respondent's life was rated as significantly greater than other aspects of SCI (Pless than or equal to0.001).

Conclusions:

 

Managing SCI bowel function in the community is complex, time consuming and remains conservative. Despite potential for bias from a low response, for this large group of responders, bowel dysfunction impacted most on life compared with other SCI-related impairments. The study findings demand further exploration of bowel management to reduce impact, minimize side effects and increase the choice of management strategies available.

Keywords:

neurogenic bowel, bowel management, community setting, spinal cord injury

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