After a spinal cord injury, can we predict who will recover independent bowel management during the first year?
Neurogenic bowel dysfunction (NBD) with symptoms of constipation and fecal incontinence is a common complication of traumatic spinal cord injury. In a new study, the aim was to identify factors that could predict the recovery of independent bowel function to assist clinicians in their prognosis of bowel function and to guide them to bowel management strategies useful for the patient.
Bowel dysfunction is a common cause of rehospitalization and is associated with a lower quality of life in patients with spinal cord injuries. The acute ASIA total motor score (TMS) has been shown to be a good predictor of possible recovery of bowel function in patients with injuries above L2.
More than 100 patients were retrospectively observed at 3 months and at 6 —12 months after their injury. Independent bowel function was measured with item 7: ‘Sphincter management — bowel’ in the Spinal cord independence measure (SCIM-III) questionnaire, and a recovering independent bowel function was defined as regaining the ability to manage bowel movements, without assistance and without/rare accidents (8 or 10 below):
- 0 Irregular timing or very low frequency - less than once in 3 days - of bowel movements
- 5 Regular timing, but requires assistance e.g., for applying suppository, and rare accidents (less than twice a month)
- 8 Regular bowel movements, without assistance; rare accidents (less than twice a month)
- 10 Regular bowel movements, without assistance; no accidents
At 3 months, after injury 49% still had impaired bowel function despite an individualized bowel management plan based on the use of pharmaceuticals and non-pharmaceutical strategies (digital stimulation, suppository use and manual removal of feces) in addition to dietary modifications.
At follow-up 6 — 12 months after injury, 66% had independent bowel function with the bowel management plan. All patients who presented with impaired bowel functioning 3 months after injury and had an acute ASIA total motor score (TMS) lower than 42 showed no recovery of bowel function during the following year.
To conclude, if a patient has a TMS lower than 42 it could be beneficial to receive early consideration and counselling for second and third-line bowel management strategies.