Risk Factors Associated With Neurogenic Bowel Complications and Dysfunction in Spinal Cord Injury

Abstract

Objectives: To (1) assess the factors associated with methods of bowel management and bowel-related complications; and (2) determine the risk factors associated with bowel complications and overall bowel dysfunction, using multivariate modeling.

Design: Cross-sectional observational study.

Setting: A Spinal Cord Injury Model System, with additional participants recruited from other sites.

Participants: Subjects (N=291) who incurred traumatic spinal cord injury (SCI) with resultant neurogenic bowel who were ≥5 years postinjury at the time of interview.

Interventions: Not applicable.

Main outcome measures: Constipation, bowel incontinence, and neurogenic bowel dysfunction questionnaire scores. These measures were all derived from the Bowel and Bladder Treatment Index. Data analyses included descriptive and bivariate statistics as well as logistic and linear regression modeling.

Results: Risk factors contributing to bowel incontinence included overall bowel dysfunction as measured by the neurogenic bowel dysfunction score, timing of bowel program, being married or having a significant other, urinary incontinence, constipation, and use of diuretics. Constipation was best predicted by age, race/ethnicity, using laxatives/oral medications, incomplete tetraplegia, frequency of bowel movements, abdominal pain, access to clinicians and caregivers, and history of bowel surgeries. Neurogenic bowel dysfunction scores were predicted by neurologic classification; use of laxatives, oral medications, or both; bowel incontinence; and frequency of fiber intake.

Conclusions: These results suggest a number of factors that should be considered when treating neurogenic bowel complications and dysfunction in persons with SCI.

Keywords: Constipation; Fecal incontinence; Neurogenic bowel; Rehabilitation; Risk factors; Spinal cord injuries.