Long-Term Outcomes and Longitudinal Changes of Neurogenic Bowel Management in Adults With Pediatric-Onset Spinal Cord Injury



      To describe long-term outcomes of neurogenic bowel dysfunction (NBD), determine changes over time in the type of bowel program, and determine changes in psychosocial outcomes associated with NBD-related factors in adults with pediatric-onset spinal cord injury (SCI).


      Longitudinal cohort survey. Follow-up occurred annually for a total of 466 interviews, with most participants (75%) contributing to at least 3 consecutive interviews.




      Adults (N=131) who had sustained an SCI before the age of 19 years (men, 64.1%; tetraplegia, 58.8%; mean age ± SD, 33.4±6.1y; mean time since injury ± SD, 19.5±7.0y).


      Not applicable.

      Main Outcome Measures

      Type and evacuation time of bowel management programs; standardized measures assessing life satisfaction, health perception, depressive symptoms, and participation. Generalized estimating equations were formulated to determine odds of change in outcomes over time.


      At first interview, rectal suppository/enema use was most common (51%). Over time, the likelihood of using manual evacuation (odds ratio [OR]=1.077; 95% confidence interval [CI], 1.023–1.134; P=.005), oral laxatives (OR=1.052; 95% CI, 1.001–1.107; P=.047), and colostomy (OR=1.071; 95% CI, 1.001–1.147; P=.047) increased, whereas the odds of rectal suppository use decreased (OR=.933; 95% CI, .896–.973; P=.001). Bowel evacuation times were likely to decrease over time in participants using manual evacuation (OR=.499; 95% CI, .256–.974; P=.042) and digital rectal stimulation (OR=.490; 95% CI, .274–.881; P=.017), but increase for rectal suppository/enema use (OR=1.871; 95% CI, 1.264–2.771; P=.002). When the level of injury was controlled for, participants using manual evacuation and digital rectal stimulation were more likely to have increases in community participation scores (P<.05).


      Changes in type of bowel program over time may be associated with the time required to complete bowel evacuation in this relatively young adult SCI population.


      List of abbreviations:

      CHART (Craig Handicap Assessment and Reporting Technique), DS (digital stimulation), GEE (generalized estimating equation), LAX (laxative), NBD (neurogenic bowel dysfunction), QOL (quality of life), SCI (spinal cord injury)
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        • Krogh K.
        • Nielsen K.
        • Djurhuus J.C.
        • Mosdal C.
        • Sabroe S.
        • Laurberg S.
        Colorectal function in patients with spinal cord lesions.
        Dis Colon Rectum. 1997; 40: 1233-1239
        • Coggrave M.
        • Norton C.
        • Wilson-Barnett J.
        Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom.
        Spinal Cord. 2009; 47: 323-330
        • Faaborg P.M.
        • Christensen P.
        • Finnerup N.
        • Laurberg S.
        • Krogh K.
        The pattern of colorectal dysfunction changes with time since spinal cord injury.
        Spinal Cord. 2008; 46: 234-238
        • Liu C.W.
        • Huang C.C.
        • Chen C.H.
        • Yang Y.H.
        • Chen T.W.
        • Huang M.H.
        Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury.
        Spinal Cord. 2010; 48: 554-559
        • Furlan J.C.
        • Urbach D.R.
        • Fehlings M.G.
        Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis.
        Br J Surg. 2007; 94: 1139-1150
        • Kassioukov A.
        • Eng J.J.
        • Claxton G.
        • Sakakibara B.M.
        • Shum S.
        Neurogenic bowel management after spinal cord injury: a systemic review of the evidence.
        Spinal Cord. 2010; 48: 718-733
        • Coggrave M.
        • Norton C.
        • Cody J.D.
        Management of faecal incontinence and constipation in adults with central neurological diseases.
        Cochrane Database Syst Rev. 2014; : CD002115
        • Adriaansen J.J.
        • van Asbeck F.W.
        • van Kuppevelt D.
        • Snoek G.J.
        • Post M.W.
        Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least 10 years.
        Arch Phys Med Rehabil. 2015; 96: 905-912
        • Burns A.S.
        • St Germain D.
        • Connolly M.
        • et al.
        Phenomenological study of neurogenic bowel from the perspective of individuals living with spinal cord injury.
        Arch Phys Med Rehabil. 2015; 96: 49-55
        • Pavot W.
        • Deiner E.
        Review of the Satisfaction With Life Scale.
        Psychol Assess. 1993; 5: 164-172
        • Bombardier C.H.
        • Richards J.S.
        • Krause J.S.
        • Tulsky D.
        • Tate D.G.
        Symptoms of major depression in people with spinal cord injury: implications for screening.
        Arch Phys Med Rehabil. 2004; 85: 1749-1756
        • Ware J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Hall K.M.
        • Dijkers M.
        • Whiteneck G.
        • Brooks C.A.
        • Krause J.S.
        The Craig Handicap Assessment and Reporting Technique (CHART): metric properties and scoring.
        J Rehabil Outcomes Meas. 1998; 2: 519-526
        • Burton P.
        • Gurrin L.
        • Sly P.
        Extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multilevel mixed modeling.
        Stat Med. 1998; 17: 1261-1291
        • Vogel L.C.
        • Chlan K.M.
        • Zebracki K.
        • Anderson C.J.
        Long-term outcomes of adults with pediatric onset spinal cord injuries as a function of neurological impairment.
        J Spinal Cord Med. 2011; 34: 60-66
        • Han T.R.
        • Kim J.H.
        • Kwon B.S.
        Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury.
        Spinal Cord. 1998; 36: 485-490
        • Engkasan J.P.
        • Sudin S.S.
        Neurogenic bowel management after spinal cord injury: Malaysian experience.
        J Rehabil Med. 2013; 43: 141-144
        • Rosito O.
        • Nino-Murcia M.
        • Wolfe V.A.
        • Kiratli B.J.
        • Perkash I.
        The effects of colostomy on the quality of life in patients with spinal cord injury: a retrospective analysis.
        J Spinal Cord Med. 2002; 25: 174-183
        • Coggrave M.J.
        • Ingram M.
        • Gardner B.P.
        • Norton C.S.
        The impact of stoma for bowel management after spinal cord injury.
        Spinal Cord. 2012; 50: 848-852
        • Hansen R.B.
        • Staun M.
        • Kalhauge A.
        • Langholz E.
        • Biering-Sorensen F.
        Bowel function and quality of life after colostomy in individuals with spinal cord injury.
        J Spinal Cord Med. 2016; 39: 281-289
        • Valles M.
        • Vidal J.
        • Clave P.
        • Mearin F.
        Bowel dysfunction in patients with motor complete spinal cord injury: clinical, neurological, and pathophysiological associations.
        Am J Gastroenterol. 2006; 101: 2290-2299
        • Valles M.
        • Mearin F.
        Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury.
        Dis Colon Rectum. 2009; 52: 1589-1597
      1. Physicians' Desk Reference. PDR Network, Montvale2015
        • Pardee C.
        • Bricker D.
        • Rundquist J.
        • MacRae C.
        • Tebben C.
        Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life.
        Rehabil Nurs. 2012; 37: 128-135
        • Harari D.
        • Sarkarati M.
        • Gurwitz J.H.
        • McGlinchey-Berroth G.
        • Minaker K.L.
        Constipation-related symptoms and bowel program concerning individuals with spinal cord injury.
        Spinal Cord. 1997; 35: 394-401
        • Menter R.
        • Weitzenkamp D.
        • Cooper D.
        • Bingley J.
        • Charlifue S.
        • Whiteneck G.
        Bowel management outcomes in individuals with long-term spinal cord injuries.
        Spinal Cord. 1997; 35: 608-612
        • Finnerup N.B.
        • Faaborg P.
        • Krogh K.
        • Jensen T.S.
        Abdominal pain in long-term spinal cord injury.
        Spinal Cord. 2008; 46: 198-203
        • Stone J.M.
        • Nino-Murcia M.
        • Wolfe V.A.
        • Perkash I.
        Chronic gastrointestinal problems in spinal cord injury patients: a prospective analysis.
        Am J Gastroenterol. 1990; 85: 1114-1119
        • Krogh K.
        • Perkash I.
        • Stiens S.A.
        • Biering-Sørensen F.
        International bowel function basic spinal cord injury data set.
        Spinal Cord. 2009; 47: 230-234
        • Krogh K.
        • Christensen P.
        • Sabroe S.
        • Laurberg S.
        Neurogenic bowel dysfunction score.
        Spinal Cord. 2006; 44: 625-631