To assess the correlation between the anorectal function and bladder detrusor function in patients with complete spinal cord injury (SCI) according to the type of lesion.
Medical records of twenty-eight patients with SCI were included in this study. We compared the anorectal manometric and urodynamic (UD) parameters in total subjects. We analyzed the anorectal manometric and UD parameters between the two groups: upper motor neuron (UMN) lesion and lower motor neuron (LMN) lesion. In addition, we reclassified the total subjects into two groups according to the bladder detrusor function: overactive and non-overactive.
In the group with LMN lesion, the mean value of maximal anal squeeze pressure (MSP) was slightly higher than that in the group with UMN lesion, and the ratio of MSP to maximal anal resting pressure (MRP) was statistically significant different between the two groups. In addition, although the mean value of MSP was slightly higher in the group with non-overactive detrusor function, there was no statistical correlation of anorectal manometric parameters between the groups with overactive and non-overactive detrusor function.
The MSP and the ratio of MSP to MRP were higher in the group with LMN lesion. In this study, we could not identify the correlation between bladder and bowel function in total subjects. We conclude that the results of UD study alone cannot predict the outcome of anorectal manometry in patients with SCI. Therefore, it is recommended to perform assessment of anorectal function with anorectal manometry in patients with SCI.
Citations
To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI).
Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography.
The constipation scores ranged from 1 to 13, and the average was 4.19±3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13±1.45. CTTs were 19.3±16.17, 19.3±13.45, 15.32±13.15, and 52.42±19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4±0.7, 1.8±0.86, 2.83±0.82, 2.14±1, and 10.19±2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28±0.7, 2.8±0.8, 2.35±0.85, and 8.45±1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05).
Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
Citations
Objective: The purposes were to determine the baseline colon transit time (CTT) and to assess the effect of dietary fiber (psyllium husk) on neurogenic bowel function in chronic spinal cord injured (SCI) persons.
Method: Eleven chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were participated. Personal interview were carried out for all studied subjects at pre and post treatment period. The baseline colon transit time (CTT) were measured for the right (rCTT), left (lCTT), rectosigmoid (rsCTT) colons as well as for the entire colon using radio-opaque markers. After 4 weeks treatment of psyllium husk, the subjects were reevaluated for their CTTs and the results were compared to the pretreatment values.
Results: The mean age of the subjects was 33.9⁑11.0 years and the level of injury ranged from C3 to T10. The mean duration after SCI was 22.6 months (6∼47 months). The rCTT, lCTT, rsCTT and tCTT were not affected after the treatment of psyllium husk. Also their bowel care patterns and satisfaction were unaffected by the treatment.
Conclusion: The results of this study suggest that the use of psyllium husk in chronic spinal cord injured persons do not show the same effect on bowel function as has been previously reported in general population with idiopathic constipation. (J Korean Acad Rehab Med 2002; 26: 533- 538)
Objective: This study was designed to investigate the effect of the rectal electrical stimulation in patients with neurogenic bowel due to SCI.
Method: Twelve patients with SCI who have the symptoms of neurogenic bowel were recruited as subjects. Before and after electrical stimulation, anorectal angle and anal pressure was measured.
Results: 1. There was a reverse correlation between pre- electrical stimulation anorectal angle and colon transit time in rectosigmoid segment (p＜0.05). 2. Anal pressure of postelectrical stimulation was significantly decreased compared with that of pre-electrical stimulation (p＜0.05). 3. Anorectal angle of post-electrical stimulation was significantly increased compared with that of pre-electrical stimulation (p＜0.05).
Conclusion: This study suggested that rectal electrical stimulation for neurogenic bowel in patients with SCI could be helpful defecation method for bowel emptying. (J Korean Acad Rehab Med 2002; 26: 526-532)
Objective: To calculate the colonic transit time (CTT) and to evaluate the effect of combined therapy of cisapride and lactulose on neurogenic bowel dysfunction in patients with chronic spinal cord injury.
Method: This study was prospectively designed. Right (rCTT), left (lCTT), rectosigmoid (rsCTT), and total (tCTT) colonic transit times were measured using the radio-opaque marker technique in twenty patients with spinal cord injury (SCI group), of which mean age was 39 years (range: 13∼67 years) and median duration after SCI was 15 months (4∼252 months). Ten ambulatory stroke patients (mean age 49 years, median duration, 12 months) were also evaluated as control group. All CTTs in both groups were compared by unpaired Student's t-test. In SCI group, the therapeutic effect of combined administration of cisapride (10 mg p.o. t.i.d) and lactulose (134.0 g/100 ml, 30∼45 ml per day p.o.) was statistically analyzed by paired Student's t-test.
Results: Total (p＜0.0001) and segmental CTT (p＜0.01) except right colon were significantly delayed in SCI group when compared to the control group. In SCI group, tCTT of non-ambulatory patients (n=13) and rCTT, lCTT, rsCTT and total CTT of ambulatory patients (n=7) were significantly decreased after the combined drug therapy (p＜0.05). In ambulatory SCI patients, duration after injury showed negative correlation with tCTT (Pearson's correlation coefficient r=0.8407, p=0.0178).
Conclusion: Combined therapy of cisapride and lactulose can improve tCTT in SCI patients with neurogenic bowel dysfunction.
Objective: The aims of this study were to evaluate the common gastrointestinal problems, diet and bowel care patterns, and to estimate the colon transit time in spinal cord injury (SCI).
Method: Fifteen chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were studied by measuring the colonic transit time and interviews. The colon transit time was studied by using radioopaque markers.
Results: Mean total colonic transit time was 43.79 h with right colonic transit time 13.71 h, left colonic transit time 20.36 h, and rectosigmoid colonic transit time 9.71 h. The right colonic transit time was delayed in 35.7% of the subjects, left colonic transit time in 64.3%, and rectosigmoid colonic transit time in 21.4%. The common gastrointestinal problem in SCI were constipation (66.7%). The defecation difficulty (73.3%) was the most significant subjective symptom. Delayed colonic transit time was shown in 80% of perceived 'constipation' group. The average time spent for the defecation was 64.7 minutes per day. 73.3% of the subjects did not control the diet.
Conclusion: Spinal cord injured persons of upper motor neuron type neurogenic bowel in Korea showed significantly delayed colonic transit time than non SCI adults, similar delayed colon transit time as Western SCI persons who consume less fibers in daily diets.
Among complications arising from spinal cord injury(SCI), chronic gastrointestinal(G-I) problems and bowel dysfunction have not received as much attention as the other fields of medical and rehabilitation research, even though their incidence is not negligible. Among SCI patients, we therefore investigated chronic G-I problems and bowel dysfunction, where the degree of these was such that activities of daily living(ADL) were significantly affected or long-term medical management was required.
Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The incidence of chronic G-I problems was very high(62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL in particular, they restricted diet (80%), restricted out door ambulation(64%), and caused unhappiness with bowel care(62%).
These chronic G-I symptoms were vague and very subjective, but significant enough to affect quality of life. Bowel dysfunction was not related to severity of injury, and bowel habits had generally settled within six months of SCI. With regard to frequency, time, and method of defecation, bowel care habits varied very considerably among individuals, and in relation to the extent to which practical results matched the level of expectation generated by a physician's recommended care program, individual satisfaction was also very subjective. We therefore suggest that an appropriate bowel program should be properly designed and adequate training provided during the early stage of rehabilitation.
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