Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury.

BACKGROUND/OBJECTIVE: To compare symptoms of neurogenic bowel dysfunction in patients with spinal cord injury (SCI) at baseline and after 10 weeks of treatment with transanal irrigation and to identify possible factors that could predict outcome of the treatment. METHODS: Sixty-two patients with SCI (45 men and 17 women; mean age, 47.5 +/- 15.5 [SD] years) from 5 specialized European SCI centers were offered treatment with transanal irrigation for a 10-week period. Bowel function was assessed at baseline and at termination using the Cleveland Clinic Constipation Scoring System (CCCSS; 0-30, 30 = severe symptoms), St. Mark's Fecal Incontinence Grading System (FIGS; 0-24, 24 = severe symptoms), and the Neurogenic Bowel Dysfunction score (NBD; 0-47, 47 severe symptoms). Factors predicting improvement in bowel function scores were identified using a general linear model. RESULTS: Severity of symptoms at termination was significantly reduced compared with baseline values (CCCSS: -3.4; 95% confidence interval [CI], -4.6 to -2.2; FIGS: - 4.1; 95% CI, -5.2 to -2.9; NBD: -4.5; 95% CI, -6.6 to -2.4; all P < 0.0001). Although several factors were associated with positive outcome, no consistent and readily explainable pattern could be identified. Surprisingly, hand function, level of dependency, predominant symptom, and colonic transit time were not associated with outcome. CONCLUSIONS: Transanal irrigation in patients with SCI reduces constipation, improves anal continence, and improves symptom-related quality of life. No readily obtainable factors could predict outcome, which might be because of the relatively low number of patients. This supports the use of trial and error as a strategy in deciding on a bowel management method for neurogenic bowel dysfunction.

A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients.

BACKGROUND & AIMS: Bowel dysfunction in patients with spinal cord injury often causes constipation, fecal incontinence, or a combination of both with a significant impact on quality of life. Transanal irrigation improves bowel function in selected patients. However, controlled trials of different bowel management regimens are lacking. The aim of the present study was to compare transanal irrigation with conservative bowel management (best supportive bowel care without irrigation). METHODS: In a prospective, randomized, controlled, multicenter trial involving 5 specialized European spinal cord injury centers, 87 patients with spinal cord injury with neurogenic bowel dysfunction were randomly assigned to either transanal irrigation (42 patients) or conservative bowel management (45 patients) for a 10-week trial period. RESULTS: Comparing transanal irrigation with conservative bowel management at termination of the study, the mean (SD) scores were as follows: Cleveland Clinic constipation scoring system (range, 0-30, 30 = severe symptoms) was 10.3 (4.4) versus 13.2 (3.4) (P = .0016), St. Mark's fecal incontinence grading system (range, 0-24, 24 = severe symptoms) was 5.0 (4.6) versus 7.3 (4.0) (P = .015), and the Neurogenic Bowel Dysfunction Score (range, 0-47, 47 = severe symptoms) was 10.4 (6.8) versus 13.3 (6.4) (P = .048). The modified American Society of Colorectal Surgeon fecal incontinence scores (for each subscale, range is 0-4, 4 = high quality of life) were: lifestyle 3.0 (0.7) versus 2.8 (0.8) (P = .13), coping/behavior 2.8 (0.8) versus 2.4 (0.7) (P = .013), depression/self perception 3.0 (0.8) versus 2.7 (0.8) (P = .055), and embarrassment 3.2 (0.8) versus 2.8 (0.9) (P = .024). CONCLUSIONS: Compared with conservative bowel management, transanal irrigation improves constipation, fecal incontinence, and symptom-related quality of life.