Assessment of neurogenic bowel dysfunction and its relationship with quality of life in spinal cord injury patients

The aim of this study was to assess the severity of neurogenic bowel dysfunction (NBD) and its relationship with clinical characteristics, functional status, depression and quality of life in long term traumatic spinal cord injury (SCI) patients. Ninety-four patients with traumatic SCI were included in the study. Demographic and clinical characteristics all patients were noted. NBD was assessed by NBD score and gaita was assessed using Bristol gaita form scale. All patients were questioned in terms of bowel care and program characteristics. Functional status was assessed by Functional Independence Measure (FIM), depression was assessed by Beck Depression Inventory (BDI) and quality of life was assessed by Short Form-36 (SF-36) questionnaire. Most frequent gastrointestinal complaints were constipation (48.9%), difficulty in bowel emptying (42.6%) and fecal incontinance (36.2%). Moderate-to-severe NBD was noted in 50% of the patients Significant correlation was found between NBD score and the extent of injury (rs=0.642, p<0.001). NBD score was significantly higher in non-ambulatory patients compared to ambulatory ones, and in those with urinary incontinence compared to ones without. Both permanent and intermittent catheterisation for bladder management as well as within-bed bowel care program were associated with significantly higher NBD scores. NBD score was negatively correlated with FIM score (rs= -0.539; p<0.001), and positively correlated with BDI score (rs=0.252; p=0.014). Physical functioning (rs= -0.413; p<0.001), energy (rs= -0.304; p=0.003) and mental health (rs= -0.224; p=0.030) dimensions of health related quality of life measured by SF-36 were found to be negatively correlated with NBD score. In conclusion, we believe that NBD and gastrointestinal complaints need to be evaluated and addressed during long term follow-up of SCI patients, as NBD was found to be associated with depression and poor quality of life in this patient population. Key words: Spinal cord injury, neurogenic bowel dysfunction, depression, health related quality of life.