Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Study design: Cross-sectional study. Objective: To analyze the predictors of severe neurogenic bowel dysfunction (NBD) in persons with spinal cord injury (SCI). Setting: The Kaohsiung Medical University Hospital, Taiwan. Methods: Two questionnaires-the NBD score and the Beck Depression Inventory second edition-were sent to 232 persons with SCI by mail. The demographic factors and injury-related factors were recorded to evaluate any relationships with severe NBD. The associations between the severity of NBD and psychological condition were also measured. Results: In all, 39.4% of the respondents suffered from severe NBD. Multiple logistic regression analysis showed that those with a cervical injury (odds ratios (OR) = 10.5, 95% confidence interval (CI) 1.6-67.7) or a thoracic injury (OR = 7.1, 95% CI 1.2-40.3) had a higher risk of severe NBD than those with a lumbar injury. Persons with American Spinal Injury Association (ASIA) A had a 12.8-fold higher risk of severe NBD than persons with ASIA D (OR = 12.8, 95% CI 3.3-50.1). Longer duration of injury ( >= 10 years) was another risk factor of severe NBD. Moderate-to-severe depression was associated with reduced bowel function. Conclusions: This study showed that high level of cord lesion, completeness of cord injury and longer duration of injury ( >= 10 years) could predict the severity of NBD in patients with SCI. Spinal Cord (2010) 48, 554-559; doi:10.1038/sc.2009.181; published online 12 January 2010