Fecal Incontinence and Neurogenic Bowel Dysfunction in Women With Traumatic and Nontraumatic Spinal Cord Injury

BACKGROUND: In the literature on chronic spinal cord injury, neurogenic bowel dysfunction has not gained as much attention as bladder dysfunction, the traditional cause of morbidity and mortality. OBJECTIVE: The purpose of this study was to investigate the prevalence of fecal incontinence and conditions associated with fecal incontinence in women with spinal cord injury. DESIGN: In this cross-sectional study, data were obtained from an electronic medical chart database containing standardized questionnaires. SETTINGS: The study was conducted at the Clinic for Spinal Cord Injuries, Rigshospitalet, where patients from Eastern Denmark are followed every second year. PATIENTS: Women who sustained a spinal cord injury between September 1999 and August 2016 and attended a consultation between August 2010 and August 2016 were included. If the bowel function questionnaire had never been answered, the woman was excluded. MAIN OUTCOME MEASURES: The newest completed questionnaire regarding bowel function, urinary bladder function, quality of life, neurologic level/completeness/etiology of injury, mobility status, and spousal relationship was obtained from each woman. RESULTS: Among the 733 identified women, 684 were included, of whom only 11% had a complete motor injury. A total of 35% experienced fecal incontinence, varying from daily to less than monthly, and 79% experienced bowel dysfunction. Fecal incontinence was associated with urinary incontinence and decreased satisfaction with life in general and psychological health. In the multivariate logistic regression analysis, the odds of daily-monthly fecal incontinence increased significantly with increasing age, myelomeningocele as etiology of injury, a more complete paraplegic injury, use of wheelchair permanently, and follow-up <3 months. LIMITATIONS: There were missing data in the study, including 12% with no answer to the fecal incontinence question. CONCLUSIONS: Fecal incontinence is a severe problem that affects more than one third of women with spinal cord injury and is associated with decreased quality of life. The present study emphasizes that women with myelomeningocele, a more complete paraplegic injury, older age, short follow-up period, and permanent wheelchair use have an increased risk of fecal incontinence. See Video Abstract at http://links.lww.com/DCR/A985.