Abstract
Bowel dysfunction is a major problem in spinal cord injury patients, however little attention has been paid to its study. This thesis collects four studies.The first study aimed to clinically evaluation bowel dysfunction in spinal cord injury (SCI) and relate it to neurological characteristics. Clinical assessment was made in 109 patients. Most patients required laxatives and/or digital stimulation; 10% had bowel movements less than twice a week and 18% spent more than one hour; 61% presented colorectal symptoms (28% constipation, 31% faecal incontinence, 31% anorectal disorders, 18% autonomic dysreflexia [AD]). Patients with American Spinal Injury Association Impairment Scale (ASIA) A, B or C with spinal sacral reflexes (SSR) took more suppositories, evacuated with less frequency and spent more time (pIn the second study, the aim was to correlate clinical, neurological and pathophysiological characteristics of neurogenic bowel in motor complete SCI. Clinical assessment, colonic transit time (CTT) and anorectal manometry were performed in 54 patients. Three patterns were observed: pattern A (neurological level upper T7), very frequent constipation (86%) and not very frequent incontinence; moderate delay in CTT, incapacity to increase intra-abdominal pressure, and absence of anal relaxation during the defecatory manoeuvre; pattern B (neurological level lower T7 with SSR), less constipation (50%) and not very frequent incontinence; moderate delay in CTT, capacity to increase intra-abdominal pressure, increased anal resistance during the defecatory manoeuvre and presence of external anal sphincter (EAS) contraction when intra-abdominal pressure increased and during rectal distension; pattern C (neurological level lower T7 without SSR), less constipation (56%) and greater incontinence; severe delay in CTT, capacity to increase intra-abdominal pressure, absence of anal resistance during the defecatory manoeuvre and absence of EAS contraction when intra-abdominal pressure increased and during rectal distension.
In the third study we evaluated the pathophysiology of faecal incontinence and constipation in motor incomplete SCI (ASIA C and D) and compared it with motor complete lesions (ASIA A and B). Clinical assessment, CTT and anorectal manometry were performed in 54 patients. CTT was delayed similarly in both groups. EAS voluntary contraction was present in most motor incomplete and absent in all motor complete lesions. Cough-anal reflex was less frequent in motor complete lesions with neurological level >T7 (pThe aim of the fourth study was to analyse the clinical response of bowel function to sacral anterior root stimulator (SARS) and evaluate physiological factors that could determine its efficacy. Clinical assessment, CTT and anorectal manometry were performed prior to SARS implantation in 18 consecutive patients and patients were clinically re-evaluated at least 12 months post-implantation. After implantation, fewer patients required laxatives, the mean number of methods used to evacuate was reduced (p
| Date of Award | 29 Jun 2009 |
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| Original language | Catalan |
| Supervisor | Fermín Mearin Manrique (Director) & Joan Monés Xiol (Director) |