Bowel Dysfunction Related to Spina Bifida: Keep It Simple
Charlène Brochard1, Benoît Peyronnet, Anne Dariel
11 Service des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes 1, Rennes, France 2 Service d'Explorations Fonctionnelles Digestives, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes 1, Rennes, France 3 Institut National de la Santé et de la Recherche Médicale U1235, Université de Nantes, Nantes, France 4 Centre d'Investigation Clinique 1414, Inflammation and Physiology, Université de Rennes 1, Rennes, France 5 Service d'Urologie, Centre Hospitalier Universitaire Pontchaillou, Rennes, France 6 Centre Référence National Maladies Rares Spina Bifida, Centre Hospitalier Universitaire Pontchaillou, Rennes, France 7 Institut National de la Santé et de la Recherche Médicale U991, Université de Rennes, Rennes, France.
Insights
Adults with spina bifida experience high rates of fecal incontinence and bowel dysfunction. Obesity and urologic issues, not neurological factors, are linked to these conditions.
Area of Science:
- Urology
- Gastroenterology
- Neurology
Background:
- Care for urological issues in spina bifida is established, but standardized bowel dysfunction management is lacking.
- Bowel dysfunction is a significant concern for adults with spina bifida.
Purpose of the Study:
- To assess bowel dysfunction and identify risk factors in adults with spina bifida.
- Utilize validated instruments to evaluate bowel dysfunction prevalence and associated risks.
Main Methods:
- Prospective data collection by a multidisciplinary team focusing on anorectal and urological symptoms.
- Assessment of 228 adults with spina bifida at a French referral center.
- Multivariate analysis to identify factors associated with severe fecal incontinence and bowel dysfunction.
Main Results:
- High prevalence rates: 60% for severe fecal incontinence and 42% for severe bowel dysfunction.
- Bowel dysfunction is the second most common patient concern after lower urinary tract dysfunction.
- Independent risk factors for severe fecal incontinence include male sex, obesity, urinary incontinence, and constipation score ≥10. Soft stools were associated with less severe dysfunction. Neurologic features were not associated.
Conclusions:
- High prevalence of severe fecal incontinence and bowel dysfunction in adults with spina bifida.
- Obesity, urologic disorders, and stool consistency are associated with bowel dysfunction and fecal incontinence, rather than neurologic features.
- Potential selection bias due to recruitment from a national referral center and missing data noted.
Background:
Although care of urological disorders in spina bifida is well established, there is yet no agreement on a standardized approach to bowel dysfunction in this population.
Objective:
The purpose of this study was to assess bowel dysfunction using validated instruments and the risk factors in adults with spina bifida.
Design:
A multidisciplinary team prospectively collected patient data, focusing on anorectal and urological symptoms.
Settings:
The study was conducted with data from a French referral center for spina bifida.
Patients:
A total of 228 adults with spina bifida (sex ratio men:women, 92 (40%):136 (60%)) with a median age of 34.7 years (range, 26.8-44.7 y) were assessed.
Main Outcomes Measures:
Factors associated with severe fecal incontinence (Cleveland Clinic Incontinence Score ≥9) and severe bowel dysfunction (Neurogenic Bowel Dysfunction score ≥14) were assessed in a multivariate analysis model.
Results:
The prevalence rates of severe fecal incontinence and severe bowel dysfunction were 60% (130/217) and 42% (71/168). Bowel dysfunction was the second most common major concern of patients after lower urinary tract dysfunction. Male sex, obesity, urinary incontinence, and a Knowles-Eccersley-Scott symptom constipation score ≥10 were independently associated with severe fecal incontinence. Patients with soft stools had significantly less severe bowel dysfunction. Neither neurologic level nor other neurologic features of spina bifida were associated with severe fecal incontinence or severe bowel dysfunction.
Limitations:
The recruitment of patients with spina bifida through a national referral center might have resulted in selection bias, and some data were missing especially regarding BMI and Neurogenic Bowel Dysfunction score (21% and 26% of missing data).
Conclusions:
The prevalence rates of severe fecal incontinence and severe bowel dysfunction in adults with spina bifida were high and were adequately perceived by the patients. The present study emphasized the association of bowel dysfunction and fecal incontinence with obesity, urologic disorders, and stool consistency rather than neurologic features. See Video Abstract at http://links.lww.com/DCR/A394.
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