The impact of stoma for bowel management after spinal cord injury

• Published in: Spinal cord Vol. 50; no. 11; pp. 848 - 852
• Main Authors: Coggrave, M J, Ingram, R M, Gardner, B P, Norton, C S
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-11-2012; Nature Publishing Group
• Subjects: 631/378/1687/1825; 692/699/1503/1581/1487; 692/700/565; Age; Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cerebrospinal fluid. Meninges. Spinal cord; Colostomy - psychology; Decision making; Female; Human Physiology; Humans; Ileostomy; Ileostomy - psychology; Injuries of the nervous system and the skull. Diseases due to physical agents; Intestine; Inventories; Laxatives; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Patient Satisfaction; Quality of Life; Rectum; Retrospective Studies; Spinal Cord Injuries - surgery; Spinal cord injury; Surgery; Surgical Stomas; Surveys and Questionnaires; Traumas. Diseases due to physical agents; spinal cord injury; stoma; colostomy; neurogenic bowel dysfunction; ileostomy; Nervous system diseases; Clinical management; Vertebral canal; Dysfunction; Spinal cord trauma; Central nervous system disease; Stoma; Spinal cord disease
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2012.66

Study design:
Multi-centre, retrospective self-report postal survey.
Objectives:
To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction.
Setting:
Five UK spinal cord injury centres.
Methods:
A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres.
Results:
Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma.
Conclusion:
The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.