The impact on individuals’ quality of life of maintaining or restoring bladder and bowel continence cannot be underestimated. It is a top user priority but this is unfortunately not always reflected in healthcare and research initiatives.
Recently, an international advisory committee gathered to address these problems and to suggest new approaches in the care of people with spinal cord injury who have continence issues. Their recommendations included actions to translate existing knowledge into clinical practice. It is clear that more joint efforts are needed to achieve a real change for people with bladder and bowel problems after spinal cord injury.
But people with spinal cord injury are far from alone in needing efficient management of bladder and bowel continence symptoms. Recently, bladder and bowel problems were investigated among patients in the early stages of Parkinson’s disease; the study showed a high prevalence of urinary incontinence (27%) and constipation (32%) compared with well-matched healthy controls.
These data show that autonomic symptoms such as bladder and bowel dysfunction may have an early onset and should be included in the screening at all stages of Parkinson’s disease. Asking patients about their bladder and bowel symptoms could make a real difference for them.
Addressing one symptom may sometimes improve another. In a clinical cohort study with one year follow-up on spina bifida patients with overactive bladder and detrusor sphincter dyssynergia, inclusion of a bowel management program significantly improved the average dry interval. Bowel management included transanal irrigation, suppositories, laxatives, and digital rectal stimulation with the aim of encouraging regular bowel movements.
The results clearly demonstrate existing treatment synergies between bladder and bowel, and highlight the importance of addressing both symptoms. This is crucial to improving quality of life for people suffering from incontinence and other troublesome bladder and bowel symptoms.
Summary of Publications
Title: Increased odds of bladder and bowel symptoms in early Parkinson’s disease.
Author and Origin
Serra MC, Landry A, Juncos JL, Markland AD, Burgio KL, Goode PS, Johnson TM 2nd, Vaughan C P.
The prevalence of urinary incontinence, nighttime voiding, constipation, and fecal incontinence was determined in patients with early-stage Parkinson’s disease and in age‑ and gender‑matched healthy
Urinary incontinence and constipation were more than 3 times more prevalent in people with early Parkinson’s disease, with a prevalence of 27% and 32% respectively.
This study shows that both bladder and bowel symptoms are common in the early stages of Parkinson’s disease, and management strategies should be implemented in a timely fashion.
See Publication Highlight.
Title: Translating promising strategies for bowel and bladder management in spinal cord injury.
Author and Origin
Wheeler TL; Bowel and Bladder Workshop Participants, de Groat W, Eisner K, Emmanuel A, French J, Grill W, Kennelly MJ, Krassioukov A, Gallo Santacruz B, Biering-Sørensen F, Kleitman N.
A review collating the conclusions from a high-level workshop concerning strategies for bladder and bowel management in patients with spinal cord injury (SCI).
Five themes were identified:
- Education and clinical standards
- Bowel physiology
- Sensory awareness
- Rehabilitation activity and exercise.
The overall conclusion was that a greater community effort is needed now to achieve a real change in the future.
Review of a workshop on bladder and bowel management in patients with SCI.
Title: The impact of bowel management in alleviating symptoms of urinary incontinence in spina bifida patients with overactive bladder and detrusor sphincter dyssynergia.
Author and Origin
Radojicic Z, Milivojevic S, Milic N, Milin Lazovic J, Lukac M, Sretenovic A.
A prospective cohort study of 70 patients with spina bifida. The study compared the average dry interval between clean intermittent catheterizations in patients undergoing bowel management and those with no bowel management.
There is a significant longer average dry time between two CICs among the patients undergoing bowel management. Bowel management should therefore be an integral part of treatment of spina bifida patients with overactive bladder and detrusor sphincter dyssynergia.
A prospective study assessing the impact of bowel management on average urinary dry time in patients with spina bifida.
This blog post is an extract of the Science Alert from June 2018 (76040-USX-20180613)