In the November 2017 issue of Diseases of the Colon and Rectum, Dr. Charlène Brochard and her colleagues from a spina bifida referral center in Rennes, France, report on the frequency of intestinal problems in 26- to 45-year-old patients with spina bifida. The multidisciplinary study included clinical data obtained over a 9-year period on nearly 400 spina bifida patients, emphasizing the association of obesity with fecal incontinence and bowel dysfunction.
Spina bifida is a common congenital abnormality resulting when there is incomplete closure of the neural tube in the lower part of the back, resulting in protrusion of part or all of the contents of the spinal canal through this defect. This abnormality can be associated with multiple problems such as leg paralysis, fluid in the brain (hydrocephalus) and the bladder, as well as bowel and sexual problems. Even though there have been many studies on these patients when they are children, there have been few reports on how these individuals fare as they develop into adulthood, especially with respect to bowel problems such as incontinence.
The authors of this study used very careful evaluation tools to assess the presence and severity of bowel incontinence, constipation, and urinary incontinence, as well as determining the presence of problems with sexual function in both men and women. Lower urinary tract dysfunction, including urinary incontinence as well as urinary tract infections, was the most common problem and occurred in 28% of patients. This was followed by bowel dysfunction in 16% of patients. Three-quarters of patients were able to walk, while one-quarter of patients were obese, defined as having a body mass index over 30kg/m2. More than half of these patients had at least moderate bowel dysfunction as measured by the Neurogenic Bowel Dysfunction Score, with 70% of patients experiencing fecal incontinence, many with severe symptoms. One-third of patients had both urine and bowel incontinence.
Men, those who were obese, those who had urinary incontinence, and those with severe constipation were more likely to have severe fecal incontinence. The neurologic level of the spina bifida defect and other neurologic factors (such as presence of hydrocephalus) were not associated with severe fecal incontinence nor with severe bowel function (defined as having fewer bowel movements, needing a longer time to move their bowels, requiring frequent use of digital stimulation for defecation and having a greater number of episodes of fecal incontinence).
The authors highlight the high rates of constipation (85%), fecal incontinence (70%), severe fecal incontinence (60%), and severe bowel dysfunction observed this group of relatively young adults. Unlike some prior studies, there was no correlation with fecal incontinence or bowel dysfunction with the neurological level of the spina bifida defect. The correlation with obesity and constipation presents modifiable factors that might significantly improve quality of life in this group of patients. Careful studies such as this have the potential to improve quality of life with many childhood disorders, in whom follow-up in adulthood is often not as good as it should be.