Bowel Management Table 15b: Colostomy after a Spinal Cord Injury

Author Year; Country

Score

Research Design

Total Sample Size

Methods

Outcome

 

 

 

Coggrave et al. 2012;

UK

Retrospective self-report survey

N=92

Population: 26 cervical (15 complete, 10 incomplete, 1 unknown), 61 thoracic (49 complete, 10 incomplete, 2 unknown), 1 missing data on level of injury; 64M:28F; Age: mean (SD) 56(9)yrs; duration of injury: mean (SD) 26(13)yrs; 91% colostomy, 9% ileostomy.

Treatment: Retrospective analysis of a self-report postal survey of individuals with SCI who had a stoma for bowel management issues (five UK spinal centres)

Outcome Measures: Tennessee Self-Concept Scale, Satisfaction with Life Scale, Hospital Anxiety and Depression Scale, 3 simple rating scales for satisfaction, ability to live with bowel dysfunction, and how much bowel care restricts life.

  1. Subjects reported experiencing bowel difficulties for a mean (SD) time of 10 (10) years before surgery. 11% would’ve preferred surgery a year earlier, 28% up to 5 years earlier, 30% up to 10 years earlier and 32% earlier still. None suggested stoma formation was too early.
  2. Subjects reporting an ileostomy were significantly more likely to need assistance than those with a colostomy.
  3. Laxative use was reduced from 58 to 31% and dietary manipulation to assist bowel care was reduced significantly.
  4. 83 (70%) reported they felt very positive about their stoma, whereas 2 subjects felt others avoided them due to the stoma.
  5. For 23%, there was impact on personal relationships; 9 reported positive impact, 6 negative and 3 neutral.

Munck et al. 2008;

Belgium

Case-series

N = 23

Population: 23 SCI subjects who had a colostomy in the digestive surgery department of Brugmann Hospital between Jan 1996 and Dec 2005 (age range 22-72). Level of injury: 13 dorsal, 7 cervical, 3 lumbar.

Treatment: Colostomy

Outcome Measures: Demographic information and medical information on the stoma formation and complications, collected from subjects’ medical records; quality of life questionnaire.

  1. 10 subjects had a stoma for perineal wounds.
  2. Average time spent on bowel care per week decreased from 5.95 hr prior to stoma formation to 1.5 hr after.
  3. Of the 10 patients, 3 reported cutaneous irritations and 1 reported detachment of the pocket.
  4. Of the 10 patients, 9 reported having much easier bowel care since the stoma formation, and 6 felt that the stoma had given them greater independence.

Luther et al. 2005;

USA

Cross-sectional

N=370

Population: SCI subjects in 6 centers that were selected to be representative of the 23 Veteran Affairs SCI centers. Survey respondents with colostomies were matched to controls based on age, year of injury, classification of paralysis and marital status by calculating propensity scores. Comparison of 74 patients with a sample of 296 matched controls without colostomies.

Treatment: Colostomy

Outcome Measures: Bowel care-related items; quality of life.

  1. No statistically significance differences were found in the demographic distributions for cases and controls.   
  2. No statistically significant differences were reported between the cases and the matched controls for any of the bowel care outcomes or bowel-related quality of life. Both groups reported low incidence of accidental/unplanned bowel movements and falls related to bowel care.
  3. Mean responses to the quality of life items were generally very high; however, a large number of respondents continue to express dissatisfaction with bowel care. The cases had a much higher percentage of responses (55.7%) in the “very dissatisfied” category than did the controls (41.7%).

Branagan et al. 2003;

UK

Retrospective chart review

N=32

Population: 10 subjects with cervical SCI, 18 with thoracic, and 3 lumbar; Age at injury: average 28.9 yrs; Duration of injury: mean 17.1 years

Treatment: Medical records were reviewed for subjects who had a previous colostomy.

Outcome Measures: Results of surgery

  1. The average time spent on bowel care per week decreased significantly from 10.3 hours to 1.9 hours after the colostomy. 
  2. 18/31 subjects felt the colostomy gave them greater independence. 
  3. 25 subjects wished they had been offered a stoma earlier. 
  4. No subjects wanted a stoma reversal. 

Safadi et al. 2003;

USA

Retrospective chart review

N=45

Population: 21 tetraplegics, 24 paraplegics; 44M 1F; Mean age 55.9yrs,

Treatment: 20 right side colostomies (RC), 21 left side colostomies (LC), 7 ileostomies (IL)

Outcome Measures: quality of life, colonic transit time, bowel care time

  1. Colonic transit time was significantly longer in the right side colostomy compared to the left side colostomy and the ileostomy.
  2. In all groups, quality of life increased (RC: 49 to 79, LC: 50 to 86, IL: 60 to 82 min) and bowel care time decreased (RC: 102 to 11 min, LC: 123 to 18 min, IL: 73 to 13 min).

 Rosito et al. 2002;

USA

Case series

N=27

Population:Level of injury: C4-L3 (17 complete, 10 incomplete); mean age: 62.9 yrs; 26M 1F; Duration of injury: 25.8yrs

Intervention:Colostomy

Outcome Measures:Quality of life questionnaire with 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure

 

  1. Quality of life improved significantly after colostomy.
  2. All 27 patients were satisfied, 16 very satisfied.
  3. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%.
  4. After colostomy, the average amount of time spent on bowel care was reduced significantly from 117.0 min/day to 12.8 min/day.
  5. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy.

Randell et al. 2001;

New Zealand

Case-control

N=52

Population: 26 subjects with colostomy: 10 with cervical SCI, 16 with lumbar/lower thoracic SCI; age: 22-87yrs, matched with 26 subjects without colostomy.

Treatment: Colostomy

Outcome Measures: Burwood Quality of Life Questionnaire: 5 areas: systemic symptoms, and emotional, social, work and bowel function.

  1. No significant difference in the group with a colostomy compared to the group without a colostomy in regard to their general well-being, emotional, social or work functioning.

 

Kelly et al. 1999;

UK

Retrospective chart review

N=14

Population: Level of injury: C4-L2 (3 cervical, 10 thoracic, 1 lumbar); 12M 2F; Age at time of operation: mean (range) 54.8 (20-65) yrs; time from injury to stoma formation: mean (range)15 (2-37) yrs

Treatment: 12 subjects underwent left iliac fossa end colostomy and 2 subjects right iliac fossa end ileostomy 

Outcome Measures: Time spent on bowel care per week; independence in bowel care; quality of life

  1. Colostomy subjects (N=12): mean time spent on bowel care per week before stoma formation was 8.8 h (0.6-12.2) compared with 1.4 h (0.3-3.5) after; 50% of these patients were independent in bowel care before, 92% independent after; 10 patients claimed that the colostomy had a beneficial effect on their quality of life.
  2. Illeostomy patients (N=2): mean time spent on bowel care per week before ileostomy was 17.5 h and this was unchanged after ileostomy formation. 1 subject decreased the time he spent on bowel care from 28 h to 14 h; the other developed complications and his time increased from 7 h to 21 h. 

Stone et al. 1990;

USA

Case Series

N=7

Population: Level of injury: C4-T10; Age: mean 51.6yrs; Duration of injury: mean 15.7 years

Treatment: Medical records were reviewed for subjects who had undergone a colostomy

Outcome Measures: Efficacy of colostomy.

  1. All seven subjects who had colostomy performed as an adjunct to the treatment of perianal pressure ulcers successfully healed their ulcers. 
  2. The amount of time spent on bowel care decreased dramatically in the patients with prolonged bowel care. 

Frisbie et al. 1986;

USA

Cross-sectional

N=20

 

Population: Level of injury: 9 cervical, 11 thoracic; 19M 1F; Age: median (range) 55 (27-75) yrs. Duration of the enterostomies at time of interview was, median (range): 11 months (3 months to 14 yrs)

Treatment: A total of 24 enterostomies were carried out in 20 subjects: 17 sigmoid colostomies, 5 transverse colostomies, and 2 ileostomies.

Outcome Measures: Bowel care time, bowel care frequency, bowel care related complaints, quality of life

  1. Bowel care frequency increased from a median 3 times/week (range 2-7) before enterostomy to a median 7 times/week (range 4-14) after enterostomy.
  2. Bowel care duration diminished from a median 6 hours/week (range 0.7-14 hours) before enterostomy to a median 1 hour/week (range 1.3-7 hours) after enterostomy.
  3. The number of patients affected by bowel care related complaints pre- vs. post-operatively, respectively, were as follows: abdominal pain in 10 vs. 2, fecal leakage in 8 vs. 0, anorexia in 7 vs. 2, flatus in 9 vs. 4, sweating in 4 vs. 2 and odour in 4 vs. 5.
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