Assessment of severity of neurogenic bowel dysfunction in chronic patients with a simple 1-item questionnaire (PGI-S).

OBJECTIVE: Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease. The prevalence of neurogenic bowel dysfunction (NBD) in rehabilitation centers is still largely unknown, their assessment difficult and the use of transanal irrigation non systematic even in presence of severe NBD.

OBSERVATIONS: Prospective study by detailed questionnaire, with use of the Neurogenic Bowel Dysfunction Score (0-47) and the Patient Global Impression of Severity (PGI-S), a 1-item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and Bristol Stool Chart for stool consistency. All patients presenting a chronic (>2months) neurological disease were included during a 3-month period in 2 rehabilitation centers. Inclusion of 169 patients, 97 with spinal cord injury, 42 with multiple sclerosis and 30 with hemiplegia. Moderate to severe bowel symptoms were seen in 61% of spinal cord injury, 43% of multiple sclerosis and 23% of hemiplegic patients, with NBD scores of 11.9±6.5, 5.7±4.9 et 3.7±4.2, respectively (p<0.01). There was a significant relation between PGI-S and NBD score (p<0.01). Significant lower NBD scores were associated with normal stool consistency (Bristol type 3 or 4) (p<0.01). In case of severe bowel symptoms, the use of transanal irrigation was hampered by patients' motivation and acceptation, and their autonomy.

DISCUSSION/CONCLUSION: This study confirms the high prevalence of bowel symptoms in patients with a chronic neurological disease. PGI-S and Bristol Stool Chart are reliable tools to assess the presence of bowel symptoms in clinical practice.