[Assessment of severity of neurogenic bowel dysfunction in chronic patients with a simple 1 item questionnaire (PGI S)
INTRODUCTION Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease, but rarely assessed in rehabilitation centres. AIM To study the prevalence of neurogenic bowel dysfunction (NBD) in those patients, and to assess its severity with the Patient Global Impression of Severity (PGI S) MATERIAL Prospective study by questionnaires, with the Neurogenic Bowel Dysfunction Score (0 47) and the PGI S, a 1 item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and the Bristol Stool Chart for stool consistency. All patients presenting a chronic >2months) neurological disease were included. RESULTS Inclusion of 169 patients, 97 with spinal cord injury, 42 with multiple sclerosis and 30 with hemiplegia. In each population, prevalence of constipation was 67 45 and 17 of pelvic floor dyssynergia 82 45 and 27 and leakages (gas or stools) de 74 48 and 43 respectively. 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 and 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. CONCLUSION PGI S and Bristol Stool Chart are reliable tools to assess the presence of bowel symptoms in clinical practice.
Progres en urologie journal de l'Association francaise d'urologie et de la Societe francaise d'urologie