First Comprehensive Study of Bowel Control Loss

The Question: What is the rate of occurrence, risk factors, and outcomes for persons with bowel control loss after traumatic brain injury?

Past Studies have not determined how often bowel control loss happens, the amount of people who experience it, and risk factors for persons with brain injuries. The ability to selectively control bowel movements may be lost when the brain is injured. This can happen if a person experiences an impaired awareness of the need to go to the bathroom, impaired thinking skills needed to carry out the tasks for the toileting process, and a breakdown of the nerve signals that coordinate bowel movements. Medications, diet, lack of access to the bathroom, and weak bowel control muscles can also contribute to bowel control loss.

Medical complications such as skin sores and infections can develop as a consequence of bowel control loss. Typically, individuals are provided with a bowel training program upon hospitalization. The bowel-training program usually includes scheduled toileting times and medication supplements to assist stool formation and movement.

Loss of bowel control can delay a persons discharge from an acute care facility, return to home, and participation in formerly enjoyable activities. Bowel control loss often results in significant physical requirements of the person with a brain injury and caregivers. It is considered to be a heavy family burden.

Traditionally, bowel control loss has been an unspeakable issue for persons with brain injuries and health care providers alike. Feelings of embarrassment, humiliation, and social isolation can contribute to the socially devastating consequences of experiencing bowel control loss.

This Study is the first comprehensive analysis of bowel control loss associated with traumatic brain injury. The researchers examined 1,013 persons with traumatic brain injury from 17 Traumatic Brain Injury Model Systems (TBIMS) acute rehabilitation inpatient settings. On admission to inpatient rehabilitation, 68% of the participants experienced bowel control loss, at discharge from rehabilitation-12.4%, and after one year-5.2%.

It appeared that bowel control loss could result directly from a brain injury specifically to the frontal part of brain, which regulates the bowel control function, or from the cumulative consequences from severe brain injury including pelvic fractures, urinary tract infections, impaired thinking skills, and decreased awareness of the need to go to the bathroom. Persons with bowel control loss tended to be a few years older than the average participant in the TBIMS, spend more days as an inpatient, and make less functional gains in rehabilitation. They were more likely to be discharged to an institutional setting.

Who May Be Affected By These Findings: Persons with brain injury, their family and friends, caregivers, healthcare providers, rehabilitation personnel, and researchers

Caveats: The researchers state that despite the obvious importance, the lack of bowel control loss research may reflect the discomfort and reluctance of researchers, clinicians, families, caregivers, and persons with brain injuries to openly discuss bowel control loss.

Bottom Line: In this study, more than two thirds of the participants experienced bowel control loss when they were admitted to inpatient rehabilitation. Of those people, 82% were able to control their bowel movements at the time of inpatient discharge and 60% at one-year post injury. It appears that bowel control loss can occur as a direct result of injury to the frontal portion of the brain or from a multitude of factors associated with severe brain injury. Bowel control loss appears to be a main factor in the decision to discharge a person to an institutional setting, rather than to home. The authors suggest that the next step for research is to focus on standardizing bowel-management programs and regulating factors that influence bowel control loss.

Find This Study:
Foxx-Orenstein, A.; Kolakowsky-Hayner, S.; Marwitz, J. H.; Cifu, D. X.; Dunbar, A.; Englander, J.; & Francisco, G. (2003). Incidence, risk factors, and outcomes of fecal incontinence after acute brain injury: Findings from the Traumatic Brain Injury Model Systems National Database. Archives of Physical Medicine and Rehabilitation, (84), 231-237.

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