# EVOLUTION OF BOWEL FUNCTION AND QUALITY OF LIFE AFTER SPINAL CORD INJURY: A LONGITUDINAL REGISTRY AND SURVEY STUDY

## TL;DR

Bowel dysfunction is common after spinal cord injury and significantly impacts quality of life, with early and sustained management being crucial.

## Contribution

This study links registry data with patient-reported outcomes to track bowel function and quality of life changes over time in spinal cord injury patients.

## Key findings

- 70% of participants had bowel dysfunction at baseline, which predicted lower quality of life.
- Incomplete spinal cord injuries were associated with improved bowel function over time.
- Severe incontinence and high bowel burden at follow-up predicted lower quality of life scores.

## Abstract

To assess changes in bowel function and quality of life over time in adults with spinal cord injury.

Retrospective cohort study linking clinical registry data with patient-reported outcomes.

236 adults with spinal cord injury in Sweden; 157 had both baseline and follow-up data.

Data from the Swedish National Quality Registry for Rehabilitation Medicine were merged with responses from the 2024 Swedish International Spinal Cord Injury Community Survey. Bowel dysfunction was assessed using the Spinal Cord Injury Secondary Conditions Scale, Constipation Scoring System, and St. Mark’s Incontinence Score. Quality of life was measured using the 3L EQ-5D questionnaire at baseline and the 5L version at follow-up, converted to a common scale. Group differences were analysed using χ2 and Mann–Whitney U tests. Logistic regression identified predictors of bowel outcomes; linear regression assessed factors associated with quality-of-life scores.

At baseline, 70% had bowel dysfunction and a mean quality-of-life score of 0.33. Bowel dysfunction was the only independent predictor of lower baseline quality of life. At follow-up, severe incontinence and high bowel burden predicted lower scores. Incomplete injury predicted improvement.

Bowel dysfunction is common and closely linked to reduced quality of life after spinal cord injury. Early and sustained management is essential.

People with spinal cord injuries often struggle with bowel function, which can greatly affect their daily lives and overall well-being. We linked medical records from Sweden’s national rehabilitation registry with a community survey of 226 adults to see how bowel problems and quality of life changed over time. At first rehabilitation, 7 out of 10 participants had bowel issues and reported lower health and mobility. After several years, nearly 30% saw improvements in bowel function, but over 40% still had ongoing problems. Those with incomplete injuries were more likely to improve. We also found that severe bowel symptoms, such as incontinence and constipation, were closely tied to poorer quality of life both early on and at follow-up. These results show that bowel care is a lasting challenge for many people after spinal cord injury and highlight the importance of early, ongoing support and treatment to enhance well-being.