Evolution of bowel function and quality of life after spinal cord injury: a longitudinal registry and survey study.

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.