Touching Lives - November 2006
Where the money goes
Many of us associate spinal cord injury with paralysis — the loss of the use of our arms or legs, or even both.
But recent research has shown that many of the 40,000 people living with this kind of injury actually consider bowel incontinence the most devastating consequence of damaging their spine, rating it as having a greater impact on quality of life than losing the ability to walk.
Maureen Coggrave is a nurse based at The National Spinal Injuries Centre (NSIC) at Stoke Mandeville Hospital in Buckinghamshire. She received an Action Medical Research award of £111,892 in 2002, as part of the Charity’s Research Training Fellowship scheme, to assess the effectiveness of the bowel management methods taught to spinal injury patients during rehabilitation, and gain a better understanding of patients’ attitudes towards the issue.
More than 700 people sustain a spinal cord injury every year in this country, usually resulting from a road or sporting accident. Maureen explains,”The unfortunate thing about spinal injury in terms of bowel control is that the nerves for this area of the body come from the base of the spine, and are therefore particularly vulnerable. In fact, virtually everybody with a spinal cord injury will experience some impact on bowel function.”
Rehabilitation Advances in treatment mean that patients are beginning rehabilitation soon after injury, learning to look after their paralysed body and make best use of their remaining function. Sport and exercise are a big part of this process, helping people to rebuild mobility and confidence, and resume other aspects of life, such as relationships, parenthood and work.
Maureen continues, “All the things that people can go on and do after injury rely on managing bowel continence. Unfortunately it is not under one’s control as it was before.”
Bowel incontinence is, understandably, a hugely embarrassing problem. “A patient may not be able to feel when they need to open their bowel, or pass wind; they may feel they need to go, but are unable to stop themselves, or they may suffer severe constipation. It can be very difficult to lead any kind of life. That’s why it’s so important to manage the problem before it embarrasses you.”
Routine The key to management, Maureen explains, is routine. If patients can find a time of day that suits them to open their bowel, using the variety of techniques taught during rehabilitation, they are in control and can regain their confidence.
Maureen says, “This research was important because as professionals we didn’t really know how patients felt about bowel management or the methods that we think are effective.”
So Maureen devised a questionnaire which she sent to NSIC patients, both current and past, to find out more about their bowel care and attitude towards the subject — the first such questionnaire ever conducted in the UK. Fifty per cent responded, a figure that Maureen feels reflects the taboo nature of the subject.
“It’s just not a popular topic of conversation! We all learn control when we’re small, and seldom mention it ever after.”
Results Maureen invited the respondents back to the centre for an interview and assessment. She wanted to find out whether the need for the more invasive bowel emptying techniques could be avoided.
“The findings indicate that they cannot; two very common methods — manual evacuation and laxatives — are both effective and acceptable to spinal cord injured patients. In fact, contrary to popular belief amongst health care professionals, they are essential to many of them.
“We plan now to publish our findings to give positive support to these methods and help patients obtain the bowel care they need outside specialist centres. We are also working on some national guidelines to help nurses and health care professionals to advise their patients, and we hope they’ll eventually become part of nursing care education.”
Maureen concludes, “Without the funding from Action Medical Research this important research would not have happened. It has enabled me to gain more and broader experience about this area of care and improve my skills and knowledge as a researcher, for which I am very grateful.”