Quality of Life in Patients with a Stoma Post Spinal Cord Injury
Authors: Brockman Stephen F , Drysdale Henry R.E. , Nunn Andrew , Robson Scott , Udayasiri Sonal , Millard Melinda , Bui Andrew , Stupart Douglas A 
Published: December 2022

Background:
Many spinal cord injury (SCI) patients experience lifelong disabilities and impaired quality of life (QoL) related to bowel dysfunction. The most common manifestation of bowel dysfunction is constipation or fecal incontinence. There are many options available for the management of bowel function, one of these is stoma formation (ileostomy of colostomy). Studies assessing QoL after stoma formation in SCI patients have yielded variable results.

Objective:
To determine the impact of stoma formation on QoL in SCI patients.

Design:
Retrospective study in which eligible patients were asked to complete a structured questionnaire.

Setting:
The study was conducted at the Austin Hospital (a tertiary referral hospital in Melbourne, Victoria, Australia). The patients were under the care of the Victorian Spinal Cord Service.

Patients (Materials) and Methods:
Patients were included if they had undergone a colostomy or an ileostomy after sustaining an SCI. The patients had to have had undergone a stoma at least 1 year prior and had a minimum time interval of 2 years post injury at the time of the study. Only adults (>18 years) were included.

Main Outcome Measures:
Time spent on bowel function and symptoms of incontinence/constipation post stoma formation. A change in QoL post stoma formation and a retrospective view on the timing of stoma formation.

Sample Size:
A total of 44 patients were initially included in the study. Of these, 15 died and four were unable to be contacted. Of the remaining 25 patients, 22 (88%) completed the questionnaire.

Results:
Most patients had sustained complete cervical or thoracic injuries. The median age of the injured patients was 28 years (12–73 years). The median time between SCI and stoma formation was 19 years (1–47 years). The patients reported fecal incontinence as the most common indication for stoma formation (12/22, 55%). Stoma formation was associated with a significant reduction in time spent on bowel function (p < 0.05), reduced symptoms of constipation (p < 0.05), and fecal incontinence (p < 0.05). Stoma formation was associated with a "much better" overall QoL in 20/22 (91%) patients. In addition, majority of the patients observed that stoma formation was associated with "much better" ease of bowel management (21/22, 95% patients) and independence (18/22, 82%). The patients (68%) noted that would have preferred to have had their stoma earlier, and no patient wanted their stoma reversed.

Conclusions:
Stoma formation in SCI patients with bowel dysfunction is associated with improved QoL. Majority of the patients with a stoma would have preferred to have had their stoma earlier.

Limitations:
The study was limited by its small sample size and retrospective nature. The data collected relied on the patients' recollection of their prestoma symptoms, which, in many cases, was some years prior and not recent. Alternative treatment options, such as medications, anal plugs, and sacral nerve neuromodulation, were not considered in this study.