New-Onset Fecal Incontinence After Stroke: Risk Factor or Consequence of Poor Outcomes After Rehabilitation?

Baztán, Juan J.; Domenech, Juan R.; González, Margarita

doi:10.1161/01.str.0000081222.82020.d3

Cited by 12 publications

(6 citation statements)

References 10 publications

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“…The physiological process of filling and emptying, which is subject to voluntary control, is contingent upon the transmission of information from the periphery to the brain. Any circumstance that interferes with the cognition, transmission, or processing of these data at the brain level has the potential to result in malfunction of the lower gastrointestinal tract [10][11][12].…”

Section: Neurologic Bowel System Controlmentioning

confidence: 99%

“…To date, limited information is available about FI persistence and risk factors in patients after sABI. Authors have also described that, during the acute phase, FI occurs in 23-70% of the sABI population [3][4][5][6] and persists in the chronic phase in 5-15% of cases [7][8][9][10][11][12][13][14][15][16]. Constipation has been reported in the chronic phase in 23% of patients [17].…”

Section: Rationale and Aim Of This Workmentioning

confidence: 99%

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Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Pelizzari,

Antoniono,

Giraudo

et al. 2023

Neurology International

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Background: In this study, we aimed to investigate the incidence of fecal incontinence (FI) after severe acquired brain injuries (sABIs) and to determine whether this symptom can lead to an inability to return home after rehabilitation. Methods: This was a retrospective observational cohort study. In total, 521 acute sABI inpatients were enrolled from the Department of Neurorehabilitation at an academic tertiary care hospital. Patients were divided into two groups, with and without FI, at the end of the rehabilitation phase. The primary and secondary endpoints were the incidence of persistent FI and any difference in the discharge destination. Results: Upon admission, new-onset FI was found in 443 (85%) patients, of which 38% had traumatic sABI. Moreover, 62.7% of all patients had FI upon admission. At discharge, 53.3% (264/495) of patients still had FI. Of these, 75.4% (199/264) had a Rancho Level of Cognitive Functioning Scale (LCFS) ≥3. A statistically significant correlation between FI at discharge and the presence of frontal lesions, autonomic crises, and increased LCFS scores was noted. Among the patients discharged to their homes, the proportion with persistent FI was lower (34% vs. 53.3). Conclusions: FI was significantly persistent after sABI, even after recovery from unconsciousness, and must be considered as a consequence of, rather than an independent risk factor for, unfavorable outcomes.

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Section: Neurologic Bowel System Controlmentioning

confidence: 99%

Section: Rationale and Aim Of This Workmentioning

confidence: 99%

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Pelizzari,

Antoniono,

Giraudo

et al. 2023

Neurology International

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“…Barsak fonksiyon bozukluklarý Baztan ve ark.nýn çalýþmasýnda fonksiyonel iyileþme üzerine negatif etkisi olan önemli bir komplikasyon olarak ele alýnmýþtýr (20). Çalýþmalarda inmeli hastalarda barsak fonksiyon bozukluðunun patofizyolojisi hakkýnda çok az bilgi olduðu, ancak fekal inkontinansýn rehabilitasyon ve iyileþme sürecini olumsuz etkilediði bildirilmektedir (21,22).…”

Section: Tartýþmaunclassified

Incontinence, Neglect Syndrome and Emotional Status in Ischemic Stroke Patients and Relation With Lateralization and Functional Independency

et al. 2010

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Stroke is characterized by the sudden loss of blood circulation of the brain. Various studies suggested that age, gender, severity of the stroke, urinary incontinence, impairment in cognitive function, unilateral neglect syndrome are the most determining factors effecting the outcomes of stroke. The aim of the study was to evaluate the incidence of urinary and fecal incontinence and neglect syndrome, anxiety, depression status level and also the relation of them with lateralization and functional independency. In this study 44 stroke patients in neurology in-patient clinic were examined for motor limitation, anxiety and depression levels, neglect syndrome, urinary and fecal incontinence. Functional independency level was measured with Barthel Index, National Institute of Health Stroke Scale (NIHSS) and Rankin scales, anxiety level was evaluated with State-Trait Anxiety Inventory (STAI) 1 and 2 and depressive symptom severity was assessed with Beck Depression Inventory (BDI). Neglect syndrome was evaluated by subscale of NIHSS, urinary incontinence was assessed by clinical observations and the information from the relatives. Frequency of fecal and urinary incontinence, neglect syndrome and BDI scores were higher in left hemiparesia than in right hemiparesia (p =0.004, p =0.02, p=0.02, p<0.001, respectively). STAI 2 was negatively correlated with Barthel Index and positively correlated with Rankin and NIHSS scores (r=-0.663, p<0.001; r=0.664, p<0.001; r=05.28, p=0.008; respectively). Our findings indicated that the incidence of urinary and fecal incontinence were higher in left hemiparesia than in right hemiparesia. Our findings shows that neglect syndrome, frequency of incontinence, and depression level were higher in right hemiparesia than in left hemiparesia. Functional independency level was lower in patients having incontinence and anxiety.

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“…1 Fecal incontinence (FI) affects Յ56% of individuals acutely after stroke, 11% at 3 months, and Յ22% at 12 months. [2][3][4] Constipation is recognized as a serious problem in clinical practice, affecting 60% of those in stroke rehabilitation wards. 5 FI may develop months after acute stroke and can be transient, consistent with constipation overflow as a possible cause.…”

mentioning

confidence: 99%

“…However, epidemiological data suggest FI is associated more with modifiable disability-related factors (eg, toilet access and anticholinergic medications) than stroke-related factors (eg, severity and lesion location). 2,3 Similarly, constipation in older people is related more to modifiable lifestyle factors such as diet, 9 -11 fluid intake, 9,10,12,13 physical activity, 14 and toileting habits 15,16 than to aging gut pathophysiology. Therefore, we hypothesized that an educational intervention targeting lifestyle factors combined with structured clinical assessment and treatment would significantly improve bowel function in stroke patients with constipation or FI compared with "usual care."…”

mentioning

confidence: 99%

Treatment of Constipation and Fecal Incontinence in Stroke Patients

Harari

Norton

Lockwood

et al. 2004

Stroke

112

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Background and Purpose-Despite its high prevalence in stroke survivors, there is little clinical research on bowel dysfunction in this population. This is the first randomized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors. Methods-Stroke patients with constipation or fecal incontinence were identified by screening questionnaire (122 community, 24 stroke rehabilitation inpatients) and randomized to intervention or routine care (73 per group). The intervention consisted of a 1-off structured nurse assessment (history and rectal examination), leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations (after consultation with geriatrician) to patient's general practitioner (GP)Ϯward physician. Results-Percentage of bowel movements (BMs) per week graded as "normal" by participants in a prospective 1-week stool diary was significantly higher in intervention versus control patients at 6 months (72% versus 55%; Pϭ0.027), as was mean number of BMs per week (5.2 versus 3.6; Pϭ0.005). There was no significant reduction in fecal incontinence, although numbers were small. At 12 months, intervention patients were more likely to be modifying their diets (odds ratio . GP prescribing of laxatives and suppositories was significantly influenced at 12 months. Conclusions-A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later, changed bowel-modifying lifestyle behaviors up to 12 months later, and influenced patient-GP interaction and physician prescribing patterns.[

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New-Onset Fecal Incontinence After Stroke: Risk Factor or Consequence of Poor Outcomes After Rehabilitation?

Cited by 12 publications

References 10 publications

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Incontinence, Neglect Syndrome and Emotional Status in Ischemic Stroke Patients and Relation With Lateralization and Functional Independency

Treatment of Constipation and Fecal Incontinence in Stroke Patients

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