Megacolon in patients with chronic spinal cord injury

Purpose: To investigate the clinical and functional correlates of megacolon in individuals with chronic spinal cold injury (SCI). Patients and methods: This is a cross-sectional study of 128 patients consecutively admitted to a SCl in-patient service in a US Veterans Administration Medical Centre (mean age 57 +/- 15 years, mean years since injury 20 +/- 13, 97% male) who underwent plain abdominal radiography for study purposes. Participants were characterised by radiological findings. 'Megacolon' was defined as colonic dilatation of >6 cms in one or more colonic segment(s). Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews were conducted with study participants regarding bowel-related symptoms and treatment over the previous 1-month period. Results: Seventy-three per cent of subjects (n = 94) had megacolon, and 52% of these individuals had associated radiological constipation. Subjects with megacolon were compared with those without colonic dilatation (n = 34). Factors significantly associated with megacolon were older age, longer duration of injury, symptom of abdominal distension, radiological constipation, urinary outlet surgery, laxative use at least once weekly, use of anticholinergic drugs, and use of calcium-containing antacids. These factors were simultaneously included in a multiple logistic regression model. Independent correlates of megacolon were more than 10 years elapsed since acute injury, age over 50 years, and use of 34 laxative doses per month. Conclusion: Megacolon is a highly prevalent disorder in individuals with chronic spinal cord injury. Out findings suggest that the presence of megacolon may be predicted in older individuals, and in those who are more than 10 years post-SCI. We also found that clinical constipation was frequently present in individuals with megacolon, despite their significantly greater use of laxatives. Sponsorship: This work was supported by a grant from the Claude D Pepper Geriatric Research and Training Center from the National Institute of Ageing-AG08812-05, and a grant from the Education and Training Foundation of the Paralyzed Veterans Association in the USA. Dr Harari is currently recipient of a grant from Action Research (UK).