Prevalence of Intestinal Neurogenic Bowel and Lower Urinary Tract Dysfunctions in Brazilians with Traumatic and Non-Traumatic Spinal Cord Injury

Prevalence of Intestinal Neurogenic Bowel and Lower Urinary Tract Dysfunctions in Brazilians with Traumatic and Non-Traumatic Spinal Cord Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence of Intestinal Neurogenic Bowel and Lower Urinary Tract Dysfunctions in Brazilians with Traumatic and Non-Traumatic Spinal Cord Injury Fabiana Faleiros, Eliz Ferreira, Geyslane Albuquerque, Luis Sousa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5046196/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Study design: Retrospective cross-sectional study. Objective: To estimate the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction in Brazilians diagnosed with traumatic and non-traumatic spinal cord injury. Setting: Brazil, several states (Bahia, Ceará, Distrito Federal, Maranhão, Minas Gerais, Rio de Janeiro). Methods: A form was used to collect sociodemographic and clinical data from medical records. The Mann-Whitney statistical tests were used for two independent samples, Pearson's Chi-Square test for categorical variables, and the Kruskal-Wallis test for more than two independent samples for quantitative variables. A logistic regression model was used to understand the factors associated with neurogenic bowel dysfunction. Results: The sample comprised 1056 participants from all regions of Brazil. Of this sample, 60.90% had traumatic spinal cord injury and 69.03% were male. The prevalence of neurogenic bowel dysfunction in the sample was 88% and the prevalence of neurogenic lower urinary tract dysfunction was 90.6%. Participants with traumatic spinal cord injury are more affected by neurogenic bowel and lower urinary tract dysfunction than those with non-traumatic spinal cord injury. Conclusions: Most people with spinal cord injury have neurogenic lower urinary tract and bowel alterations, especially those with traumatic spinal cord injury. Further studies are needed, and bowel and bladder re-education programs should be provided in rehabilitation centers. Health sciences/Neurology/Neurological disorders/Spinal cord diseases Health sciences/Medical research/Epidemiology Neurogenic bowel dysfunction neurogenic Lower urinary tract dysfunction Prevalence Rehabilitation Spinal cord trauma Figures Figure 1 Figure 2 Figure 3 Introduction Spinal cord injury (SCI) is characterized by motor, sensory, and autonomic deficits that can vary according to the level and extent of the injury [ 1 – 4 ]. The World Health Organization has estimated an annual incidence of SCI of between 250,000 and 500,000 people worldwide [ 5 ]. In Brazil, despite the lack of official epidemiologic data, an estimated 10,000 new cases occur every year, of which 80% are male and 60% are between 10 and 30 years old [ 3 , 6 ]. Neurogenic bowel dysfunction (NBD) and neurogenic lower urinary tract dysfunction (NLUTD) affect most people with SCI and are associated with significantly reduced quality of life, complications, readmissions, and even increased mortality [ 7 , 8 ]. NBD is characterized by motor and sensitivity changes of the gastrointestinal tract, disordered bowel reflexes, incontinence, and/or constipation, all of which prevent voluntary control and personal management of defecation [ 9 – 13 ]. In NLUTD, these changes can result in voiding urgency, urinary incontinence, and complications such as lithiasis, vesicoureteral reflux, hydronephrosis, recurrent infections, and renal failure [ 1 , 4 ]. Individuals with SCI stated that NBD and NLUTD are some of the main problems associated with SCI and suggested more research on these topics [ 14 ]. Despite the huge impact on the lives of these individuals, few studies have been conducted on NBD and NLUTD [4,15]. In Brazil, the dimension of this problem is underexplored, and evidence is lacking from nationwide studies [ 14 ]. In this context and considering that studies and statistical data on this portion of the population in Brazil are very scarce, the present study estimates the prevalence of NBD and NLUTD in Brazilians diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). Methods This is a quantitative, cross-sectional, exploratory, and descriptive study, based on the analysis of medical records between January 2018 and December 2023. The project was approved by the Research Ethics Committee of the Sarah Network of Rehabilitation Hospitals, under CAAE number: 61830122.2.0000.0022. Sarah Network of Rehabilitation Hospitals has nine units in several Brazilian capital cities that provide free medical assistance and rehabilitation services for neurology and orthopedics with exclusive public funding. The initial population consisted of all individuals with SCI enrolled in the Hospital Information System ("SIH"), totaling 47,118 users. For greater detail and reliability of the data, a representative sample was selected, stratified according to the unit of origin, composed of 1,056 people. The sample was calculated with a margin of error of 3% and a confidence interval of 95% (95% CI). The records were read in random order until the sample size was reached. Figure 1 shows the flowchart and exclusion criteria. Figure 1 - General flowchart of the sample participants selected for the study, with the exclusion criteria, Brazil, 2024. To direct and standardize the information contained in this study, a data collection form was developed and applied to characterize the sample. The variables were related to sociodemographic data and clinical data, including diagnosis of NBD and NLUTD (Table 1). Table 1 - Study variables, collected from electronic medical records, Brazil, 2024. The quantitative variables were presented as medians and interquartile ranges since the Shapiro-Wilk test indicated the non-normality of the data. The qualitative variables were listed in an absolute and relative frequency table. The two qualitative variables were associated using the Chi-Square test. The Mann-Whitney test was used for two independent samples, and the Kruskal-Wallis test was used for more than two independent samples for quantitative variables. A logistic regression model was used to understand which variables or factors were associated with NBD. All analyses were performed using IBM SPSS version 25 software at a 5% significance level. Results Most of the sample, considering sex at birth, was male (69.03%). The median age at lesion occurrence was 29 years (19–43), excluding participants with congenital SCI (myelomeningocele/spina bifida). The TSCI sample totaled 643 individuals (60.89%) and the NTSCI sample totaled 413 individuals (39.11%) (Table 2). Table 2 - Distribution of participants according to the cause of SCI, gender, current age, age at the time of injury, and time of injury, in years (n = 1056), Brazil, 2023. According to the data in the medical records, the neurological level was verified in 623 individuals with TSCI. Of these individuals, 33.40% had quadriplegia and 66.60% had paraplegia. According to the AIS score (591 subjects), 59.20% had complete lesions (ASIA “A”) and 40.80% had incomplete lesions. A prevalence of 88.10% for NBD and 90.60% for NLUTD was observed in people with SCI enrolled at the institution (Fig. 2 ). Figure 2 - Distribution of the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction among sample participants (n = 1056), Brazil, 2023. NLUTD was diagnosed in 79.90% of the individuals with NTSCI (413 participants) and in 97.51% of the individuals with TSCI (627 participants). The association between NBD and the cause of SCI was analyzed. It was observed that individuals with SCI without NBD predominantly have NTSCI (108 participants) and individuals with NBD predominantly have TSCI (625 participants) (p ≤ 0.001, Chi-Square test) (Fig. 3 ). Figure 3 - Distribution of participants according to the traumatic or non-traumatic cause of spinal cord injury and the presence of neurogenic bowel dysfunction (n = 1056), Brazil, 2023. The associations between NBD, neurological level, and AIS score in the participants with TSCI were tested in 580 respondents. No associations were found between NBD and neurological level. Participants with NBD (n = 566) predominantly had complete lesions (61.10%), while those without NBD (n = 14) predominantly had incomplete lesions (92.90%) (p ≤ 0.001, Chi-Square test). Among individuals with NTSCI, a higher proportion of participants diagnosed with myelomeningocele/spina bifida (33.4%) was observed among those with NBD (p ≤ 0.001, Chi-Square test). The individuals without NBD were older at the time of data collection, with a median age of 54 years (40–62), compared to those with NBD, with a median of 41 years at the time of data collection (31–53) (p < 0.0001, Mann Whitney test). The individuals with NBD had a longer injury time, with a median of 11 years of injury (6–20), compared to those without NBD, with a median of 8 years of injury (4–16) (p = 0.001, Mann Whitney test). The NBD and sex of the participants were analyzed and an association with sex was found. Among the 930 participants with NBD, 71.40% were male (p < 0.0001, Chi-Square test). NBD was analyzed in relation to gender, age, and time of injury through logistic regression. The older the individual, the lesser the likelihood of having NBD (OR 1). It was also observed that men are 2.515 times more likely to have NBD than women. In percentage terms, the chance of having NBD is 151.5% higher in men than in women. Discussion In Brazil, there is no mandatory reporting, government statistical data, or database on the prevalence and incidence of SCI that would allow comparisons [ 3 , 14 , 16 ]. Considering the national coverage of the network of rehabilitation hospitals, the data collected in this study may serve as a basis for Brazil [ 4 ]. The higher proportion of TSCI in men found in the sample and the higher frequency of NTSCI in women found in the sample are consistent with the findings of previous studies [ 16 – 18 ]. Findings from the national and international literature reveal that the incidence, prevalence, and years with SCI have been consistently higher in men than in women, possibly due to the greater exposure of males to the causes of SCI, especially traumatic causes, such as violence, high-risk work conditions, and radical physical activities [ 5 , 14 , 16 , 19 , 20 ]. Most of the participants had SCI of traumatic origin. This fact is corroborated by the literature given the increased risk of falling associated with aging. Moreover, higher rates of urban violence and automobile accidents and higher survival rates among individuals with TSCI have increased the incidence and prevalence of SCI of traumatic origin [ 5 , 14 , 16 , 19 ]. In addition, there is a report of bias regarding the access of patients with NTSCI to specialized rehabilitation services for SCI [ 21 ]. The sample of Pelosi et al. (2021) [ 4 ], as well as that of the present study, also revealed a majority of complete injuries among participants with TSCI. In another epidemiologic study conducted in developing countries, the difference between the frequency of complete injury (49.47%) and incomplete injury (50.53%) was considered Insignificant [ 22 ]. The type of SCI significantly affects outcomes and the burden of disease. While incomplete SCI is associated with better outcomes and less disability, complete SCI is permanent and carries substantial social, economic, and emotional burdens [ 5 ]. Data from the USA indicate that 80% of people with SCI have an associated diagnosis of NLUTD. In Brazil, a prevalence of 94.65% of NLUTD was found in a study conducted at the same institution as the present study [ 4 ]. Previous studies have reported varied data on the prevalence of NBD in the population with SCI, ranging from 20–80%, with an estimated prevalence of 250,000 in the United States and 250,000 in Europe [ 9 , 13 , 23 , 24 ]. As in the studies of Ture; Ozkaya; and Sivrioglu (2023) [ 25 ], in the present study, no association was found between NBD and neurological level; however, participants with NBD predominantly had complete lesions, while the participants without NBD predominantly had incomplete lesion. According to Vallès and Mearin (2009) [ 26 ], NBD involves many serious pathophysiological mechanisms that affect both patients with complete and incomplete SCI. Although NBD is also common in incomplete SCI, the symptoms are milder than in complete lesions [ 9 ]. Previous studies have reported that the risk factors for severe NBD are cervical lesions, complete lesions, and chronic lesions (10 years or more of SCI) [ 25 , 27 , 28 ]. The SCI level interferes with thoracic sympathetic innervation, sacral parasympathetic control, and colonic motility, resulting in more severe bowel dysfunction [ 28 ]. It was observed that individuals with NBD had a longer injury time in relation to the participants without NBD. Generally, gastrointestinal function deteriorates with normal aging, however, a longer duration of SCI has also been identified as a more significant risk factor for severe NBD in other studies [ 7 , 25 ]. NBD was more common in individuals with TSCI. Moreover, older people and women are less likely to have NBD, which may be explained by the greater prevalence of young men with TSCI, while NTSCI prevailed among women and older people. This is possible because most of the participants with TSCI had a complete lesion, which usually presents with more evident symptoms of NBD [ 9 ]. In addition, the cases of NTSCI present with lower neurological impairment, predominantly presenting with paraplegia [ 29 ], which is less associated with severe NBD than higher lesions [ 25 , 27 , 28 ]. The higher proportion of participants with myelomeningocele/spina bifida among those with NBD in NTSCI can be corroborated by Faleiros et al (2021) [ 30 ], who found 77.3% of NBD in a sample of German residents with spina bifida. In addition, Awad (2011) [ 27 ] reported that this health condition prolongs colonic transit time and reduces anal sphincter pressure. Strengths and Limitations of the Study Some considerations should be noted regarding the present study. Our study provides an overview of individuals with SCI treated in a single hospital network in Brazil. This network is a reference in rehabilitation, which includes NBD and NLUTD, possibly explaining the high prevalence of these conditions in the sample. Given the cross-sectional nature of this study, causality could not be verified, only associated factors. Studies based on secondary sources may have limitations during data collection, such as missing information in electronic medical records, which explains the variation in the number of respondents for the data regarding neurological level and AIS score, mainly predicted in patients with TSCI. The variations in the clinical presentation of patients with NTSCI did not allow the distinction of lesion level or whether these were complete or incomplete in this group. In addition, gastrointestinal function decreases with normal aging, which may be a confounding factor in the associations of NBD with age and time of injury. The strength of this study is the large number of participants, totaling 1,056 individuals. The size of the sample from all regions of Brazil shows that the study achieved a nationwide representation of people with SCI. Conclusion This study showed that TSCI was prevalent among men and NTSCI was prevalent among women. The analysis showed that participants with TSCI were more affected by NBD and NLUTD than those with NTSCI. In view of the results, health workers should closely consider that the vast majority of individuals with SCI have neurogenic alterations of the bowel and lower urinary tract, especially those whose cause of injury is traumatic. The expectation of this study is to generate and disseminate knowledge about NBD in individuals with SCI. The surveying of its prevalence can stimulate new studies and guide public health policies, such as the structuring of bowel and bladder re-education programs in rehabilitation centers for individuals with SCI. Declarations Ethical Approval All applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during this research. The project was approved by the Research Ethics Committee of the SARAH network, under CAAE number: 61830122.2.0000.0022, and the informed consent statement was waived since this research involves secondary data. Competing Interests The authors declare no conflicts of interest. Funding No financial support was received for this study. Author Contributions All authors contributed significantly to the development of this research. Fabiana Faleiros designed the study. Eliz Ferreira collected and analyzed the data, Geyslane Albuquerque, Filipe Lopes, Luis Sousa, and Ana Champs contributed substantially with data interpretation and preparing the article, and the authors agree with the content of the manuscript. Acknowledgements The institutional support and infrastructure provided by SARAH Network of Rehabilitation Hospitals have played a significant role in the successful completion of this study. Data Availability Statement The data supporting this study’s findings are available from the corresponding author on reasonable request. References Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, et al . Traumatic spinal cord injury. Nat Rev Dis Primers. 2017; https://doi.org/10.1038/nrdp.2017.18. Anjum A, Yazid MD, Daud MF, Idris J, Ng AMH, Naicker AS, et al . Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms. Int J Mol Sci. 2020; https://doi.org/10.3390/ijms21207533. Ministry of Health of Brazil. Care guidelines for the person with spinal cord injury. 2nd ed. Ministry of Health, Brasilia; 2015. Pelosi G, Faleiros F, Pereira MRC, Bimbatti KF, Tholl AD. Study on the prevalence of neurogenic bladder in Brazilians with traumatic and non-traumatic spinal cord injury. J Spinal Cord Med. 2023; 46:677-681. Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, et al . Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019. Spine (Phila Pa 1976). 2022; 47:1532-1540. Faleiros F, Silva JCF, Cordeiro A, Tholl AD, Fumincelli L, Tate D. Qualidade de vida e lesão medular traumática: um estudo com uso de data sets internacionais. Rev. Eletr. Enferm. 2020; https://doi.org/10.5216/ree.v22.56256. Dietz N, Sarpong K, Ugiliweneza B, Wang D, Aslan SS, Castillo C, et al . Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2021; 27:53-67 Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, et al . Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med. 2020; 43:141-164. Magnuson FS, Christensen P, Krassioukov A, Rodriguez G, Emmanuel A, Kirshblum S, et al . Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm. J Clin Med. 2023; https://doi.org/10.3390/jcm12226971. Hakim S, Gaglani T, Cash BD. Neurogenic Bowel Dysfunction: The Impact of the Central Nervous System in Constipation and Fecal Incontinence. Gastroenterol Clin North Am. 2022; 51:93-105. Rodriguez GM, Stiens SA. Neurogenic bowel: dysfunction and rehabilitation. In: Cifu DX. Braddom's Physical Medicine and Rehabilitation. 6th ed. Elsevier, Philadelphia; 2021. pp. 407-430. Emmanuel A. Neurogenic bowel dysfunction. 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Amidei CB, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022; 60:812-819 Smith E, Fitzpatrick P, Lyons F, Morris S, Synnott K. Epidemiology of non-traumatic spinal cord injury in Ireland - a prospective population-based study. J Spinal Cord Med. 2022; 45:76-81 Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, et al . Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023; 22:1026-1047. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al . Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396:1204-1222. New PW, Cripps RA, Bonne Lee B. Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord. 2014; 52:97-109. Golestani A, Shobeiri P, Sadeghi-Naini M, Jazayeri SB, Maroufi SF, Ghodsi Z, et al . Epidemiology of Traumatic Spinal Cord Injury in Developing Countries from 2009 to 2020: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2022; 56:219-239. Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, et al . Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair. 2019; 33:902-910. White AR, Holmes GM. Investigating neurogenic bowel in experimental spinal cord injury: where to begin? Neural Regen Res. 2019; 14:222-226. Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med. 2023; 46:424-432. Vallès M, Mearin F. Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury. Dis Colon Rectum. 2009; 52:1589-1597. Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease. World J Gastroenterol. 2011; 17:5035-5048 Liu CW, Huang CC, Chen CH, Yang YH, Chen TW, Huang MH. Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury. Spinal Cord. 2010; 48:554-559. Choi Y, Leigh JH. Epidemiology of Traumatic and Non-Traumatic Spinal Cord Injury in Korea: A Narrative Review. Korean J Neurotrauma. 2023; 19:434-445. Faleiros F, Santos LM, Bimbatti K, Käppler C. Bowel Emptying Methods Used by German Residents Living With Spina Bifida. J Wound Ostomy Continence Nurs. 2021; 48:149-152. Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations There is no duality of interest Supplementary Files Table1.xlsx Table 1 - Study variables, collected from electronic medical records, Brazil, 2024. Source: Prepared by the authors, 2024. Table2.xlsx Table 2 - Distribution of participants according to the cause of SCI, gender, current age, age at the time of injury, and time of injury, in years (n= 1056), Brazil, 2023. TSCI: traumatic spinal cord injury NTSCI: non-traumatic spinal cord injury *NTSCI ages do not include congenital lesion data Source: Prepared by the authors, 2024. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5046196","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":369042004,"identity":"c0159289-a9fc-4deb-b6c8-d8e2c7aebc3c","order_by":0,"name":"Fabiana 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2024.\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/f00bd1963b1cc1d4d4e07376.jpg"},{"id":67371334,"identity":"8cba9029-6d78-44df-95c2-0180c0fc3721","added_by":"auto","created_at":"2024-10-24 07:55:51","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":210141,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction among sample participants (n=1056), Brazil, 2023.\u003c/p\u003e\n\u003cp\u003eNBD: neurogenic bowel dysfunction\u003c/p\u003e\n\u003cp\u003eNLUTD: neurogenic lower urinary tract dysfunction\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2024.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/8700c42122e827de6cc45b8f.jpg"},{"id":67371107,"identity":"a4f98072-cd07-4bd5-a79a-e358a3d3ad07","added_by":"auto","created_at":"2024-10-24 07:55:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":190004,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of participants according to the traumatic or non-traumatic cause of spinal cord injury and the presence of neurogenic bowel dysfunction (n=1056), Brazil, 2023.\u003c/p\u003e\n\u003cp\u003eNBD: neurogenic bowel dysfunction\u003c/p\u003e\n\u003cp\u003eTSCI: traumatic spinal cord injury\u003c/p\u003e\n\u003cp\u003eNTSCI: non-traumatic spinal cord injury\u003c/p\u003e\n\u003cp\u003e*Chi-Square test p value≤0.001\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2024.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/68db0ed16f75d9988267d0c3.jpg"},{"id":69020221,"identity":"fefbf16b-f4d1-4af8-9bb8-b3c7e3030339","added_by":"auto","created_at":"2024-11-14 15:39:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":869714,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/16a7dd8b-dba7-4601-abb2-2501183acd57.pdf"},{"id":67371261,"identity":"f8d6b729-5213-4b2a-aa51-b08489bdd733","added_by":"auto","created_at":"2024-10-24 07:55:49","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14134,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1 -\u003c/strong\u003e Study variables, collected from electronic medical records, Brazil, 2024.\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2024.\u003c/p\u003e","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/955e2ac4483ac16b27bf42df.xlsx"},{"id":67371351,"identity":"93df281b-6640-4492-a0b0-20a9495f4fa5","added_by":"auto","created_at":"2024-10-24 07:55:56","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":8350,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 2 - \u003c/strong\u003eDistribution of participants according to the cause of SCI, gender, current age, age at the time of injury, and time of injury, in years (n= 1056), Brazil, 2023.\u003c/p\u003e\n\u003cp\u003eTSCI: traumatic spinal cord injury\u003c/p\u003e\n\u003cp\u003eNTSCI: non-traumatic spinal cord injury\u003c/p\u003e\n\u003cp\u003e*NTSCI ages do not include congenital lesion data\u003c/p\u003e\n\u003cp\u003eSource: Prepared by the authors, 2024.\u003c/p\u003e","description":"","filename":"Table2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5046196/v1/e11e6064297e5b4f8b77ee9e.xlsx"}],"financialInterests":"There is no duality of interest","formattedTitle":"\u003cp\u003ePrevalence of Intestinal Neurogenic Bowel and Lower Urinary Tract Dysfunctions in Brazilians with Traumatic and Non-Traumatic Spinal Cord Injury\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal cord injury (SCI) is characterized by motor, sensory, and autonomic deficits that can vary according to the level and extent of the injury [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization has estimated an annual incidence of SCI of between 250,000 and 500,000 people worldwide [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Brazil, despite the lack of official epidemiologic data, an estimated 10,000 new cases occur every year, of which 80% are male and 60% are between 10 and 30 years old [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNeurogenic bowel dysfunction (NBD) and neurogenic lower urinary tract dysfunction (NLUTD) affect most people with SCI and are associated with significantly reduced quality of life, complications, readmissions, and even increased mortality [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. NBD is characterized by motor and sensitivity changes of the gastrointestinal tract, disordered bowel reflexes, incontinence, and/or constipation, all of which prevent voluntary control and personal management of defecation [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In NLUTD, these changes can result in voiding urgency, urinary incontinence, and complications such as lithiasis, vesicoureteral reflux, hydronephrosis, recurrent infections, and renal failure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Individuals with SCI stated that NBD and NLUTD are some of the main problems associated with SCI and suggested more research on these topics [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the huge impact on the lives of these individuals, few studies have been conducted on NBD and NLUTD [4,15]. In Brazil, the dimension of this problem is underexplored, and evidence is lacking from nationwide studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this context and considering that studies and statistical data on this portion of the population in Brazil are very scarce, the present study estimates the prevalence of NBD and NLUTD in Brazilians diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a quantitative, cross-sectional, exploratory, and descriptive study, based on the analysis of medical records between January 2018 and December 2023. The project was approved by the Research Ethics Committee of the Sarah Network of Rehabilitation Hospitals, under CAAE number: 61830122.2.0000.0022. Sarah Network of Rehabilitation Hospitals has nine units in several Brazilian capital cities that provide free medical assistance and rehabilitation services for neurology and orthopedics with exclusive public funding.\u003c/p\u003e \u003cp\u003eThe initial population consisted of all individuals with SCI enrolled in the Hospital Information System (\"SIH\"), totaling 47,118 users. For greater detail and reliability of the data, a representative sample was selected, stratified according to the unit of origin, composed of 1,056 people. The sample was calculated with a margin of error of 3% and a confidence interval of 95% (95% CI). The records were read in random order until the sample size was reached. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the flowchart and exclusion criteria.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003e-\u003c/b\u003e General flowchart of the sample participants selected for the study, with the exclusion criteria, Brazil, 2024.\u003c/p\u003e \u003cp\u003eTo direct and standardize the information contained in this study, a data collection form was developed and applied to characterize the sample. The variables were related to sociodemographic data and clinical data, including diagnosis of NBD and NLUTD (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1 -\u003c/b\u003e Study variables, collected from electronic medical records, Brazil, 2024.\u003c/p\u003e \u003cp\u003eThe quantitative variables were presented as medians and interquartile ranges since the Shapiro-Wilk test indicated the non-normality of the data. The qualitative variables were listed in an absolute and relative frequency table. The two qualitative variables were associated using the Chi-Square test. The Mann-Whitney test was used for two independent samples, and the Kruskal-Wallis test was used for more than two independent samples for quantitative variables. A logistic regression model was used to understand which variables or factors were associated with NBD. All analyses were performed using IBM SPSS version 25 software at a 5% significance level.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMost of the sample, considering sex at birth, was male (69.03%). The median age at lesion occurrence was 29 years (19\u0026ndash;43), excluding participants with congenital SCI (myelomeningocele/spina bifida). The TSCI sample totaled 643 individuals (60.89%) and the NTSCI sample totaled 413 individuals (39.11%) (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;2 -\u003c/b\u003e Distribution of participants according to the cause of SCI, gender, current age, age at the time of injury, and time of injury, in years (n\u0026thinsp;=\u0026thinsp;1056), Brazil, 2023.\u003c/p\u003e \u003cp\u003eAccording to the data in the medical records, the neurological level was verified in 623 individuals with TSCI. Of these individuals, 33.40% had quadriplegia and 66.60% had paraplegia. According to the AIS score (591 subjects), 59.20% had complete lesions (ASIA \u0026ldquo;A\u0026rdquo;) and 40.80% had incomplete lesions.\u003c/p\u003e \u003cp\u003eA prevalence of 88.10% for NBD and 90.60% for NLUTD was observed in people with SCI enrolled at the institution (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003e-\u003c/b\u003e Distribution of the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction among sample participants (n\u0026thinsp;=\u0026thinsp;1056), Brazil, 2023.\u003c/p\u003e \u003cp\u003eNLUTD was diagnosed in 79.90% of the individuals with NTSCI (413 participants) and in 97.51% of the individuals with TSCI (627 participants). The association between NBD and the cause of SCI was analyzed. It was observed that individuals with SCI without NBD predominantly have NTSCI (108 participants) and individuals with NBD predominantly have TSCI (625 participants) (p\u0026thinsp;\u0026le;\u0026thinsp;0.001, Chi-Square test) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003e-\u003c/b\u003e Distribution of participants according to the traumatic or non-traumatic cause of spinal cord injury and the presence of neurogenic bowel dysfunction (n\u0026thinsp;=\u0026thinsp;1056), Brazil, 2023.\u003c/p\u003e \u003cp\u003eThe associations between NBD, neurological level, and AIS score in the participants with TSCI were tested in 580 respondents. No associations were found between NBD and neurological level. Participants with NBD (n\u0026thinsp;=\u0026thinsp;566) predominantly had complete lesions (61.10%), while those without NBD (n\u0026thinsp;=\u0026thinsp;14) predominantly had incomplete lesions (92.90%) (p\u0026thinsp;\u0026le;\u0026thinsp;0.001, Chi-Square test).\u003c/p\u003e \u003cp\u003eAmong individuals with NTSCI, a higher proportion of participants diagnosed with myelomeningocele/spina bifida (33.4%) was observed among those with NBD (p\u0026thinsp;\u0026le;\u0026thinsp;0.001, Chi-Square test).\u003c/p\u003e \u003cp\u003eThe individuals without NBD were older at the time of data collection, with a median age of 54 years (40\u0026ndash;62), compared to those with NBD, with a median of 41 years at the time of data collection (31\u0026ndash;53) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Mann Whitney test). The individuals with NBD had a longer injury time, with a median of 11 years of injury (6\u0026ndash;20), compared to those without NBD, with a median of 8 years of injury (4\u0026ndash;16) (p\u0026thinsp;=\u0026thinsp;0.001, Mann Whitney test). The NBD and sex of the participants were analyzed and an association with sex was found. Among the 930 participants with NBD, 71.40% were male (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Chi-Square test).\u003c/p\u003e \u003cp\u003eNBD was analyzed in relation to gender, age, and time of injury through logistic regression. The older the individual, the lesser the likelihood of having NBD (OR\u0026thinsp;\u0026lt;\u0026thinsp;1). The longer the injury time, the greater the likelihood of having NBD (OR\u0026thinsp;\u0026gt;\u0026thinsp;1). It was also observed that men are 2.515 times more likely to have NBD than women. In percentage terms, the chance of having NBD is 151.5% higher in men than in women.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Brazil, there is no mandatory reporting, government statistical data, or database on the prevalence and incidence of SCI that would allow comparisons [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Considering the national coverage of the network of rehabilitation hospitals, the data collected in this study may serve as a basis for Brazil [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe higher proportion of TSCI in men found in the sample and the higher frequency of NTSCI in women found in the sample are consistent with the findings of previous studies [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Findings from the national and international literature reveal that the incidence, prevalence, and years with SCI have been consistently higher in men than in women, possibly due to the greater exposure of males to the causes of SCI, especially traumatic causes, such as violence, high-risk work conditions, and radical physical activities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost of the participants had SCI of traumatic origin. This fact is corroborated by the literature given the increased risk of falling associated with aging. Moreover, higher rates of urban violence and automobile accidents and higher survival rates among individuals with TSCI have increased the incidence and prevalence of SCI of traumatic origin [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, there is a report of bias regarding the access of patients with NTSCI to specialized rehabilitation services for SCI [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe sample of Pelosi et al. (2021) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e], as well as that of the present study, also revealed a majority of complete injuries among participants with TSCI. In another epidemiologic study conducted in developing countries, the difference between the frequency of complete injury (49.47%) and incomplete injury (50.53%) was considered Insignificant [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The type of SCI significantly affects outcomes and the burden of disease. While incomplete SCI is associated with better outcomes and less disability, complete SCI is permanent and carries substantial social, economic, and emotional burdens [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData from the USA indicate that 80% of people with SCI have an associated diagnosis of NLUTD. In Brazil, a prevalence of 94.65% of NLUTD was found in a study conducted at the same institution as the present study [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous studies have reported varied data on the prevalence of NBD in the population with SCI, ranging from 20\u0026ndash;80%, with an estimated prevalence of 250,000 in the United States and 250,000 in Europe [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs in the studies of Ture; Ozkaya; and Sivrioglu (2023) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e], in the present study, no association was found between NBD and neurological level; however, participants with NBD predominantly had complete lesions, while the participants without NBD predominantly had incomplete lesion. According to Vall\u0026egrave;s and Mearin (2009) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], NBD involves many serious pathophysiological mechanisms that affect both patients with complete and incomplete SCI. Although NBD is also common in incomplete SCI, the symptoms are milder than in complete lesions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Previous studies have reported that the risk factors for severe NBD are cervical lesions, complete lesions, and chronic lesions (10 years or more of SCI) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The SCI level interferes with thoracic sympathetic innervation, sacral parasympathetic control, and colonic motility, resulting in more severe bowel dysfunction [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt was observed that individuals with NBD had a longer injury time in relation to the participants without NBD. Generally, gastrointestinal function deteriorates with normal aging, however, a longer duration of SCI has also been identified as a more significant risk factor for severe NBD in other studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNBD was more common in individuals with TSCI. Moreover, older people and women are less likely to have NBD, which may be explained by the greater prevalence of young men with TSCI, while NTSCI prevailed among women and older people. This is possible because most of the participants with TSCI had a complete lesion, which usually presents with more evident symptoms of NBD [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition, the cases of NTSCI present with lower neurological impairment, predominantly presenting with paraplegia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e], which is less associated with severe NBD than higher lesions [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe higher proportion of participants with myelomeningocele/spina bifida among those with NBD in NTSCI can be corroborated by Faleiros et al (2021) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e], who found 77.3% of NBD in a sample of German residents with spina bifida. In addition, Awad (2011) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e] reported that this health condition prolongs colonic transit time and reduces anal sphincter pressure.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations of the Study\u003c/h3\u003e\n\u003cp\u003eSome considerations should be noted regarding the present study. Our study provides an overview of individuals with SCI treated in a single hospital network in Brazil. This network is a reference in rehabilitation, which includes NBD and NLUTD, possibly explaining the high prevalence of these conditions in the sample.\u003c/p\u003e \u003cp\u003eGiven the cross-sectional nature of this study, causality could not be verified, only associated factors. Studies based on secondary sources may have limitations during data collection, such as missing information in electronic medical records, which explains the variation in the number of respondents for the data regarding neurological level and AIS score, mainly predicted in patients with TSCI. The variations in the clinical presentation of patients with NTSCI did not allow the distinction of lesion level or whether these were complete or incomplete in this group. In addition, gastrointestinal function decreases with normal aging, which may be a confounding factor in the associations of NBD with age and time of injury.\u003c/p\u003e \u003cp\u003eThe strength of this study is the large number of participants, totaling 1,056 individuals. The size of the sample from all regions of Brazil shows that the study achieved a nationwide representation of people with SCI.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed that TSCI was prevalent among men and NTSCI was prevalent among women. The analysis showed that participants with TSCI were more affected by NBD and NLUTD than those with NTSCI.\u003c/p\u003e \u003cp\u003eIn view of the results, health workers should closely consider that the vast majority of individuals with SCI have neurogenic alterations of the bowel and lower urinary tract, especially those whose cause of injury is traumatic.\u003c/p\u003e \u003cp\u003eThe expectation of this study is to generate and disseminate knowledge about NBD in individuals with SCI. The surveying of its prevalence can stimulate new studies and guide public health policies, such as the structuring of bowel and bladder re-education programs in rehabilitation centers for individuals with SCI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e All applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during this research. The project was approved by the Research Ethics Committee of the SARAH network, under CAAE number: 61830122.2.0000.0022, and the informed consent statement was waived since this research involves secondary data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo financial support was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contributions\u003c/h2\u003e \u003cp\u003eAll authors contributed significantly to the development of this research. Fabiana Faleiros designed the study. Eliz Ferreira collected and analyzed the data, Geyslane Albuquerque, Filipe Lopes, Luis Sousa, and Ana Champs contributed substantially with data interpretation and preparing the article, and the authors agree with the content of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003e The institutional support and infrastructure provided by SARAH Network of Rehabilitation Hospitals have played a significant role in the successful completion of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this study\u0026rsquo;s findings are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAhuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, \u003cem\u003eet al\u003c/em\u003e. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017; https://doi.org/10.1038/nrdp.2017.18. \u003c/li\u003e\n\u003cli\u003eAnjum A, Yazid MD, Daud MF, Idris J, Ng AMH, Naicker AS, \u003cem\u003eet al\u003c/em\u003e. Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms. Int J Mol Sci. 2020; https://doi.org/10.3390/ijms21207533.\u003c/li\u003e\n\u003cli\u003eMinistry of Health of Brazil. Care guidelines for the person with spinal cord injury. 2nd ed. Ministry of Health, Brasilia; 2015.\u003c/li\u003e\n\u003cli\u003ePelosi G, Faleiros F, Pereira MRC, Bimbatti KF, Tholl AD. Study on the prevalence of neurogenic bladder in Brazilians with traumatic and non-traumatic spinal cord injury. J Spinal Cord Med. 2023; 46:677-681.\u003c/li\u003e\n\u003cli\u003eDing W, Hu S, Wang P, Kang H, Peng R, Dong Y, \u003cem\u003eet al\u003c/em\u003e. Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019. Spine (Phila Pa 1976). 2022; 47:1532-1540.\u003c/li\u003e\n\u003cli\u003eFaleiros F, Silva JCF, Cordeiro A, Tholl AD, Fumincelli L, Tate D. Qualidade de vida e les\u0026atilde;o medular traum\u0026aacute;tica: um estudo com uso de data sets internacionais. Rev. Eletr. Enferm. 2020; https://doi.org/10.5216/ree.v22.56256.\u003c/li\u003e\n\u003cli\u003eDietz N, Sarpong K, Ugiliweneza B, Wang D, Aslan SS, Castillo C,\u003cem\u003e et al\u003c/em\u003e. Longitudinal Trends and Prevalence of Bowel Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2021; 27:53-67\u003c/li\u003e\n\u003cli\u003eTate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F,\u003cem\u003e et al\u003c/em\u003e. Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med. 2020; 43:141-164.\u003c/li\u003e\n\u003cli\u003eMagnuson FS, Christensen P, Krassioukov A, Rodriguez G, Emmanuel A, Kirshblum S, \u003cem\u003eet al\u003c/em\u003e. Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis-An Updated and Simplified Treatment Algorithm. J Clin Med. 2023; https://doi.org/10.3390/jcm12226971.\u003c/li\u003e\n\u003cli\u003eHakim S, Gaglani T, Cash BD. Neurogenic Bowel Dysfunction: The Impact of the Central Nervous System in Constipation and Fecal Incontinence. Gastroenterol Clin North Am. 2022; 51:93-105.\u003c/li\u003e\n\u003cli\u003eRodriguez GM, Stiens SA. Neurogenic bowel: dysfunction and rehabilitation. In: Cifu DX. Braddom\u0026apos;s Physical Medicine and Rehabilitation. 6th ed. Elsevier, Philadelphia; 2021. pp. 407-430.\u003c/li\u003e\n\u003cli\u003eEmmanuel A. Neurogenic bowel dysfunction. F1000Res. 2019; https://doi.org/10.12688/f1000research.20529.1.\u003c/li\u003e\n\u003cli\u003eHolmes GM, Blanke EN. Gastrointestinal dysfunction after spinal cord injury. Exp Neurol. 2019; https://doi.org/10.1016/j.expneurol.2019.113009.\u003c/li\u003e\n\u003cli\u003eFaleiros F, Braga DCO, Schoeller SD, Henriques SH, Cunha NBF, Videira LGN, \u003cem\u003eet al\u003c/em\u003e. Surveying people with spinal cord injuries in Brazil to ascertain research priorities. Sci Rep. 2023; https://doi.org/10.1038/s41598-022-26733-7.\u003c/li\u003e\n\u003cli\u003eBurns AS, Delparte JJ, Hitzig SL, Shephard J, Craven BC. Development of a novel neurogenic bowel patient reported outcome measure: the Spinal Cord Injury Patient Reported Outcome Measure of Bowel Function \u0026amp; Evacuation (SCI-PROBE). Spinal Cord. 2020; 58:1060-1068.\u003c/li\u003e\n\u003cli\u003eBarbetta DC, Smanioto TR, Poletto MF, Ferreira R, Lopes A, Casaro FM, \u003cem\u003eet al\u003c/em\u003e. Spinal cord injury epidemiological profile in the Sarah Network of Rehabilitation Hospitals-a Brazilian population sample. Spinal Cord Ser Cases. 2018; https://doi.org/10.1038/s41394-018-0049-8.\u003c/li\u003e\n\u003cli\u003eAmidei CB, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022; 60:812-819\u003c/li\u003e\n\u003cli\u003eSmith E, Fitzpatrick P, Lyons F, Morris S, Synnott K. Epidemiology of non-traumatic spinal cord injury in Ireland - a prospective population-based study. J Spinal Cord Med. 2022; 45:76-81\u003c/li\u003e\n\u003cli\u003eSafdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, \u003cem\u003eet al\u003c/em\u003e. Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023; 22:1026-1047.\u003c/li\u003e\n\u003cli\u003eVos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, \u003cem\u003eet al\u003c/em\u003e. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396:1204-1222.\u003c/li\u003e\n\u003cli\u003eNew PW, Cripps RA, Bonne Lee B. Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord. 2014; 52:97-109.\u003c/li\u003e\n\u003cli\u003eGolestani A, Shobeiri P, Sadeghi-Naini M, Jazayeri SB, Maroufi SF, Ghodsi Z, \u003cem\u003eet al\u003c/em\u003e. Epidemiology of Traumatic Spinal Cord Injury in Developing Countries from 2009 to 2020: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2022; 56:219-239.\u003c/li\u003e\n\u003cli\u003ePavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, \u003cem\u003eet al\u003c/em\u003e. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair. 2019; 33:902-910.\u003c/li\u003e\n\u003cli\u003eWhite AR, Holmes GM. Investigating neurogenic bowel in experimental spinal cord injury: where to begin? Neural Regen Res. 2019; 14:222-226.\u003c/li\u003e\n\u003cli\u003eTure SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med. 2023; 46:424-432.\u003c/li\u003e\n\u003cli\u003eVall\u0026egrave;s M, Mearin F. Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury. Dis Colon Rectum. 2009; 52:1589-1597.\u003c/li\u003e\n\u003cli\u003eAwad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson\u0026apos;s disease. World J Gastroenterol. 2011; 17:5035-5048\u003c/li\u003e\n\u003cli\u003eLiu CW, Huang CC, Chen CH, Yang YH, Chen TW, Huang MH. Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury. Spinal Cord. 2010; 48:554-559.\u003c/li\u003e\n\u003cli\u003eChoi Y, Leigh JH. Epidemiology of Traumatic and Non-Traumatic Spinal Cord Injury in Korea: A Narrative Review. Korean J Neurotrauma. 2023; 19:434-445.\u003c/li\u003e\n\u003cli\u003eFaleiros F, Santos LM, Bimbatti K, K\u0026auml;ppler C. Bowel Emptying Methods Used by German Residents Living With Spina Bifida. J Wound Ostomy Continence Nurs. 2021; 48:149-152.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurogenic bowel dysfunction, neurogenic Lower urinary tract dysfunction, Prevalence, Rehabilitation, Spinal cord trauma","lastPublishedDoi":"10.21203/rs.3.rs-5046196/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5046196/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eStudy design: Retrospective cross-sectional study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: To estimate the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction in Brazilians diagnosed with traumatic and non-traumatic spinal cord injury.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSetting: Brazil, several states (Bahia, Ceará, Distrito Federal, Maranhão, Minas Gerais, Rio de Janeiro).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A form was used to collect sociodemographic and clinical data from medical records. The Mann-Whitney statistical tests were used for two independent samples, Pearson's Chi-Square test for categorical variables, and the Kruskal-Wallis test for more than two independent samples for quantitative variables. A logistic regression model was used to understand the factors associated with neurogenic bowel dysfunction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The sample comprised 1056 participants from all regions of Brazil. Of this sample, 60.90% had traumatic spinal cord injury and 69.03% were male. The prevalence of neurogenic bowel dysfunction in the sample was 88% and the prevalence of neurogenic lower urinary tract dysfunction was 90.6%. Participants with traumatic spinal cord injury are more affected by neurogenic bowel and lower urinary tract dysfunction than those with non-traumatic spinal cord injury.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Most people with spinal cord injury have neurogenic lower urinary tract and bowel alterations, especially those with traumatic spinal cord injury. Further studies are needed, and bowel and bladder re-education programs should be provided in rehabilitation centers.\u003c/p\u003e","manuscriptTitle":"Prevalence of Intestinal Neurogenic Bowel and Lower Urinary Tract Dysfunctions in Brazilians with Traumatic and Non-Traumatic Spinal Cord Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-24 07:55:09","doi":"10.21203/rs.3.rs-5046196/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05f576ac-7bc9-40e9-aa20-e9c95c354b8a","owner":[],"postedDate":"October 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39354874,"name":"Health sciences/Neurology/Neurological disorders/Spinal cord diseases"},{"id":39354875,"name":"Health sciences/Medical research/Epidemiology"}],"tags":[],"updatedAt":"2024-11-14T15:30:56+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-24 07:55:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5046196","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5046196","identity":"rs-5046196","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}