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Abdominal Pain: A Comparison between Neurogenic Bowel Dysfunction and Chronic Idiopathic Constipation

DOI: 10.1155/2013/365037

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Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominal pain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT) were measured by radiopaque markers. Results. Seventeen (81%) SCI and 14 (93%) CIC patients reported abdominal pain or discomfort within the last month ( ). Pain was considered more intense by CIC than by SCI patients ( ). Only minor differences were found in patient’s qualitative description of abdominal pain or in the location of pain. In neither SCI nor CIC was pain associated with GITT. Conclusion. Most characteristics of abdominal pain among SCI patients resemble those of CIC. This indicates that constipation is a major cause of pain after SCI. 1. Introduction Spinal cord injury (SCI) has severe consequences for colorectal and anal sphincter function. The term neurogenic bowel dysfunction (NBD) has been introduced and includes constipation, faecal incontinence, and abdominal pain [1]. It is well documented that faecal incontinence affects up to 75% and constipation approximately 80% of subjects with SCI [2]. In contrast to other symptoms, abdominal pain after SCI has received very little attention. Abdominal pain can have severe consequences for the quality of life of SCI patients [3]. It usually has a late onset as it is present in only 5–10% after five years [4] but in one-third after 10 years or more [5]. The nature of abdominal pain in NBD is unknown. This is unfortunate as the choice of treatment should reflect the underlying cause. We have previously described an association between infrequent defecation and abdominal pain suggesting a relation to constipation [5]. This is consistent with the fact that most able-bodied patients with chronic constipation have abdominal pain [6]. Abdominal pain in SCI is sometimes considered neuropathic pain if no underlying visceral pathology is identified. Neuropathic pain is present in other parts of the body in about


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