Bowel dysfunction is perceived as one of the most disabling aspects of SCI, causing great anxiety and being a source of emotional upset. Of all the medical problems experienced by persons with SCI, many rate the loss or change in bowel habit as one of the most significant factors affecting their quality of life. A colostomy is the surgical formation of an artificial anus by connecting the colon to an opening in the abdominal wall. SCI patients who receive elective colostomy usually have exhausted all other medical treatments available to them for bowel management.  Colostomy is an option when the extent of bowel dysfunction becomes severe and other non-surgical methods have failed to produce the desired result.  Colostomy is also frequently advocated as an adjunct to the treatment of perineal pressure ulcers in SCI patients. However, colostomy following SCI is not routinely used and is seen by many as the failure of rehabilitation services. There is no general consensus as to when colostomy should be performed in patients with SCI because there has been no way to capture the GI problems that often necessitate colostomy. 

Table 9: Colostomy after a spinal cord injury

Discussion

Colostomy is a safe, effective and well-accepted method of managing severe and chronic GI problems in persons with SCI. As research shows, colostomy reliably reduces the number of hours spent on bowel care (Munck et al. 2008; Branagan et al. 2003; Rosito et al. 2002; Kelly et al. 1999; Stone et al. 1990; Frisbie et al. 1986), reduces the number of hospitalizations caused by GI problems (Rosito et al. 2002) and bowel care-related complaints (Frisbie et al. 1986), simplifies bowel care routine (Frisbie et al. 1986), and improves quality of life (Munck et al. 2008;  Safadi et al. 2003; Rosito et al. 2002;Kelly et al. 1999). Colostomy increases independence, facilitates travel, elevates feelings of self-efficacy, and does not negatively affect body image (Branagan et al. 2003; Rosito et al. 2002). Colostomy was well-received by patients and either met or exceeded their expectations (Rosito et al. 2002). Most wished to have the colostomy done earlier (Branagan et al. 2003). The evolution of health care will require physicians to evaluate more critically the impact of surgical interventions, including colostomy, on the patient’s well-being.

Conclusions

• There is level 4 evidence (from six studies) (Frisbie et al. 1986; Stone et al. 1990; Kelly et al. 1999; Rosito et al. 2002; Branagan et al. 2003, Munck et al. 2008) that colostomy reduces the number of hours spent on bowel care.
• There is level 4 evidence (from 1 retrospective pre-post study) (Frisbie et al. 1986) that colostomy greatly simplifies bowel care routines.
• There is level 4 evidence (from 1 case study) (Rosito et al. 2002) that colostomy reduces the number of hospitalizations caused by gastrointestinal problems and improves physical health, psychosocial adjustment and self-efficacy areas within quality of life.

• Colostomy is a safe and effective treatment for severe, chronic gastrointestinal problems and perianal pressure ulcers in persons with SCI, and greatly improves their quality of life.