Role of urodynamics in predicting fecal incontinence in spina bifida and spinal cord injury patients.

Objective: Spina bifida fecal incontinence (FI) rates reach 65%. Spinal cord injuries display 63% rates. Previously, we identified wheelchair use, VP shunt presence, and urinary incontinence as predictors of bowel control. Bowel control can be predicted in anorectal malformations, predictions for patients with spina bifida or spinal cord injuries have not been established.

Methods: Single-center, retrospective, observational study including patients 4 years or older at last follow-up, seen at Children's Hospital Colorado multidisciplinary spina bifida and spinal cord injury clinic, September 2020 to January 2023.

Results: FI was seen in 73% of patients. FI patients had higher end-fill pressures (EFP) (median 25 vs. 20 cmH2O), lower leak point pressures (mean 42.55 vs. 50.74 cmH2O). Analysis of 142 children younger than four, found; greater filling pressure changes (median 20 vs. 15 cmH2O), post-void residual volumes (median 20 vs. 5 ml), lower leak point pressures (mean 43.0 vs. 52.85 cmH2O). On multiple logistic regression wheelchair users (OR 2.71) and EFP greater than 24.5 cmH2O (OR 2.71) had increased odds for FI.

Conclusions: Before age 4 urodynamics are useful to predict FI in spina bifida and spinal cord injury patients. A cutoff of 24.5 cmH2O in EFP is the best predictor in urodynamics.