Current Bladder Dysfunction Reports

, Volume 11, Issue 4, pp 334–340 | Cite as

Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder

  • Laura Martinez
  • Leila Neshatian
  • Rose KhavariEmail author
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction


Patients with primary neurologic conditions often experience urinary and bowel dysfunction due to loss of sensory and/or motor control. Neurogenic bowel dysfunction is frequently characterized by both constipation and fecal incontinence. In general, the management of neurogenic bowel dysfunction has been less well studied than bladder dysfunction despite their close association. It is widely accepted that establishment of a multifaceted bowel regimen is the cornerstone of conservative management. Continuing assessment is necessary to determine the need for more invasive interventions. In the clinical setting, the Urologist may be the principle provider addressing bowel concerns in addition to bladder dysfunction, and furthermore, treatment of one often impacts the other. Future directions should include development of follow-up and management guidelines that address the comprehensive care of this patient population.


Neurogenic bowel Neurogenic bladder Constipation Fecal Incontinence Spinal cord injury Spinal dysraphism Myelomeningiocele Multiple sclerosis 


Compliance with Ethical Standards

Conflict of Interests

Drs Martinez, Neshatian and Khavari declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain studies with human or animal subjects performed by the author.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Wyndaele JJ, Kovindha A, Igawa Y, Madersbacher H, Radziszewski P, Ruffion A, et al. Neurologic fecal incontinence. NeurourolUrodyn. 2010;29(1):207–12.Google Scholar
  2. 2.•
    Cameron AP, Rodriguez GM, Gursky A, He C, Clemens JQ, Stoffel JT. The severity of bowel dysfunction in patients with neurogenic bladder. J Urol. 2015;194(5):1336–41. This cross-sectional analysis of a prospective neurogenic bladder database highlights the characteristics of neurogenic bowel dysfunction in this population. One important finding was that patients with worse bladder function experienced worse bowel dysfunction.PubMedCrossRefGoogle Scholar
  3. 3.
    Sonnenberg A, Tsou VT, Muller AD. The "institutional colon": a frequent colonic dysmotility in psychiatric and neurologic disease. Am J Gastroenterol. 1994;89(1):62–6.PubMedGoogle Scholar
  4. 4.
    Trivedi PM, Kumar L, Emmanuel AV. Altered colorectal compliance and anorectal physiology in upper and lower motor neurone spinal injury may explain bowel symptom pattern. Am J Gastroenterol. 2016;111(4):552–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord. 2010;48(10):718–33.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Tate DG, Forchheimer M, Rodriguez G, Chiodo A, Cameron AP, Meade M, et al. Risk Factors Associated With Neurogenic Bowel Complications and Dysfunction in Spinal Cord Injury. Arch Phys Med Rehabil. 2016;97(10):1679–86.Google Scholar
  7. 7.•
    Coggrave M, Norton C, Cody JD. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev. 2014;(1):CD002115. This is a comprehensive systematic review of management options for NBD with level of evidence.Google Scholar
  8. 8.
    Vande Velde S, Van Biervliet S, Van Renterghem K, Van Laecke E, Hoebeke P, Van Winckel M. Achieving fecal continence in patients with spina bifida: a descriptive cohort study. J Urol. 2007;178(6):2640–4. discussion 4.PubMedCrossRefGoogle Scholar
  9. 9.
    Cameron KJ, Nyulasi IB, Collier GR, Brown DJ. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Spinal Cord. 1996;34(5):277–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Korsten MA, Singal AK, Monga A, Chaparala G, Khan AM, Palmon R, et al. Anorectal stimulation causes increased colonic motor activity in subjects with spinal cord injury. J Spinal Cord Med. 2007;30(1):31–5.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, et al. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology. 2006;131(3):738–47.PubMedCrossRefGoogle Scholar
  12. 12.
    Choi EK, Shin SH, Im YJ, Kim MJ, Han SW. The effects of transanal irrigation as a stepwise bowel management program on the quality of life of children with spina bifida and their caregivers. Spinal Cord. 2013;51(5):384–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Preziosi G, Gosling J, Raeburn A, Storrie J, Panicker J, Emmanuel A. Transanal irrigation for bowel symptoms in patients with multiple sclerosis. Dis Colon Rectum. 2012;55(10):1066–73.PubMedCrossRefGoogle Scholar
  14. 14.
    Shandling B, Chait PG, Richards HF. Percutaneous cecostomy: a new technique in the management of fecal incontinence. J Pediatr Surg. 1996;31(4):534–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Blair GK, Djonlic K, Fraser GC, Arnold WD, Murphy JJ, Irwin B. The bowel management tube: an effective means for controlling fecal incontinence. J Pediatr Surg. 1992;27(10):1269–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Lopez Pereira P, Salvador OP, Arcas JA, Martinez Urrutia MA, Romera RL, Monereo EJ. Transanal irrigation for the treatment of neuropathic bowel dysfunction. J Pediatr Urol. 2010;6(2):134–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Christensen P, Andreasen J, Ehlers L. Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients. Spinal Cord. 2009;47(2):138–43.PubMedCrossRefGoogle Scholar
  18. 18.
    Ayas S, Leblebici B, Sozay S, Bayramoglu M, Niron EA. The effect of abdominal massage on bowel function in patients with spinal cord injury. Am J Phys Med Rehabil. 2006;85(12):951–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Janssen TW, Prakken ES, Hendriks JM, Lourens C, van der Vlist J, Smit CA. Electromechanical abdominal massage and colonic function in individuals with a spinal cord injury and chronic bowel problems. Spinal Cord. 2014;52(9):693–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657–64.PubMedCrossRefGoogle Scholar
  21. 21.
    Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5(3):331–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Mazor Y, Jones M, Andrews A, Kellow JE, Malcolm A. Anorectal biofeedback for neurogenic bowel dysfunction in incomplete spinal cord injury. Spinal Cord. 2016. doi: 10.1038/sc.2016.67.
  23. 23.
    Wiesel PH, Norton C, Roy AJ, Storrie JB, Bowers J, Kamm MA. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000;69(2):240–3.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Wald A. Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele. Pediatrics. 1981;68(1):45–9.PubMedGoogle Scholar
  25. 25.
    Yi Z, Jie C, Wenyi Z, Bin X, Hongzhu J. Comparison of efficacies of vegetable oil based and polyethylene glycol based bisacodyl suppositories in treating patients with neurogenic bowel dysfunction after spinal cord injury: a meta-analysis. Turk J Gastroenterol. 2014;25(5):488–92.PubMedCrossRefGoogle Scholar
  26. 26.
    Leibold S, Ekmark E, Adams RC. Decision-making for a successful bowel continence program. Eur J Pediatr Surg. 2000;10 Suppl 1:26–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Rendeli C, Ausili E, Tabacco F, Focarelli B, Pantanella A, Di Rocco C, et al. Polyethylene glycol 4000 vs. lactulose for the treatment of neurogenic constipation in myelomeningocele children: a randomized-controlled clinical trial. Aliment Pharmacol Ther. 2006;23(8):1259–65.PubMedCrossRefGoogle Scholar
  28. 28.
    Krogh K, Jensen MB, Gandrup P, Laurberg S, Nilsson J, Kerstens R, et al. Efficacy and tolerability of prucalopride in patients with constipation due to spinal cord injury. Scand J Gastroenterol. 2002;37(4):431–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Korsten MA, Rosman AS, Ng A, Cavusoglu E, Spungen AM, Radulovic M, et al. Infusion of neostigmine-glycopyrrolate for bowel evacuation in persons with spinal cord injury. Am J Gastroenterol. 2005;100(7):1560–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Rosman AS, Chaparala G, Monga A, Spungen AM, Bauman WA, Korsten MA. Intramuscular neostigmine and glycopyrrolate safely accelerated bowel evacuation in patients with spinal cord injury and defecatory disorders. Dig Dis Sci. 2008;53(10):2710–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Maeda Y, O’Connell PR, Lehur PA, Matzel KE, Laurberg S. Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement. Colorectal Dis. 2015;17(4):O74–87.PubMedCrossRefGoogle Scholar
  32. 32.
    Horrocks EJ, Thin N, Thaha MA, Taylor SJ, Norton C, Knowles CH. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg. 2014;101(5):457–68.PubMedCrossRefGoogle Scholar
  33. 33.
    Lombardi G, Nelli F, Mencarini M, Del Popolo G. Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury. Spinal Cord. 2011;49(5):629–36.PubMedCrossRefGoogle Scholar
  34. 34.
    Lombardi G, Del Popolo G, Cecconi F, Surrenti E, Macchiarella A. Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord. 2010;48(2):154–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lansen-Koch SM, Govaert B, Oerlemans D, Melenhorst J, Vles H, Cornips E, et al. Sacral nerve modulation for defaecation and micturition disorders in patients with spina bifida. Colorectal Dis. 2012;14(4):508–14.PubMedCrossRefGoogle Scholar
  36. 36.
    Mentes BB, Yuksel O, Aydin A, Tezcaner T, Leventoglu A, Aytac B. Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury: preliminary report. Tech Coloproctol. 2007;11(2):115–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Sinha CK, Grewal A, Ward HC. Antegrade continence enema (ACE): current practice. Pediatr Surg Int. 2008;24(6):685–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Yeung CK TA. Laparoscopy in Pediatric Urology. Tech Coloproctol. 2007;11(2):115–9Google Scholar
  39. 39.
    Wong AL, Kravarusic D, Wong SL. Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation: ten years of experience in pediatric population. J Pediatr Surg. 2008;43(8):1445–51.PubMedCrossRefGoogle Scholar
  40. 40.
    Hoy NY, Metcalfe P, Kiddoo DA. Outcomes following fecal continence procedures in patients with neurogenic bowel dysfunction. J Urol. 2013;189(6):2293–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Bar-Yosef Y, Castellan M, Joshi D, Labbie A, Gosalbez R. Total continence reconstruction using the artificial urinary sphincter and the Malone antegrade continence enema. J Urol. 2011;185(4):1444–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Chan DS, Delicata RJ. Meta-analysis of antegrade continence enema in adults with faecal incontinence and constipation. Br J Surg. 2016;103(4):322–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Ok JH, Kurzrock EA. Objective measurement of quality of life changes after ACE Malone using the FICQOL survey. J Pediatr Urol. 2011;7(3):389–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Imai K, Shiroyanagi Y, Kim WJ, Ichiroku T, Yamazaki Y. Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida. Spinal Cord. 2014;52(1):54–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Bani-Hani AH, Cain MP, King S, Rink RC. Tap water irrigation and additives to optimize success with the Malone antegrade continence enema: the Indiana University algorithm. J Urol. 2008;180(4 Suppl):1757–60. discussion 60.PubMedCrossRefGoogle Scholar
  46. 46.
    Chu DI, Balsara ZR, Routh JC, Ross SS, Wiener JS. Experience with glycerin for antegrade continence enema in patients with neurogenic bowel. J Urol. 2013;189(2):690–3.PubMedCrossRefGoogle Scholar
  47. 47.
    Rosito O, Nino-Murcia M, Wolfe VA, Kiratli BJ, Perkash I. The effects of colostomy on the quality of life in patients with spinal cord injury: a retrospective analysis. J Spinal Cord Med. 2002;25(3):174–83.PubMedCrossRefGoogle Scholar
  48. 48.
    Pannek J BB, Castro-Diaz D, Del Popolo G, Kramer G, Radziszewski P, Reitz A, Stohrer M, Wyndaele J-J. EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction. J Urol. 2013;189(2):690–3Google Scholar
  49. 49.
    Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. NeurourolUrodyn. 2010;29(1):213–40.Google Scholar
  50. 50.•
    Guidelines for Management of Neurogenic Bowel Dysfunction in Individuals with Central Neurological Conditions. Eur Urol. 2009;56(1):81–8.This is a very comprehensive review of all aspects neurogenic bowel dysfunction from the U.K. published by the MASCIP. It also includes practical aspects of the management modalities that would have practicality for providers taking care of patients with NBD.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Urology, Houston Methodist HospitalHoustonUSA
  2. 2.Division of Gastroenterology and Hepatology, Houston Methodist HospitalHoustonUSA

Personalised recommendations