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.
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Wyndaele JJ, Kovindha A, Igawa Y, Madersbacher H, Radziszewski P, Ruffion A, et al. Neurologic fecal incontinence. NeurourolUrodyn. 2010;29(1):207–12.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Wald A. Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele. Pediatrics. 1981;68(1):45–9.
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.
Leibold S, Ekmark E, Adams RC. Decision-making for a successful bowel continence program. Eur J Pediatr Surg. 2000;10 Suppl 1:26–30.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sinha CK, Grewal A, Ward HC. Antegrade continence enema (ACE): current practice. Pediatr Surg Int. 2008;24(6):685–8.
Yeung CK TA. Laparoscopy in Pediatric Urology. Tech Coloproctol. 2007;11(2):115–9
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.
Hoy NY, Metcalfe P, Kiddoo DA. Outcomes following fecal continence procedures in patients with neurogenic bowel dysfunction. J Urol. 2013;189(6):2293–7.
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.
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.
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.
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.
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.
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.
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.
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):690–3
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.
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.
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.
This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction
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Martinez, L., Neshatian, L. & Khavari, R. Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder. Curr Bladder Dysfunct Rep 11, 334–340 (2016). https://doi.org/10.1007/s11884-016-0390-3
- Neurogenic bowel
- Neurogenic bladder
- Fecal Incontinence
- Spinal cord injury
- Spinal dysraphism
- Multiple sclerosis