Neurogenic bowel dysfunction

Anton Emmanuel

doi:10.12688/f1000research.20529.1

Home Browse Neurogenic bowel dysfunction

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Review

Neurogenic bowel dysfunction

[version 1; peer review: 2 approved]

Anton Emmanuel

PUBLISHED 28 Oct 2019

Author details Author details

GI Physiology Unit, University College London Hospital, Euston Road, London, WC1E 6DB, UK

Anton Emmanuel
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

The symptoms of neurogenic bowel dysfunction (NBD) comprise constipation and fecal incontinence. These have a major impact on quality of life and dignity. Bowel symptoms occur in the majority of patients with chronic neurological diseases like multiple sclerosis, spinal cord injury, and Parkinson’s disease. Management relies on obtaining a careful bowel history, including assessment of bowel function prior to the onset of neurological symptoms. Objective measures of NBD are available and important in terms of monitoring response for what are often intensely personal and difficult-to-elicit symptoms. Conservative management begins by establishing an effective and regular bowel regime by optimizing diet and laxative use. If this is insufficient, as seen in about half of patients, transanal irrigation has been shown to reduce NBD symptoms and improve quality of life. Failing that, there are more invasive surgical options available. This review aims to provide practical guidance for the clinician who encounters these patients, focusing on a stepwise approach to assessment, interventions, and monitoring.

Keywords

Neurogenic Bladder, Bowel Dysfunction, Constipation, Faecal incontinence

Corresponding author: Anton Emmanuel

Competing interests: The author has served on advisory boards for Coloplast, McGregor Healthcare, Wellspect.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2019 Emmanuel A. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Emmanuel A. Neurogenic bowel dysfunction [version 1; peer review: 2 approved]. F1000Research 2019, 8(F1000 Faculty Rev):1800 (https://doi.org/10.12688/f1000research.20529.1) First published: 28 Oct 2019, 8(F1000 Faculty Rev):1800 (https://doi.org/10.12688/f1000research.20529.1) Latest published: 28 Oct 2019, 8(F1000 Faculty Rev):1800 (https://doi.org/10.12688/f1000research.20529.1)

Introduction

The number of individuals vulnerable to bowel and bladder dysfunction is ever-increasing. Spinal cord injury (SCI), both traumatic and non-traumatic, has an estimated prevalence of over 2.5 million worldwide¹ and an incidence of 15 per million in the UK². Similarly, multiple sclerosis (MS; the commonest disabling neurological disease of young adults) and Parkinson’s disease (the second commonest neurodegenerative disease) affect over 1.5 million and 3 million people, respectively³.

Amongst those suffering from central nervous system injury or disease, bowel symptoms are experienced commonly^4,5. Of those with SCI, up to 95% report constipation⁶ and 75% have experienced episodes of fecal incontinence⁷. Two-thirds of individuals with MS experience constipation and/or fecal incontinence⁵, and in spina bifida patients only 32% report normal bowel function⁸. Constipation affects over 25–63% of those with Parkinson’s disease (depending on definition used)⁹. Stroke may also result in neurogenic bowel dysfunction (NBD), with chronic fecal incontinence occurring in 15% of patients¹⁰.

The symptoms of NBD have a substantial negative impact on quality of life, social integration, and personal independence¹¹. Only 6% of SCI patients require no intervention to support their bowel function¹². As many as 65% need to employ intrusive options such as digital stimulation or evacuation of the anorectum⁷, and one-third require assistance with bowel care¹². In 22% of individuals with SCI, bowel management takes up to an hour on every occasion, and in 14% it takes over 60 minutes⁷. The consequences of all this are loss of independence and dignity, embarrassment, anxiety, depression, social isolation, and loss of sexual relationships^11,13. In fact, the burden of NBD is so great that SCI patients report bowel dysfunction as more problematic than any of bladder dysfunction, sexual dysfunction, pain, fatigue, or perception of body image⁶.

Assessment

A GI history should be obtained from the patient and any carers they may have. Details of bowel habit prior to injury or neurological disease onset should be explored. This is especially relevant in Parkinson’s disease patients, where bowel dysfunction can begin decades before neurological symptoms¹⁴. A bowel diary can be especially helpful to quantify symptoms over a one- or two-week period as well as helping to identify any factors that influence bowel function.

Current symptoms should be thoroughly assessed, including frequency of bowel motions, stool consistency (the Bristol Stool Form scale can be helpful), episodes of fecal or flatus incontinence or urgency, maneuvers required for bowel management (digital anorectal stimulation or digital evacuation), time spent toileting, episodes of fecal impaction, laxative/anti-diarrheal usage, need for pads/plugs^11,14,15, and limitations on quality of life engendered by bowel symptoms.

The presence of associated morbidity should also be considered. For NBD, this can include urinary tract infections (UTIs), hemorrhoids, abdominal pain, rectal bleeding and prolapse, anal fissures, and autonomic dysreflexia^16–18. Autonomic dysreflexia most commonly occurs in individuals with incomplete SCI and may present as feelings of general uneasiness, headache, and perspiration that occur during defecation¹⁹. In children, fussiness and irritability may be more suggestive²⁰. Frequency and content of meals should also be gauged at this stage¹¹.

Past medical history must include any co-existing GI or anal sphincter dysfunction. Functional bowel disorders such as irritable bowel syndrome and anal sphincter lesions from childbirth are common amongst the general population and may contribute to symptoms of NBD such as fecal incontinence^21,22. This may affect treatment outcomes. Prior histories of pelvic organ prolapses or surgical procedures involving the GI tract (including the perianal region) are also relevant¹⁴. Symptoms may deteriorate with time: a longitudinal study suggested that patients require increasingly intrusive treatment options to maintain quality of life²³.

Scoring systems may be helpful in quantifying symptoms. Standard instruments such as the Cleveland constipation score and St Mark’s incontinence score may be used depending on dominant symptoms^24,25. A condition-specific NBD score has been developed and is validated in SCI and adolescents/children with spina bifida, but not in Parkinson’s disease^26–28. It has been used in MS²⁹.

Digital rectal examination is a necessary part of assessment and should include evaluation of rectal filling, resting anal tone, and ability to produce a voluntary contraction. This will also provide a crude assessment of anal sensitivity¹⁴. Perineal sensitivity may be examined by pinprick¹¹. Formal anorectal physiology studies are not usually required if physical examination is adequate¹¹. Examination should also include looking for complications of chronic constipation, namely anal fissures, complicated hemorrhoids, rectal bleeding, and prolapse.

Investigations

As with non-NBD patients, appropriate colonic imaging should be performed in the presence of any “red flag” symptoms. Clearly, these are harder to recognize in patients with NBD. In general, any worsening of bowel dysfunction or weight or blood loss signals a need for further investigation¹⁴.

More invasive physiological or radiological transit investigations do not have an established place in assessment. Whilst there is some suggestion that electrophysiology may identify neural dysfunction as a cause of anorectal symptoms, this has not been universally shown^7,12,14. Their use may be appropriate in the presence of co-morbidity such as prior anal surgery, obstetric history, or pelvic organ prolapse¹⁴. Otherwise, evidence of slow transit can usually be obtained from history based on an urge frequency of daily or less in the presence of hard stool¹¹.

The most frequently undertaken radiological testing comprises colonic transit studies. Typically, these are undertaken by taking an abdominal X-ray at a fixed time a few days after ingesting radio-opaque markers, and there exist a range of protocols³⁰. In patients with central neurological disease, these characteristically show delayed transit, which may relate to neuropathy secondary to the disease, reduced mobility, or concomitant medication. Anorectal physiology testing involves the assessment of anorectal pressures, sensation, and coordination through minimally invasive manometry and electrophysiology³¹. These tests are capable of identifying hindgut denervation as part of the disease, indicating severity.

Treatments

Traditionally, treatment begins with a conservative approach focusing on optimizing the bowel regime and progresses to more invasive measures as needed. Invasive measures can be categorized into irrigation methods, electrical stimulation therapies, and surgical procedures¹¹. There is, however, an increasing recognition that treatment needs to be tailored to the individual’s situation, and some patients may opt for a more interventional approach in the first instance¹⁵.

Conservative bowel regime

The three cardinal aims of bowel care are to ensure toileting occurs in as time efficient a way as possible, to avoid fecal incontinence, and to minimize impairment of quality of life secondary to the bowel management plan³². This can be achieved through the use of diet, bowel routine, medication, and physical techniques. No matter the methods used, patient education and training are central to achieving success³².

Diet should be optimized to suit the predominant symptoms. In patients with a slow bowel, a diet high in fiber is likely to cause bloating and flatulence. These symptoms may be improved by decreasing the amount of insoluble fiber, especially cereals, in the diet. Conversely, for those with accelerated bowel transit, higher levels of fiber in the diet may help to bulk up stools and so decrease the likelihood of soiling. For these patients, products that loosen the stools, such as caffeine, alcohol, and food containing the sweetener sorbitol, should also be used with caution. Whatever the diet content, the most important step in achieving optimal bowel motility is to establish a regular eating pattern¹¹. Fluid intake should also be optimized whilst taking bladder constraints into account³³.

Medication history should be reviewed, as drugs such as bladder anticholinergics, opiates, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics may all contribute to bowel dysfunction¹¹.

Establishing a routine for bowel care is also vitally important. Patients should attempt to defecate at a scheduled time, either daily or on alternate days. Frequency would depend on the individual’s bowel habit prior to the onset of their neurological disorder. Chances of success may be maximized by scheduling defecation to occur when bowel contractions are strongest: on waking and after a meal/warm drink. Privacy and comfort for the patient are also of crucial importance in creating an environment conducive to successful defecation. Similarly, position during toileting can be used to maximize bowel efficiency. Gravity can be best exploited in a seated position, on a toilet or commode, if this is practical for the patient¹¹.

There are a number of adjuvant techniques to assist bowel evacuation, according to the patient’s hand function and toileting independence. Abdominal massage involves using the heel of the palm to massage the abdomen from left to right in circular movements. The Valsalva maneuver is performed by attempting exhalation against a closed airway (closed glottis or pinched nose) to ensure effective propulsion. Digital rectal stimulation is where a gloved and lubricated finger is inserted into the anus and moved in a circular motion for 20–30 seconds; its aim is to stimulate the recto-colic reflex and therefore a bowel movement. The process can be repeated again 5 minutes later if required and should be used with caution in SCI patients, as it may induce autonomic dysreflexia¹⁹. Digital evacuation of stools does not depend on contraction but involves physically removing formed stools present in the rectum using a hooking motion; using a Valsalva maneuver simultaneously may improve efficacy. Suppositories and enemas may also aid in stimulating reflex contraction; they should be used only if stool is present within the rectum on digital rectal examination and should be retained for a minimum of 10 minutes. Available options are glycerin (lubricant), bisacodyl (stimulant), and lecicarbon (carbon dioxide releasing). Anal plugs prevent the leakage of flatus and small volumes of feces in those with passive incontinence and are best tolerated in patients with reduced anal sensation. Suppository inserters, finger extensions, digital stimulators, and perineal cleaners may all help to preserve patient independence when carrying out bowel care. Appropriate toilet adaptations should be employed to optimize patient comfort¹¹.

Transanal irrigation methods

Transanal irrigation (TAI) assists the evacuation of feces from the bowel by introducing water into the colon and rectum through the anus in order to induce a reflex colorectal voiding. The water is introduced using a single-use device, either a single-use cone or catheter. The choice of cone or catheter depends on patient choice, hand function, and anal sphincter integrity; a cone is preferred if the patient can retain the device in situ by hand or sphincter tone whilst instilling the fluid. After the device is removed, the contents of the rectum and some of the more proximal colon is emptied. With regular use, TAI aids the re-establishment of controlled bowel function and allows the patient to control when and where evacuation takes place. In the case of fecal incontinence, effective evacuation of the colon and rectum delays the arrival of new feces for approximately two days, which prevents leakage occurring between irrigations³⁴. Regular emptying of the rectosigmoid region in those suffering from constipation could avert blockages by supporting transport through the whole colon.

A study into the long-term results of TAI found that approximately 60% continue with treatment at long-term follow-up and resulted in lower rates of stoma surgery, UTIs, and episodes of fecal incontinence with improved quality-adjusted life years compared to conservative bowel care¹⁵. This was associated with cost savings of £21,768 per patient compared to continuation of standard bowel care¹⁵.

Electrical stimulation

Nerve stimulation via implantation of electrodes is another method that has been explored in some patients who have failed conservative therapy. The approach involves implanting the electrodes onto sacral roots. This sacral nerve stimulation is thought to have an effect on both afferent fibers to the brain and sacral efferents¹¹. A more invasive approach requires a laparotomy to implant a sacral anterior root stimulator. This can be accompanied by a posterior rhizotomy (to prevent autonomic dysreflexia) followed by the placement of electrodes on the efferent sacral roots³⁵. Although these devices are more commonly implanted for bladder control, their positive effects on bowel function have been shown to be significant³⁵. However, the technical complexity, expense, and invasiveness of the methodology means they are little used. Alternate forms of neuromodulation have been studied in patients with NBD but with limited efficacy and wider uptake despite being described many years ago³⁶.

Surgical antegrade colonic irrigation

Antegrade irrigation through an appendicostomy has been used in children with NBD, particularly those with spina bifida, providing long-term success in over 80% of patients³⁷. Unfortunately, results in adults have been less promising, the main problem being the development of tract stenosis³⁸. Another limitation of this approach is that it can take time for the whole colon to be washed out¹¹.

Alternatively, irrigation may be performed via a percutaneous endoscopic colostomy. In this approach, a tube is placed into the sigmoid colon and used to wash out the distal bowel. Although effective in the majority of patients, the technique can have substantial complications, making it a less useful approach in the long term^11,39.

Stoma formation

Surgical formation of a stoma is generally considered a last option, since it is invasive and not simply reversible. However, it can be extremely successful for patients with good use of their upper limbs and when fecal incontinence dominates¹¹. Stoma formation is associated with improved quality of life and reduced bowel management time⁴⁰. Unfortunately, complications (including rectal mucus discharge, diversion colitis, and post-surgical adhesions) may be as high as 37.5%^32,41,42. Furthermore, laxatives or stoma irrigation may still be necessary, unless a loop ileostomy is performed¹¹. In terms of location, left-sided colostomy may be the most suitable for those requiring fecal diversion due to complicated perianal wounds. However, this approach is associated with poor colonic emptying and so should be for those with good colonic motility. Right-sided colostomy is less likely to cause these problems but results in more liquid stools, increased stoma care requirements, and greater risk of leaks⁴³.

A treatment hierarchy has been proposed (Figure 1), an alternative to the traditional “pyramid”, as it reflects the range of options available and their frequency of use rather than indicating an evidence-based patient pathway.

Figure 1. Care options for the management of neurogenic bowel dysfunction.

Font size reflects the frequency of the options being used. Color gradation: green = conservative, orange = minimally invasive, red = invasive¹⁵.

Summary

Bowel dysfunction is a pathophysiological term that encompasses symptoms that can have an overwhelming effect on a patient’s life. Fecal incontinence and chronic constipation are the symptoms that result, and these have a large impact on the patient’s ability to function in a social or work capacity. Patients who develop these in the context of neurological disease have an especially heavy burden, as the neurodisability aspect has an impact on the presentation and management of these symptoms. Approximately two out of three patients with neurological disease develop bowel symptoms in the course of their illness, and these may deteriorate with time. Those individuals who develop bowel dysfunction have greater rates of hospitalization and health care utilization. Assessment is directed towards understanding the impact of the symptoms on the individual’s quality of life and determining if the resulting dysfunction is associated with a reflexic (upper motor neuron type lesion) or flaccid (lower motor neuron) pathophysiology.

Treatment is directed at avoiding fecal incontinence, minimizing time spent toileting, preventing complications (including UTIs), and optimizing quality of life. Lifestyle interventions, tailoring of the bowel regime, and laxative manipulation are the first-line approaches. These are based on clinical experience in the absence of a strong evidence base. The use of TAI has emerged as a well-studied option with a long-term response rate of over 60%. In refractory cases, or according to patient choice, surgical stoma formation is associated with improved quality of life.

Faculty Opinions recommended

References

1. Saunders LL, Selassie AW, Hill EG, et al.: Traumatic spinal cord injury mortality, 1981–1998. J Trauma. 2009; 66(1): 184–90. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
2. National Spinal Cord Injury Strategy Board (NSCISB): The initial management of adults with spinal cord injury, 2012. Reference Source
3. Lang AE, Lozano AM: Parkinson's disease. First of two parts. N Engl J Med. 1998; 339(15): 1044–53. PubMed Abstract | Publisher Full Text
4. Edwards LL, Quigley EM, Pfeiffer RF: Gastrointestinal dysfunction in Parkinson's disease: Frequency and pathophysiology. Neurology. 1992; 42(4): 726–32. PubMed Abstract | Publisher Full Text
5. Hinds JP, Eidelman BH, Wald A: Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology. 1990; 98(6): 1538–42. PubMed Abstract | Publisher Full Text
6. Glickman S, Kamm MA: Bowel dysfunction in spinal-cord-injury patients. Lancet. 1996; 347(9016): 1651–3. PubMed Abstract | Publisher Full Text
7. Krogh K, Nielsen J, Djurhuus JC, et al.: Colorectal function in patients with spinal cord lesions. Dis Colon Rectum. 1997; 40(10): 1233–9. PubMed Abstract | Publisher Full Text
8. Verhoef M, Lurvink M, Barf HA, et al.: High prevalence of incontinence among young adults with spina bifida: Description, prediction and problem perception. Spinal Cord. 2005; 43(6): 331–40. PubMed Abstract | Publisher Full Text
9. Stocchi F, Torti M: Constipation in Parkinson's Disease. Int Rev Neurobiol. In: Nonmotor Parkinson’s: The Hidden Face - Management and the Hidden Face of Related Disorders: Elsevier; 2017; 134: 811–826. PubMed Abstract | Publisher Full Text
10. Harari D, Coshall C, Rudd AG, et al.: New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke. 2003; 34(1): 144–50. PubMed Abstract | Publisher Full Text
11. Emmanuel A: Managing neurogenic bowel dysfunction. Clin Rehabil. 2010; 24(6): 483–8. PubMed Abstract | Publisher Full Text
12. Stone JM, Nino-Murcia M, Wolfe VA, et al.: Chronic gastrointestinal problems in spinal cord injury patients: A prospective analysis. Am J Gastroenterol. 1990; 85(9): 1114–9. PubMed Abstract
13. DeLisa JA, Kirshblum S: A review: Frustrations and needs in clinical care of spinal cord injury patients. J Spinal Cord Med. 1997; 20(4): 384–90. PubMed Abstract | Publisher Full Text
14. Preziosi G, Emmanuel A: Neurogenic bowel dysfunction: Pathophysiology, clinical manifestations and treatment. Expert Rev Gastroenterol Hepatol. 2009; 3(4): 417–23. PubMed Abstract | Publisher Full Text
15. Emmanuel A, Kumar G, Christensen P, et al.: Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction. PLoS One. 2016; 11(8): e0159394. PubMed Abstract | Publisher Full Text | Free Full Text
16. Correa GI, Rotter KP: Clinical evaluation and management of neurogenic bowel after spinal cord injury. Spinal Cord. 2000; 38(5): 301–8. PubMed Abstract | Publisher Full Text
17. Harari D, Sarkarati M, Gurwitz JH, et al.: Constipation-related symptoms and bowel program concerning individuals with spinal cord injury. Spinal Cord. 1997; 35(6): 394–401. PubMed Abstract | Publisher Full Text
18. Lynch AC, Antony A, Dobbs BR, et al.: Bowel dysfunction following spinal cord injury. Spinal Cord. 2001; 39(4): 193–203. PubMed Abstract | Publisher Full Text
19. Faaborg PM, Christensen P, Krassioukov A, et al.: Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014; 52(6): 494–8. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
20. Hickey KJ, Vogel LC, Willis KM, et al.: Prevalence and Etiology of Autonomic Dysreflexia in Children with Spinal Cord Injuries. J Spinal Cord Med. 2004; 27(suppl 1): S54–60. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
21. Krogh K, Emmanuel A, Perrouin-Verbe B, et al.: International spinal cord injury bowel function basic data set (Version 2.0). Spinal Cord. 2017; 55(7): 692–698. PubMed Abstract | Publisher Full Text
22. Hallock JL, Handa VL: The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016; 43(1): 1–13. PubMed Abstract | Publisher Full Text | Free Full Text | Faculty Opinions Recommendation
23. Nielsen SD, Faaborg PM, Finnerup NB, et al.: Ageing with neurogenic bowel dysfunction. Spinal Cord. 2017; 55(8): 769–773. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
24. Agachan F, Chen T, Pfeifer J, et al.: A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996; 39(6): 681–5. PubMed Abstract | Publisher Full Text
25. Vaizey CJ, Carapeti E, Cahill JA, et al.: Prospective comparison of faecal incontinence grading systems. Gut. 1999; 44(1): 77–80. PubMed Abstract | Publisher Full Text | Free Full Text
26. Krogh K, Christensen P, Sabroe S, et al.: Neurogenic bowel dysfunction score. Spinal Cord. 2006; 44(10): 625–31. PubMed Abstract | Publisher Full Text
27. Hubert K, Sideridis G, Sherlock R, et al.: Validation of a bowel dysfunction instrument for adolescents with spina bifida. J Pediatr Urol. 2015; 11(4): 199.e1–7. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
28. Kelly MS, Hannan M, Cassidy B, et al.: Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida. Neurourol Urodyn. 2016; 35(2): 212–7. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
29. Preziosi G, Raptis DA, Storrie J, et al.: Bowel Biofeedback Treatment in Patients With Multiple Sclerosis and Bowel Symptoms. Dis Colon Rectum. 2011; 54(9): 1114–21. PubMed Abstract | Publisher Full Text
30. Evans RC, Kamm MA, Hinton JM, et al.: The normal range and a simple diagram for recording whole gut transit time. Int J Colorect Dis. 1992; 7(1): 15–7. PubMed Abstract | Publisher Full Text
31. Emmanuel AV, Chung EA, Kamm MA, et al.: Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients. Spinal Cord. 2009; 47(8): 623–7. PubMed Abstract | Publisher Full Text
32. Cotterill N, Madersbacher H, Wyndaele JJ, et al.: Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013. Neurourol Urodyn. 2018; 37(1): 46–53. PubMed Abstract | Publisher Full Text
33. Clinical practice guidelines: Neurogenic bowel management in adults with spinal cord injury. Spinal Cord Medicine Consortium. J Spinal Cord Med. 1998; 21(3): 248–293. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
34. Emmanuel AV, Krogh K, Bazzocchi G, et al.: Consensus review of best practice of transanal irrigation in adults. Spinal Cord. 2013; 51(10): 732–8. PubMed Abstract | Publisher Full Text
35. Creasey GH, Grill JH, Korsten M, et al.: An implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: A multicenter trial. Arch Phys Med Rehabil. 2001; 82(11): 1512–9. PubMed Abstract | Publisher Full Text
36. Minardi D, Muzzonigro G: Lower urinary tract and bowel disorders and multiple sclerosis: Role of sacral neuromodulation: a preliminary report. Neuromodulation. 2005; 8(3): 176–81. PubMed Abstract | Publisher Full Text
37. Curry JI, Osborne A, Malone PS: The MACE procedure: Experience in the United Kingdom. J Pediatr Surg. 1999; 34(2): 338–40. PubMed Abstract | Publisher Full Text
38. Gerharz EW, Vik V, Webb G, et al.: The value of the MACE (Malone antegrade colonic enema) procedure in adult patients. J Am Coll Surg. 1997; 185(6): 544–7. PubMed Abstract | Publisher Full Text
39. Cowlam S, Watson C, Elltringham M, et al.: Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc. 2007; 65(7): 1007–14. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
40. Branagan G, Tromans A, Finnis D: Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury. Spinal Cord. 2003; 41(12): 680–3. PubMed Abstract | Publisher Full Text
41. Frisbie J, Ahmed N, Hirano I, et al.: Diversion Colitis in Patients with Myelopathy: Clinical, Endoscopic, and Histopathological Findings. J Spinal Cord Med. 2000; 23(2): 142–9. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation
42. Randell N, Lynch AC, Anthony A, et al.: Does a colostomy alter quality of life in patients with spinal cord injury? A controlled study. Spinal Cord. 2001; 39(5): 279–82. PubMed Abstract | Publisher Full Text
43. Safadi BY, Rosito O, Nino-Murcia M, et al.: Which stoma works better for colonic dysmotility in the spinal cord injured patient? Am J Surg. 2003; 186(5): 437–42. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 28 Oct 2019

Author details Author details

GI Physiology Unit, University College London Hospital, Euston Road, London, WC1E 6DB, UK

Anton Emmanuel
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

The author has served on advisory boards for Coloplast, McGregor Healthcare, Wellspect.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 28 Oct 2019, 8:1800

https://doi.org/10.12688/f1000research.20529.1

Copyright

© 2019 Emmanuel A. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

0

SEE MORE DETAILS

CITE

how to cite this article

Emmanuel A. Neurogenic bowel dysfunction [version 1; peer review: 2 approved]. F1000Research 2019, 8(F1000 Faculty Rev):1800 (https://doi.org/10.12688/f1000research.20529.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Version 1

VERSION 1

PUBLISHED 28 Oct 2019

Views

0

Reviewer Report 28 Oct 2019

Anne-Marie Leroi, Physiology Unit, University of Rouen, Rouen, France

Approved

https://doi.org/10.5256/f1000research.22564.r55639

I confirm that I have read this submission and believe that I have an ... Continue reading

CITE

Report a concern

Respond or Comment

Views

1

Reviewer Report 28 Oct 2019

Blayne Welk, Division of Urology, Western University, London, ON, Canada

Approved

https://doi.org/10.5256/f1000research.22564.r55638

I confirm that I have read this submission and believe that I have an ... Continue reading

CITE

Report a concern

Respond or Comment

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 28 Oct 2019

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2
Version 1 28 Oct 19	read	read

Blayne Welk, Western University, London, Canada
Anne-Marie Leroi, University of Rouen, Rouen, France

Comments on this article

All Comments(0)

Add a comment

Sign up for content alerts

Browse by related subjects

Back to all reports

Reviewer Report

0 Views

28 Oct 2019 | for Version 1

Anne-Marie Leroi, Physiology Unit, University of Rouen, Rouen, France

0 Views Cite this report Responses(0)

Approved

Competing Interests

No competing interests were disclosed.

Faculty Reviews are commissioned and written by members of the prestigious Faculty Opinions Faculty, and are edited as a service to our readers. In order to make these reviews as comprehensive and accessible as possible, we seek the reviewers’ input before publication. The reviewers’ names and any additional comments they may have are published alongside the review, as is usual on F1000Research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

1 Views

28 Oct 2019 | for Version 1

Blayne Welk, Division of Urology, Western University, London, ON, Canada

1 Views Cite this report Responses(0)

Approved

Competing Interests

No competing interests were disclosed.

Faculty Reviews are commissioned and written by members of the prestigious Faculty Opinions Faculty, and are edited as a service to our readers. In order to make these reviews as comprehensive and accessible as possible, we seek the reviewers’ input before publication. The reviewers’ names and any additional comments they may have are published alongside the review, as is usual on F1000Research.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

[1] 1. Saunders LL, Selassie AW, Hill EG, et al.: Traumatic spinal cord injury mortality, 1981–1998. J Trauma. 2009; 66(1): 184–90. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[2] 2. National Spinal Cord Injury Strategy Board (NSCISB): The initial management of adults with spinal cord injury, 2012. Reference Source

[3] 3. Lang AE, Lozano AM: Parkinson's disease. First of two parts. N Engl J Med. 1998; 339(15): 1044–53. PubMed Abstract | Publisher Full Text

[4] 4. Edwards LL, Quigley EM, Pfeiffer RF: Gastrointestinal dysfunction in Parkinson's disease: Frequency and pathophysiology. Neurology. 1992; 42(4): 726–32. PubMed Abstract | Publisher Full Text

[5] 5. Hinds JP, Eidelman BH, Wald A: Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology. 1990; 98(6): 1538–42. PubMed Abstract | Publisher Full Text

[6] 6. Glickman S, Kamm MA: Bowel dysfunction in spinal-cord-injury patients. Lancet. 1996; 347(9016): 1651–3. PubMed Abstract | Publisher Full Text

[7] 7. Krogh K, Nielsen J, Djurhuus JC, et al.: Colorectal function in patients with spinal cord lesions. Dis Colon Rectum. 1997; 40(10): 1233–9. PubMed Abstract | Publisher Full Text

[8] 8. Verhoef M, Lurvink M, Barf HA, et al.: High prevalence of incontinence among young adults with spina bifida: Description, prediction and problem perception. Spinal Cord. 2005; 43(6): 331–40. PubMed Abstract | Publisher Full Text

[9] 9. Stocchi F, Torti M: Constipation in Parkinson's Disease. Int Rev Neurobiol. In: Nonmotor Parkinson’s: The Hidden Face - Management and the Hidden Face of Related Disorders: Elsevier; 2017; 134: 811–826. PubMed Abstract | Publisher Full Text

[10] 10. Harari D, Coshall C, Rudd AG, et al.: New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke. 2003; 34(1): 144–50. PubMed Abstract | Publisher Full Text

[11] 11. Emmanuel A: Managing neurogenic bowel dysfunction. Clin Rehabil. 2010; 24(6): 483–8. PubMed Abstract | Publisher Full Text

[12] 12. Stone JM, Nino-Murcia M, Wolfe VA, et al.: Chronic gastrointestinal problems in spinal cord injury patients: A prospective analysis. Am J Gastroenterol. 1990; 85(9): 1114–9. PubMed Abstract

[13] 13. DeLisa JA, Kirshblum S: A review: Frustrations and needs in clinical care of spinal cord injury patients. J Spinal Cord Med. 1997; 20(4): 384–90. PubMed Abstract | Publisher Full Text

[14] 14. Preziosi G, Emmanuel A: Neurogenic bowel dysfunction: Pathophysiology, clinical manifestations and treatment. Expert Rev Gastroenterol Hepatol. 2009; 3(4): 417–23. PubMed Abstract | Publisher Full Text

[15] 15. Emmanuel A, Kumar G, Christensen P, et al.: Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction. PLoS One. 2016; 11(8): e0159394. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Correa GI, Rotter KP: Clinical evaluation and management of neurogenic bowel after spinal cord injury. Spinal Cord. 2000; 38(5): 301–8. PubMed Abstract | Publisher Full Text

[17] 17. Harari D, Sarkarati M, Gurwitz JH, et al.: Constipation-related symptoms and bowel program concerning individuals with spinal cord injury. Spinal Cord. 1997; 35(6): 394–401. PubMed Abstract | Publisher Full Text

[18] 18. Lynch AC, Antony A, Dobbs BR, et al.: Bowel dysfunction following spinal cord injury. Spinal Cord. 2001; 39(4): 193–203. PubMed Abstract | Publisher Full Text

[19] 19. Faaborg PM, Christensen P, Krassioukov A, et al.: Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014; 52(6): 494–8. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[20] 20. Hickey KJ, Vogel LC, Willis KM, et al.: Prevalence and Etiology of Autonomic Dysreflexia in Children with Spinal Cord Injuries. J Spinal Cord Med. 2004; 27(suppl 1): S54–60. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[21] 21. Krogh K, Emmanuel A, Perrouin-Verbe B, et al.: International spinal cord injury bowel function basic data set (Version 2.0). Spinal Cord. 2017; 55(7): 692–698. PubMed Abstract | Publisher Full Text

[22] 22. Hallock JL, Handa VL: The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016; 43(1): 1–13. PubMed Abstract | Publisher Full Text | Free Full Text | Faculty Opinions Recommendation

[23] 23. Nielsen SD, Faaborg PM, Finnerup NB, et al.: Ageing with neurogenic bowel dysfunction. Spinal Cord. 2017; 55(8): 769–773. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[24] 24. Agachan F, Chen T, Pfeifer J, et al.: A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996; 39(6): 681–5. PubMed Abstract | Publisher Full Text

[25] 25. Vaizey CJ, Carapeti E, Cahill JA, et al.: Prospective comparison of faecal incontinence grading systems. Gut. 1999; 44(1): 77–80. PubMed Abstract | Publisher Full Text | Free Full Text

[26] 26. Krogh K, Christensen P, Sabroe S, et al.: Neurogenic bowel dysfunction score. Spinal Cord. 2006; 44(10): 625–31. PubMed Abstract | Publisher Full Text

[27] 27. Hubert K, Sideridis G, Sherlock R, et al.: Validation of a bowel dysfunction instrument for adolescents with spina bifida. J Pediatr Urol. 2015; 11(4): 199.e1–7. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[28] 28. Kelly MS, Hannan M, Cassidy B, et al.: Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida. Neurourol Urodyn. 2016; 35(2): 212–7. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[29] 29. Preziosi G, Raptis DA, Storrie J, et al.: Bowel Biofeedback Treatment in Patients With Multiple Sclerosis and Bowel Symptoms. Dis Colon Rectum. 2011; 54(9): 1114–21. PubMed Abstract | Publisher Full Text

[30] 30. Evans RC, Kamm MA, Hinton JM, et al.: The normal range and a simple diagram for recording whole gut transit time. Int J Colorect Dis. 1992; 7(1): 15–7. PubMed Abstract | Publisher Full Text

[31] 31. Emmanuel AV, Chung EA, Kamm MA, et al.: Relationship between gut-specific autonomic testing and bowel dysfunction in spinal cord injury patients. Spinal Cord. 2009; 47(8): 623–7. PubMed Abstract | Publisher Full Text

[32] 32. Cotterill N, Madersbacher H, Wyndaele JJ, et al.: Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013. Neurourol Urodyn. 2018; 37(1): 46–53. PubMed Abstract | Publisher Full Text

[33] 33. Clinical practice guidelines: Neurogenic bowel management in adults with spinal cord injury. Spinal Cord Medicine Consortium. J Spinal Cord Med. 1998; 21(3): 248–293. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[34] 34. Emmanuel AV, Krogh K, Bazzocchi G, et al.: Consensus review of best practice of transanal irrigation in adults. Spinal Cord. 2013; 51(10): 732–8. PubMed Abstract | Publisher Full Text

[35] 35. Creasey GH, Grill JH, Korsten M, et al.: An implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: A multicenter trial. Arch Phys Med Rehabil. 2001; 82(11): 1512–9. PubMed Abstract | Publisher Full Text

[36] 36. Minardi D, Muzzonigro G: Lower urinary tract and bowel disorders and multiple sclerosis: Role of sacral neuromodulation: a preliminary report. Neuromodulation. 2005; 8(3): 176–81. PubMed Abstract | Publisher Full Text

[37] 37. Curry JI, Osborne A, Malone PS: The MACE procedure: Experience in the United Kingdom. J Pediatr Surg. 1999; 34(2): 338–40. PubMed Abstract | Publisher Full Text

[38] 38. Gerharz EW, Vik V, Webb G, et al.: The value of the MACE (Malone antegrade colonic enema) procedure in adult patients. J Am Coll Surg. 1997; 185(6): 544–7. PubMed Abstract | Publisher Full Text

[39] 39. Cowlam S, Watson C, Elltringham M, et al.: Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc. 2007; 65(7): 1007–14. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[40] 40. Branagan G, Tromans A, Finnis D: Effect of stoma formation on bowel care and quality of life in patients with spinal cord injury. Spinal Cord. 2003; 41(12): 680–3. PubMed Abstract | Publisher Full Text

[41] 41. Frisbie J, Ahmed N, Hirano I, et al.: Diversion Colitis in Patients with Myelopathy: Clinical, Endoscopic, and Histopathological Findings. J Spinal Cord Med. 2000; 23(2): 142–9. PubMed Abstract | Publisher Full Text | Faculty Opinions Recommendation

[42] 42. Randell N, Lynch AC, Anthony A, et al.: Does a colostomy alter quality of life in patients with spinal cord injury? A controlled study. Spinal Cord. 2001; 39(5): 279–82. PubMed Abstract | Publisher Full Text

[43] 43. Safadi BY, Rosito O, Nino-Murcia M, et al.: Which stoma works better for colonic dysmotility in the spinal cord injured patient? Am J Surg. 2003; 186(5): 437–42. PubMed Abstract | Publisher Full Text

Neurogenic bowel dysfunction

Abstract

Keywords

Introduction

Assessment

Investigations

Treatments

Conservative bowel regime

Transanal irrigation methods

Electrical stimulation

Surgical antegrade colonic irrigation

Stoma formation

Figure 1. Care options for the management of neurogenic bowel dysfunction.

Summary

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated