WHAT DO WE KNOW ABOUT NEUROGENIC BOWEL DYSFUNCTION?

Central neurological diseases such as spinal cord injury, multiple sclerosis and Parkinson's disease are highly prevalent. Neurogenic bowel dysfunction symptoms (mainly constipation and incontinence) in these patients are very common and have a major negative impact on quality of life. In neurogenic bowel dysfunction patients with spinal cord injury and multiple sclerosis, we can identify two different clinical syndromes depending on the level and extent of the lesion. In supraconal (above the conus medularis) injuries there is an upper motor neuron syndrome with hypertonia and hyperreflexia of the colon and rectum. In injuries involving the conus medularis or the cauda equina a lower motor neuron syndrome occurs, associating hypotonia and areflexia of the colon and rectum. In Parkinson's disease constipation is caused by dystonia of the external anal sphincter and loss of dopaminergic neurons within the enteric nervous system. It is important to perform adequate assessment of the patient prior to treatment, including previous gastrointestinal diseases, proper anamnesis, physical examination and functional evaluation. A step-wise approach of gradually escalating degree of invasiveness is the preferred management strategy for neurogenic bowel disease. Initial management is based on bowel routine, dietary modifications and use of laxatives. In non-responders transanal irrigation may be a suitable approach. Finally, in patients that are refractory to all available treatments, surgical formation of a definitive stoma must be considered.