Neurogenic Bowel

(Bowel, Neurogenic)
  • Definition

    Neurogenic bowel occurs when the body has problems storing and removing stool from the intestines due to nerve damage.
    Intestines
    Normal Anatomy of the Large and Small Intestine
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    The digestion process is partly managed by messages sent between the brain and digestive system. These messages are sent through nerves. When these nerves are damaged, messages between the brain and digestive system are blocked. This prevents the bowels from working properly.
    The spinal cord runs from the base of the brain to the lower back. There are two main types of neurogenic bowel, depending on where along the spinal cord the damage occurs.
    Reflexic Bowel
    This happens when there is damage around the neck or chest. Messages between the colon (large intestine) and the brain are interrupted. As a result, a person may not feel the need to have a bowel movement. However, stool is still building up in the rectum. The build-up triggers a reflex causing the rectum and colon to react, leading to a bowel movement without warning.
    Areflexic Bowel
    This happens when there is damage around the lower end of the spinal cord. When these lower nerves are damaged, a person is unable to feel when he needs to have a bowel movement. Also, the reflex may be reduced, so the rectum has a difficult time emptying stool. This can lead to constipation.
  • Risk Factors

    Spinal cord injury is the main risk factor.
  • Symptoms

    If you have any of these symptoms, do not assume they are due to neurogenic bowel. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
    • Trouble having a bowel movement
    • Repeated bowel accidents
    • Swollen abdomen
    • Feeling full (not hungry) quickly
    • Loose stools or very hard stools
    • Bleeding from the rectum
    • Abdominal pain
  • Diagnosis

    Your doctor will:
    • Ask about your symptoms and medical history
    • Do a physical exam
    Tests may include:
    • Rectal exam
    • Test to check for blood in the stool
  • Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include:
    Bowel Program
    Your doctor will work with you to set up a bowel program. This program will help by:
    • Providing effective ways to have a bowel movement
    • Preventing bowel accidents
    • Establishing a predictable bowel movement schedule
    With the program, you may:
    • Follow a certain diet and physical activity plan
    • Be given a combination of medicines to promote bowel function
    • Undergo digital stimulation to cause a bowel movement
    • Work with your healthcare team to find an ideal time for going to the bathroom and position to use when having a bowel movement
    • Participate in other methods to encourage bowel movement (eg, doing push-ups, massaging the abdomen, deep breathing, drinking warm fluids, sitting in a forward-leaning position)
    Medication
    The main types of medicines to treat neurogenic bowel include:
    • Stool softeners—soften the stool to make bowel movement easier
    • Colonic stimulants—stimulate the colon to move the stool through the digestive tract faster
    • Osmotic laxatives—pull water into the intestines to increase stool bulk
    • Bulk formers—increase stool bulk
    The types of medicines you will take will depend on certain factors, such as the type of neurogenic bowel you have, other medicines you may be taking, and your diet.
    Digital Stimulation
    Digital stimulation is done to encourage movement of the bowels by stimulating the rectum. With this procedure, the doctor will insert his gloved and lubricated finger into your rectum. He will slowly move his finger in a circle. Other types of stimulation include:
    • Suppositories—stimulate the nerves in the rectum lining
    • Enemas—stimulate the nerves and soften stool
    Surgery
    Sometimes surgery may be needed, such as:
    • Colostomy—An opening is made from the colon to the surface of the body. The opening acts like an anus where solid waste is removed.
    • Ileostomy—An opening is made from the small intestine to the surface of the body.
  • Prevention

    This condition cannot be prevented. You can decrease the risk of spinal cord injury by taking safety precautions, such as:
    • Wearing seat belts
    • Avoiding activities that can put you at risk for injuring your spine
  • RESOURCES

    National Association for Continence http://www.nafc.org/

    United Spinal Association http://www.unitedspinal.org/

    CANADIAN RESOURCES

    BC Health Guide http://www.bchealthguide.org/

    Canadian/American Spinal Research Organization http://www.csro.com/

    References

    Benevento BT, Sipski ML. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther . 2002;82(6):601-612.

    LaRusso L. Neurogenic bladder—adult. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 20, 2010. Accessed January 26, 2011.

    Neurogenic bowel management in adults with spinal cord injury. National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=850 . Updated December 1, 1998. Accessed June 26, 2011.

    Neurogenic bowel: what you should know. A guide for people with spinal cord injury. Consortium for Spinal Cord Medicine website. Available at: http://www.scicpg.org/cpg%5Fcons%5Fpdf/BWLC.pdf . Accessed June 26, 2011.

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