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 a bowel movement is needed. 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

    Symptoms of neurogenic bowel may include:
    • 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

    You will be asked about your symptoms and medical history. A physical exam will be done. A rectal exam may also be done.
    Your waste products may be tested. This can be done with stool tests.
  • 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 medications 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, such as doing push-ups, massaging the abdomen, deep breathing, drinking warm fluids, and sitting in a forward-leaning position
    Medication
    Common medications to treat neurogenic bowel include:
    • Stool softeners to make bowel movement easier
    • Colonic stimulants to stimulate the colon to move the stool through the digestive tract faster
    • Osmotic laxatives to pull water into the intestines to increase stool bulk
    • Bulk formers to ncrease stool bulk
    The types of medications you will take will depend on certain factors, such as the type of neurogenic bowel you have, other medications 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 a gloved and lubricated finger into your rectum. The will slowly move the 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

    HealthLink BC http://www.bchealthguide.org

    Canadian 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.

    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. Published March 1999. Accessed November 20, 2014.

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