neurogenic bowel

What is Neurogenic Bowel?

Neurogenic bowel, also known as neurogenic bowel dysfunction (NBD), is a condition characterized by the loss of normal bowel function due to a nerve problem in the lower part of the colon. This can be caused by a spinal cord injury or a nerve disease such as multiple sclerosis, Parkinson's disease, or diabetes.

Symptoms

The symptoms of neurogenic bowel include:

• Constipation
• Fecal incontinence (leaking stool)
• Trouble having a bowel movement
• Belly pain
• Frequent bowel movements

Causes

Neurogenic bowel can be caused by various factors, including:

• Spinal cord injury or disease
• Nerve damage due to conditions such as multiple sclerosis, Parkinson's disease, or diabetes
• Autonomic dysfunction (damage to the autonomic nervous system)
• Altered reflexes and sphincter tone

Types of Neurogenic Bowel

There are two main types of neurogenic bowel:

• Reflexic bowel: This type is characterized by a spastic or hyperactive bowel that empties small amounts at random times.
• Areflexic bowel: This type is characterized by a lack of reflexes and a failure to empty the bowel.

Impact on Quality of Life

Neurogenic bowel can have a significant impact on quality of life, causing embarrassment, anxiety, and social isolation. It is essential to seek medical attention if you are experiencing symptoms of neurogenic bowel.

References:

• [1] A Emmanuel (2019) - The symptoms of neurogenic bowel dysfunction (NBD) comprise constipation and fecal incontinence.
• [3] Jeffery S. Johns MD, in Essentials of Physical Medicine and Rehabilitation (Fourth Edition), 2020 - Neurogenic Bowel
• [5] - A neurogenic bowel occurs when there is damage to the part of the nervous system that controls these reflexes.
• [11] - Neurogenic bowel is the loss of normal bowel function due to a nerve problem. It causes constipation and stool leakage or incontinence.
• [12] - Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation.

Neurogenic Bowel Signs and Symptoms

Neurogenic bowel, also known as neurogenic bowel dysfunction (NBD), is a condition characterized by the loss of normal bowel function due to nerve damage or disease. The symptoms of neurogenic bowel can vary from person to person, but common signs include:

• Loss of bowel control: This is one of the most common symptoms of neurogenic bowel, where individuals may experience involuntary bowel movements or difficulty controlling their bowel movements.
• Constipation: Neurogenic bowel can cause constipation due to slowed movement of food and feces through the lower gastrointestinal tract (GI tract).
• Fecal incontinence: This is another symptom of neurogenic bowel, where individuals may experience involuntary leakage of stool.
• Bowel frequency: Some people with neurogenic bowel may experience an increase or decrease in bowel movements.

According to [6], the symptoms of NBD comprise constipation and fecal incontinence. These have a major impact on quality of life and dignity. Similarly, [7] states that NBD is fecal incontinence or constipation resulting from central nervous system (CNS) disease or injury.

In children with neurogenic bowels, symptoms may include constipation and stool incontinence due to the following reasons: hard stool, intermittent diarrhea, and being past the age of [5].

It's essential to note that the symptoms of neurogenic bowel can vary depending on the type and location of nerve damage. Potential symptoms may also include frequent or urgent urination, which is a symptom of neurogenic bladder [3].

Diagnostic Tests for Neurogenic Bowel

Neurogenic bowel, also known as neurogenic bowel dysfunction, can be diagnosed using various tests that assess the structure and function of the muscles and nerves involved in bowel movements.

• Anorectal Manometry: This test measures the strength of the anal sphincter muscle and the pressure within the rectum. It helps to determine if there is any weakness or abnormality in the muscle tone.
• Electromyography (EMG): EMG tests the electrical activity of the muscles around the anus, which can help identify any abnormalities in nerve function.
• Endoanal Ultrasonography: This imaging test uses high-frequency sound waves to create images of the anal sphincter and surrounding tissues. It helps to assess the structure and function of the muscle.
• MRI or CT Scans: These imaging tests use magnetic fields or X-rays to view the internal structures involved in bowel movements, such as the rectum, anus, and surrounding nerves.

Other methods for diagnosing neurogenic bowel include:

• Ultrasound Imaging: This test uses high-frequency sound waves to create images of the internal structures involved in bowel movements.
• Electromyography (EMG): EMG tests the electrical activity of the muscles around the anus, which can help identify any abnormalities in nerve function.

These diagnostic tests are used to assess the structure and function of the muscles and nerves involved in bowel movements, and to determine if there is any weakness or abnormality that may be contributing to neurogenic bowel dysfunction. [1][2][3][4][5]

References: [1] Context 1: Anorectal manometry to measure sphincter strength [2] Context 2: Electromyography to test the electrical activity of the muscles around ... [3] Context 3: MRI or CT scans to view the internal structures involved in having a bowel ... [4] Context 4: Other methods for diagnosing neurogenic bowel include: MRI or CT scans; Ultrasound imaging; Electromyography; Anorectal manometry. [5] Context 5: by P Durney · 2020 · Cited by 12 — Evaluation of Neurogenic Bowel​​ The Bristol Stool Scale5 is widely used to assess whether stool is of the appropriate consistency, and it has been validated in ...

Medications for Neurogenic Bowel Dysfunction

Neurogenic bowel dysfunction (NBD) can be managed through various drug treatments, which aim to stimulate bowel movements and improve overall gut function.

• Laxatives and Stool Softeners: These medications are commonly used to stimulate peristalsis and help with bowel movements. They work by increasing the frequency of bowel movements or making stool softer and easier to pass [6].
• Prokinetic Drugs: Metoclopramide, prucalopride, and neostigmine are examples of prokinetic drugs that can be used to activate the muscles of the gastrointestinal tract. These medications have been shown to improve gut function in individuals with NBD [7][8].
• Stool Softeners: Stool softeners, such as docusate, can help make stool softer and easier to pass, reducing the risk of constipation and bowel obstruction.
• Colonic Stimulants: These medications stimulate the muscles of the colon, helping to move food through the digestive system more efficiently.

Other Medications

In addition to these primary categories, other medications may be used in the management of NBD. These can include:

• Contact Irritants: These medications irritate the lining of the rectum, stimulating a bowel movement.
• Bulk Forming Agents: These medications help add bulk to stool, making it easier to pass.

Important Considerations

It's essential to note that each individual with NBD may require a unique treatment plan. A healthcare professional should be consulted to determine the best course of medication for an individual's specific needs [9].

References: [6] - 6. Feb 10, 2023 — Drugs used for management of neurogenic bowel dysfunction (NBD) include laxatives and stool softeners aimed at stimulating peristalsis with subsequent ... [7] - by JS Johns · 2021 · Cited by 26 — Metoclopramide stimulates the muscles of the gastrointestinal tract through dopamine and acetylcholine receptors and is approved for use to ... [8] - Prokinetic drugs like prucalopride, metoclopramide, and neostigmine are used to activate the muscles of the GI tract. Research has shown that metoclopramide or ... [9] - The four main categories of medications used in the management of neurogenic bowel [18,19] are stool softeners, colonic stimulants, contact irritants, and bulk ...

Differential Diagnosis of Neurogenic Bowel

Neurogenic bowel, also known as neurogenic bowel dysfunction (NBD), refers to the loss of normal bowel function caused by a nerve problem. The differential diagnosis of NBD involves considering various conditions that can cause or contribute to this condition.

Common Causes of NBD:

• Spinal cord injury (SCI) [3]
• Amyotrophic lateral sclerosis (ALS) [3]
• Spina bifida [3]
• Myelomeningocele (MMC) [3]
• Multiple sclerosis (MS) [3]
• Parkinson disease (PD) [3]
• Stroke [3]
• Diabetes mellitus [3]
• Cerebral palsy or other diagnoses [3]

Other Conditions to Consider:

• Ogilvie syndrome [1]
• Gastrointestinal neoplasm [1]

These conditions can all contribute to the development of NBD, and a thorough medical history and physical examination are essential in making an accurate diagnosis.

Diagnostic Tests:

Depending on the outcome of the initial exam, your doctor may order diagnostic tests to confirm or rule out a neurogenic bowel diagnosis. These tests may include:

• Digital rectal examination [10]
• Diagnostic tests such as flat plate x-ray of the abdomen [14]

It's essential to note that almost all people with spinal cord injury/disease (SCI/D) suffer from NBD, and left untreated, the effects of NBD can lead to serious health consequences [13].

References:

[1] - Ogilvie syndrome [3] - Common causes of NBD [10] - Diagnostic tests [13] - Effects of NBD on SCI/D patients [14] - Bowel management options for people with neurogenic bowel