Neurogenic Bowel Dysfunction

Neurogenic bowel dysfunction is when you have problems with your bowels because of nerve damage. Muscles in your bowels (intestines) depend on nerve signals to tell them when to move — or not to move. If those nerve signals aren’t working right, you may have trouble moving or controlling your bowels. This is how nervous system diseases and injuries can lead to constipation and fecal incontinence.

Types of neurogenic bowel dysfunction

Different parts of your nervous system affect different parts of your bowel function. So, where the damage to your nervous system occurs determines the kinds of issues you might have. Healthcare providers classify neurogenic bowel into two types based on your symptoms and where the damage is:

• Upper motor neuron (UMN) bowel syndrome: This type involves nerve damage above your sacral spinal cord. It makes your bowel muscles and anal muscles unnaturally tense. This can lead to constipation because your muscles hold onto poop and don’t let it pass through.
• Lower motor neuron (LMN) bowel syndrome: This type involves nerve damage at or below your sacral spinal cord. It weakens your bowel, pelvic floor muscles and anal muscles. When it reaches the end, you may have trouble starting or stopping a bowel movement.

Symptoms of neurogenic bowel dysfunction

Neurogenic bowel dysfunction can cause a variety of issues with pooping. You might have:

• Abdominal pain and bloating
• A feeling like you have to poop, but you can’t (tenesmus)
• Trouble feeling when you need to poop (loss of sensation)
• Infrequent and hard bowel movements (constipation)
• Painful pooping (dyschezia)
• Poop coming out when you don’t mean it to (fecal incontinence)
• Sudden and immediate need to poop (urgency)
• Trouble coordinating your pooping muscles (obstructed defecation)

These issues can also affect your mental health and social life. Your provider will want to know if it does.

Neurogenic bowel causes

Common causes of neurogenic bowel dysfunction include:

• Amyotrophic lateral sclerosis (ALS)
• Cerebral palsy
• Diabetes mellitus
• Multiple sclerosis (MS)
• Parkinson’s disease
• Spina bifida
• Spinal cord injury
• Stroke

Complications of neurogenic bowel dysfunction

Severe bowel dysfunction can lead to serious complications like:

• Anal fissures
• Fecal impaction
• Overflow incontinence
• Rectal prolapse
• Toxic megacolon
• Volvulus

Other side effects can include loss of independence, social isolation and psychological effects.

How doctors diagnose neurogenic bowel

To diagnose neurogenic bowel dysfunction, your healthcare provider will start by asking about your symptoms, daily habits and medical history. They might use a standardized assessment form, like the Neurogenic Bowel Dysfunction score. Then, they’ll test your bowel function. These tests might include:

• Anorectal manometry
• Defecography
• Digital rectal exam

How is neurogenic bowel treated?

Your healthcare provider will work with you to develop a customized treatment plan to manage your neurogenic bowel. It may involve diet and lifestyle changes, medications and supplements, and physical therapy or muscle stimulation. Regularly scheduled enemas or colonics are another helpful method.

• Food choices: Getting enough fiber and fluids is an important starting point in bowel health. You and your provider might also identify certain foods that make your symptoms better or worse.
• Lifestyle: Developing a daily routine that includes scheduled mealtimes, time for exercise and time in the bathroom may help regulate your bowel movements. Your provider may also add other steps.
• Laxatives: Fiber supplements, oral laxatives or suppositories may play a role in your treatment plan. Your provider will monitor your use.
• Prokinetic agents: These medications help encourage muscle contractions in your bowels to move poop along. They can reduce constipation by speeding up your colonic transit time.
• Physical therapy: If you have weak pelvic floor muscles, exercises can help. Sometimes, providers recommend methods like biofeedback or electrical stimulation to train your muscles.
• Colonic cleansing: Scheduling regular enemas at home may be a part of your treatment plan. Transanal irrigation (TAI) is one method providers often recommend.
• Surgery: When the above methods don’t help enough, you might consider surgery. One option is a minor procedure to create a port for antegrade enemas. Other options include sacral nerve stimulators and ostomy

When should I see my healthcare provider?

You’ll continue to see your provider regularly so they can keep track of how your treatment plan is working. But if you develop new or worsening symptoms before that, don’t hesitate to see them sooner. Severe constipation can lead to serious complications — possibly before you’re aware of the problem.

What can I expect if I have neurogenic bowel dysfunction?

The outlook for neurogenic bowel dysfunction mostly depends on the condition that causes it. Some of these conditions may improve with time, while others may stay the same or get worse. These conditions may also cause a variety of other issues besides bowel dysfunction. For example, you may also have a neurogenic bladder or mental health issues to manage. This could make things more complicated.

Most people with neurogenic bowel dysfunction will need to develop a new long-term routine to help keep their bowels functioning. This routine may be relatively simple or may be more time- and labor-intensive. It may work well to manage your bowel movements, or you may feel it doesn’t work well enough or improve your quality of life enough. In this case, you might consider surgery as a last resort.