Chapter 8 - Approach and evaluation of neurogenic bowel dysfunction

Summary

Symptoms of colorectal and anal sphincter dysfunction are common in patients with neurological disorders. The most frequent symptoms of neurogenic bowel dysfunction (NBD) are constipation, fecal incontinence, and abdominal pain. Bowel dysfunction should be viewed in relation to other complications following spinal cord injury (SCI). The international bowel function SCI data sets were developed to collect data on bowel symptoms after SCI in a common format. Most clinicians prefer to support the history with more objective investigations. The technique most often used to study colorectal functions in patients with neurological diseases is radiographically determined colorectal transit time (CTT). Physical evaluation should be performed in all patients. Perianal inspection should be performed to detect pressure sores, hemorrhoids, anal fissures, rectal prolapse or signs of soiling. Anorectal digitations should be performed to assess anorectal sensibility, anal tone and voluntary contraction.