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.

Evidence to support management of neurogenic bowel dysfunction remains sparse in comparison to other areas of care; such evidence as is available arises mostly from the spinal cord injury arena. This chapter discusses the clinical and investigational assessment, management of fecal impaction, gastrocolic reflex, abdominal massage, rectal stimulation, and feces evacuation methods. Dysfunction of the bowel has considerable implications for quality of life. Assessment of an individual for neurogenic bowel management is a multidisciplinary activity. Anorectal manometry tests can quantify more precisely the functional status of the anorectum. Irregular or too infrequent management is associated with incontinence and constipation. The majority of individuals with neurogenic bowel dysfunction will use the conservative methods to manage their bowel dysfunction. Biofeedback, Transanal irrigation, surgical interventions, and antegrade continence enema (ACE) are some useful options when conservative methods are not effective.