Silla de ruedas, disfunción intestinal neurogénica

What is a neurogenic bowel and how to deal with it?

Most people do not know how chronic constipation affects the life of people with spinal cord injury. They are not aware of these other effects of the spinal cord injury. But if the legs don’t move, neither do the intestines.

60% of people with spinal cord injury suffer from chronic constipation and this problem seriously affects their quality of life [1]. They can spend more than two hours in the bathroom each day and if they do not evacuate successfully, they do not leave the house for fear of suffering a fecal accident. Because chronic constipation has another serious side effect: fecal incontinence.

Patients with spinal cord injury confess that the intestinal dysfunction they experience is more problematic than the one of the bladder, sexual dysfunction, pain, fatigue or the perception of body image [2]. Their gut has stopped working properly because of the injury they suffered in their central nervous system. Technically, they suffer from neurogenic bowel dysfunction.

But not only those with spinal cord injuries suffer from it. It can also happen to patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis, or Parkinson’s. 80% of patients with neurological diseases suffer from chronic constipation due to neurogenic bowel. This dysfunction can also be suffered in cases of spina bifida, diabetes mellitus or after a stroke [3].

We will see how a neurogenic bowel differs from one that functions correctly, what intestinal problems the patient develops depending on the pathology he suffers, and how to deal with neurogenic bowel dysfunction.

What is neurogenic bowel disease?

Let’s remember how the large intestine works: the fecal contents are propelled by involuntary movements, called peristaltic waves. This way, they advance to the rectum, which stores the feces until it is full. When this occurs, pressure receptors in the pelvic floor receive a stimulus that triggers the inhibitory anorectal reflex and allows internal relaxation of the anal sphincters. This means that the external anal sphincter contracts until it relaxes voluntarily. The voluntary relaxation of the external sphincter reduces the pressure and, therefore, allows defecation.

When an injury occurs or when there is a central nervous system disorder, the described bowel function is affected in several ways, depending on the location and severity of the damage [4]. Patients with spinal cord injury are not affected in the same way as those with Parkinson or stroke:

  • Neurogenic bowel dysfunction in spinal cord injury, multiple sclerosis and spina bifida. The pathophysiology of neurogenic intestinal dysfunction is very similar for spinal cord injury, multiple sclerosis and spina bifida, although the nature of the lesion is different. Traumatic injuries are usually well defined, while sclerosis lesions can be found at multiple sites and most patients with spina bifida have low spinal cord injuries. If the spinal cord injury occurs in the upper part, there are more problems of intestinal dysfunction and chronic constipation and also anal dysfunction. In many cases they need need anal digital stimulation, which is usually done by another person, do evacuate. Those who suffer from low spinal cord injury usually have reduced resting tone in the anal sphincter (atonic sphincter) and constipation problems combined with fecal incontinence, especially if the lesion is complete [5].
  • Neurogenic bowel dysfunction in Parkinson’s disease. In these cases, neurogenic intestinal dysfunction is characterized by dystonia of striated muscles of the pelvic floor and the external anal sphincter. Moreover, the colonic transit time is extended as a consequence of the loss of dopamine within the central nervous system and the enteric nervous system [6].
  • Neurogenic bowel dysfunction in brain injury. Patients with brain injury and stroke survivors have intestinal dysfunction caused by loss of sacral reflex inhibition. [7].

How to deal with neurogenic bowel dysfunction?

Patients should be taught long-term management of bowel dysfunction so that they can cope with it properly. They should know how to safely use assistive devices for intestinal emptying and understand effective techniques for bowel evacuation, digital stimulation and the use of rectal suppositories. They should also be informed about the prevention of complications related to the intestine, such as chronic constipation, hemorrhoids and fecal impaction, etc. It is important to create good bathroom habits.

The medical device MOWOOT can be part of an effective bowel management program. As demonstrated by clinical studies, the intestinal therapy of Mowoot, inspired by the abdominal massage facilitates intestinal transit and relieves constipation.

 

References:

(1) PM Faaborg et al. Gastroenterol Res Pract 2013, 365037.

https://www.hindawi.com/journals/grp/2013/365037/

(2) Glickman S, Kamm MA. Bowel dysfunction in spinal-cord-injury patients. Lancet. 1996 Jun 15. 347 (9016).

https://www.ncbi.nlm.nih.gov/pubmed/8642958

(3) Coggrave M, Norton C. Neurogenic bowel. Handb Clin Neurol. 2013. 110.

https://www.ncbi.nlm.nih.gov/pubmed/23312643

(4) Poggio J. L., Moberg-Wolff E.A. et al. Neurogenic Bowel Dysfunction. Medscape updated: Aug 13, 2017.

https://emedicine.medscape.com/article/321172-clinical

(5) Vallés Casanova, M. Intestino neurógeno en la lesión medular: nuevos conceptos y perspectivas. Focus. Jan 2012.

http://revistafocus.es/pdf/RevistaFOCUS_N3.pdf

(6) Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol. 2009. 23 (4).

https://www.ncbi.nlm.nih.gov/pubmed/19647688

(7) Pellat GC. Neurogenic continence. Part 1: pathophysiology and quality of ilfe. Br J Nurs. 2008 Jul 10-23. 17 (13).

https://www.ncbi.nlm.nih.gov/pubmed/18856146