Neurogenic Bowel
Loss of bowel control due to nerve damage
Quick Facts
- Type: Neurological and digestive condition
- Cause: Damage to nerves controlling the bowel
- Common in: Spinal cord injury, spina bifida, MS
- Management: Structured bowel program
Overview
Neurogenic bowel is a loss of normal bowel function and control that results from damage to the nervous system. Moving stool through the intestines and controlling when it is passed depend on signals between the brain, spinal cord, and the nerves of the gut. When these nerve pathways are injured or affected by disease, the bowel may not work normally, leading to problems such as constipation, difficulty emptying, or accidental loss of stool.
This condition commonly affects people with spinal cord injury, spina bifida, multiple sclerosis, and other neurological disorders. While neurogenic bowel can be challenging and affect quality of life and dignity, a structured, individualized plan known as a bowel program can usually achieve predictable, manageable bowel movements and prevent complications.
Symptoms
Symptoms depend on where and how the nerves are affected and may include:
- Constipation and difficulty passing stool
- Loss of the urge to have a bowel movement
- Accidental leakage of stool (fecal incontinence)
- Long, unpredictable, or incomplete bowel movements
- Abdominal bloating and discomfort
- Straining or needing assistance to empty the bowel
In people with a spinal cord injury above a certain level, a full bowel can trigger a dangerous reaction called autonomic dysreflexia, with a sudden, severe rise in blood pressure, pounding headache, sweating, and flushing. This is a medical emergency and requires immediate action.
Causes
Neurogenic bowel is caused by conditions that damage the nerves controlling the bowel. The pattern of dysfunction depends on the level of injury:
- Spinal cord injury: A leading cause; the effects differ depending on whether the injury is in the upper or lower spinal cord.
- Spina bifida: A common cause from birth, due to abnormal development of the lower spinal cord.
- Multiple sclerosis and other neurological diseases: Damage to nerve pathways over time.
- Stroke and brain injury: Can affect bowel control.
- Conditions that tether or compress the spinal cord: Such as a tethered cord or spinal tumors.
Risk Factors
- Spinal cord injury or disease
- Spina bifida and other neural tube conditions
- Multiple sclerosis, Parkinson disease, and similar disorders
- Stroke or traumatic brain injury
- Diabetes with nerve damage
- Reduced mobility, which can worsen constipation
Diagnosis
Diagnosis is based on the person's neurological condition and bowel symptoms:
- Medical history and examination: Reviewing the underlying neurological condition, bowel habits, and a rectal examination to assess tone and reflexes.
- Bowel diary: Tracking patterns helps guide a management plan.
- Imaging or specialized tests: Occasionally used to evaluate the colon, rectum, and how the bowel empties.
- Ruling out other causes: Checking for additional reasons for constipation or incontinence.
Treatment and Management
The cornerstone of care is a personalized bowel program that produces regular, predictable emptying and prevents accidents and complications.
- Bowel program: A scheduled routine, often at the same time each day, using techniques to trigger emptying and a consistent approach to diet and fluids.
- Diet and fluids: Adequate fiber and water to keep stool soft and regular.
- Medications: Stool softeners, fiber supplements, laxatives, or suppositories as advised.
- Physical techniques: Such as digital stimulation or manual emptying, taught by a clinician.
- Advanced options: For some people, special irrigation systems or, rarely, surgery may be considered.
A consistent routine and support from the care team are key to long-term success.
Self-Care and Prevention of Complications
- Follow your bowel program consistently and at regular times
- Drink enough fluids and eat adequate fiber unless told otherwise
- Stay as active as your condition allows
- Watch for and report constipation, impaction, or new incontinence
- Learn the warning signs of autonomic dysreflexia if you have a high spinal cord injury
- Keep skin around the buttocks clean and dry to prevent breakdown
When to See a Doctor
Contact your care team if you have:
- New or worsening constipation, leakage, or loss of bowel control
- Severe abdominal pain, bloating, or no bowel movement for several days
- Signs of stool impaction
- Skin breakdown around the buttocks
Seek emergency care immediately if you have a high spinal cord injury and develop a sudden, severe (pounding) headache, sweating, flushing, and a spike in blood pressure, which can signal autonomic dysreflexia, a life-threatening emergency often triggered by a full bowel or bladder.
Frequently Asked Questions
What is neurogenic bowel?
Neurogenic bowel is loss of normal bowel function and control caused by damage to the nerves that coordinate the intestines and rectum. It is common after spinal cord injury and in conditions such as spina bifida and multiple sclerosis.
What is a bowel program?
A bowel program is a personalized, scheduled routine to empty the bowel regularly and predictably. It combines timing, diet and fluids, medications, and physical techniques, and it is the main way neurogenic bowel is managed to prevent accidents and complications.
Can neurogenic bowel be cured?
The underlying nerve damage usually cannot be reversed, but symptoms can be well managed. A consistent bowel program, proper diet, and medications help most people achieve regular, manageable bowel movements and a better quality of life.
What is autonomic dysreflexia and why does it matter?
In people with a high spinal cord injury, a full bowel or bladder can trigger autonomic dysreflexia, a sudden, dangerous rise in blood pressure with a pounding headache, sweating, and flushing. It is a medical emergency that needs immediate action, often by relieving the trigger.
How can I prevent constipation with neurogenic bowel?
Follow your bowel program consistently, drink enough fluids, eat adequate fiber unless advised otherwise, stay as active as possible, and use prescribed medications. Report worsening constipation early to avoid impaction.
References
- MedlinePlus, U.S. National Library of Medicine. Neurogenic bowel.
- National Institute of Neurological Disorders and Stroke (NINDS). Spinal Cord Injury.
- Christopher & Dana Reeve Foundation. Bowel management.
- Paralyzed Veterans of America. Neurogenic bowel management clinical practice guidelines.