Bowel dysfunction in spinal cord injury

Spinal cord injury is a primary cause of neurogenic bowel or neurogenic bowel dysfunction, terms used to define a colonic dysfunction originated by a disease or lesions of the central nervous system. A high percentage of subjects with spinal cord injury present some kind of symptoms linked to neurogenic bowel dysfunction, mainly constipation, fecal incontinence, pain, and abdominal distension. The assessment of neurogenic bowel dysfunction is usually almost exclusively clinical, and additional investigations such as the measurement of colonic transit time or anorectal manometry are scarcely used in clinical practice. The Bristol scale is a fast and simple instrument to assess stool consistency. The International SCI Bowel Function Basic and Extended Data Sets are data collection protocols of bowel function used after SCI that provide clinical and research uniformity. The aim of the treatment is to achieve continence and empty the bowel at a planned time and frequency, to prevent complications. Thus, the initial therapeutic approach focuses on the establishment of a bowel program and includes dietary changes and physical/pharmacological techniques. Should these measures fail, transanal irrigation may be the solution. Finally, surgical techniques are indicated to selected patients for whom conservative methods are insufficient to control the symptoms or with complications derived from SCI.