Neurogenic Bowel: Dysfunction and Rehabilitation

Abstract Neurogenic bowel dysfunction (NBD) results from a constellation of interacting impairments that prevent the voluntary control, process and personal management of defecation. NBD results in colonic dysmotility and pelvic floor defecation disorder and directly contributes to symptoms of constipation, fecal incontinence, and abdominal complaints. Taken together, the severity of these often preventable sequelae cause serious medical problems, retract severely from quality of life and increase the expense of care. This chapter presents pertinent anatomy, contemporary physiology, and pathophysiological processes to prepare the clinician to understand NBD issues, and recognize impairments as targets for patient-centered multiple intervention rehabilitation designs. Informed history taking and guided physical examination reveal patterns of impairment such as reflexic upper motor neuron versus areflexic!lower motor neuron NBD, and limitations related to the primary disease processes. Problem and goal-based care plans are assembled as the Bowel Program which is the comprehensive treatment and rehabilitation system including essential components: diet, fluids, physical activity, medications, scheduled Bowel Care, and rectal stimulation. Bowel Care is the process of assisted defecation which includes one or more of the following components: positioning, assistive techniques, rectal stimulation, and adaptive equipment. Innovative and validated surgical procedures accomplish improvements in independence, reductions in care time, and prevention of incontinence. Research and expert opinion have provided evidence-based best practices outlined in randomized studies, very recently updated clinical practice guidelines and patient education media. This chapter meets the education goals required to prepare clinicians to establish interdisciplinary programs of intervention to detect impairments, educate to implement effective treatments and achieve unique life participation outcomes for each patient and family.