Management of neurogenic bowel dysfunction

There are several modalities for treating neurogenic bowel dysfunction (NBD), including conservative treatments (diet, medications, biofeedback, transanal irrigation, massage, electrical stimulation, anal plug). When conservative treatments fail, clinicians can choose from a variety of therapeutic options, including colostomies, Malone anterograde continence enemas, sacral anterior root stimulator implantations, graciloplasties, and artificial bowel sphincters. We reviewed the various treatments for constipation and/or fecal incontinence in patients with NBD and propose over-reaching stepwise algorithms for the management of NBD. Our review included English language articles, randomized controlled studies, cohort studies, case-control studies, and retrospective studies (if necessary) that assessed the management of NBD. Our literature search identified 577 articles, of which 79 met our inclusion criteria. There is little evidence for the success of conservative but non-pharmacological treatments. There is strong evidence for the success of pharmacological interventions (i.e., prokinetic agents) in the treatment of chronic constipation. While surgical interventions may be considered, there is little evidence of their effectiveness. Bowel management programs for patients with neurologic diseases require a multi-faceted approach. While a range of medical and surgical treatments are available, there is little evidence for their effectiveness, with the exception of pharmacological interventions.