Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013

Abstract

Background Evidence‐based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world‐wide relevance. Aims To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009. Materials and Methods A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013. Results The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management. Discussion The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.

Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

“…Therefore, the level of evidence was not adequate to be able to make any strong recommendations for the management of NBD in patients with MS 5. However, no intervention has absolute contraindication, and a structured approach, employing all the existing armamentarium and the lessons learned particularly with SCI patients, should allow the development of a bowel regime and a routine 6…”

“…Given the paucity of studies, particularly on treatment, a systematic review was not possible, and this is therefore a narrative review, which includes all studies on the pathophysiology of MS-related bowel dysfunction and its treatment. With regards to symptom management strategies, any recommendation is based on the 2014 Cochrane review on the management of neurogenic bowel dysfunction5 (NBD) and on expert consensus 6…”

Neurogenic bowel dysfunction

“…The three cardinal aims of bowel care are to ensure toileting occurs in as time efficient a way as possible, to avoid fecal incontinence, and to minimize impairment of quality of life secondary to the bowel management plan 32 . This can be achieved through the use of diet, bowel routine, medication, and physical techniques.…”

“…This can be achieved through the use of diet, bowel routine, medication, and physical techniques. No matter the methods used, patient education and training are central to achieving success 32 .…”

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

“…weight or blood loss) or comorbidities. 378 The National Institute for Health and Care Excellence (NICE) guidelines, 379 instead, suggest clinical examination as a first step and a combination of anorectal physiology tests and endoanal ultrasonography (or MRI if ultrasonography is not available) in patients with FI who are candidates for surgical treatment. These data, as also indicated by our review, emphasize the lack of standardization in FI assessment.…”