What is a neurogenic bowel and what causes it?
A neurogenic bowel means that you are suffering from nerve damage that is causing your bowel to not work properly. The nerves and muscles in your digestive tract need to work together for your bowels to work correctly. When these nerves are damaged, and the signals from brain to bowel are disrupted, you are likely to have difficulties controlling your bowels. This means that you might not be able to go for a poo when you want, or you might not be able to feel when you have a bowel movement anymore. A neurogenic bowel is caused by a neurological condition like spinal cord injuries or certain nerve diseases like MS or Parkinson’s disease.
What are the symptoms of a neurogenic bowel?
The symptoms of a neurogenic bowel aren’t much different to the symptoms caused by bowel problems that aren’t related to nerve damage. The root cause is the main thing that’s different. As we have already explored, with a neurogenic bowel you might have trouble going for a poo or you might leak stool involuntarily. In addition, you might also get belly pains and aches, and, in some cases, you might experience a complete loss of sensation and bowel control. The most common symptoms of a neurogenic bowel are:
- Rectal bleeding
- Feeling full quickly or not feeling hungry at all
- Leaking stool or frequent accidents
- Not being able to feel that your bowel is full
- Constipation of diarrhoea
- Trouble having bowel movements
- Upset stomach, nausea, or belly aches
- Swollen abdomen
- Loose stools or very hard stools
- Sudden bowel movements without warning
Different types of neurogenic bowel
Which type of neurogenic bowel you experience is fully dependent on where along the spinal cord the nerve damage has occurred. If the damage is above the T12 vertebrae, you are most likely experiencing a reflex or spastic bowel, below the T12 vertebrae you are likely to experience a flaccid bowel.
Reflex or spastic bowel
If you are suffering from a reflex or spastic bowel, the nerve damage will have likely happened around your neck or chest. With a spastic bowel it is likely that you’re not able to relax your anal sphincter or you might not even be able to feel the need to go for a poo. Stool is still building up in your rectum, however, which can trigger the reflex to have a bowel movement. If your anal sphincter relaxes, this can lead to a bowel movement without warning.
A flaccid bowel is common when the nerve damage has occurred at the lower end of your spine. This will likely leave you unable to feel when you need to go for a poo. It can also cause reduced movement of your bowel and your sphincters might also be looser than normal. If your reflex is reduced, you can have difficulty emptying stool from your rectum, which can lead to constipation with frequent leaking of stool.
How is a neurogenic bowel diagnosed?
To diagnose a neurogenic bowel, your doctor will likely ask you to keep a stool diary, do an MRI and a CT scan of your brain and spinal cord, an ultrasound of the anus, called nonometry, or conduct a transit study. Your doctor will also speak to you about your health history as well as the recent symptoms you have been experiencing, e.g. how often accidents happen or how constipated you have been lately.
How is a neurogenic bowel treated?
Once you have been diagnosed with a neurogenic bowel, the treatment usually consists of a routine bowel management program. These programs can include anything from small dietary changes to a whole diet plan, an exercise plan to train the abdominal muscles, or medication to promote your bowel function.
- Digital rectal stimulation to help with your bowel movements
- An exercise and activity plan to strengthen your abdominal muscles
- Scheduled routines to remove stool from the rectum to prevent accidents and constipation
- Small dietary changes or a whole diet plan
- Medication to promote your bowel function
- Stoma surgery
This plan will generally be created together with your nurse and doctor to work out the best bowel management program for your individual requirements.
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