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Management of Bowel Dysfunction in Patients with Central Nervous System Diseases

  • Gabriele BazzocchiEmail author
  • Mimosa Balloni
  • Erica Poletti
  • Roberta Manara
  • Paola Mongardi
  • Marica Vicchi
  • Eugenia Fragalà
  • Elena Demertzis
  • Antonella Manzan
  • Humberto Cerrel Bazo
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)

Abstract

Pathologies affecting the central nervous system (CNS), involve alterations of digestive functions and, in particular, defecation disorders. This is not surprising when considering that the ability to control bladder and bowel emptying is the last function that the Homo sapiens “cub” learns. Even minor injuries of nerve pathways and control centers can easily compromise the integrated and delicate visceral, pelvic, and perineal dynamic. Reduced propulsion within the large intestine; abdominal-perineal dyssynergia due to deficiency and incoordination of pelvic floor muscles, associated with anorectal hyposensitivity; deficit of voluntary contraction of external anal sphincter; and abnormalities of internal sphincter reflex are the pathophysiological mechanisms underlying Neurogenic Bowel Dysfunction. Differently from bladder, in the digestive tract wall lies a neuronal network which is comparable, in terms of number and complexity of cells and connections, to the brain, which allows the bowel to have its own peristalsis even if totally isolated from CNS and ANS. Moreover, the type of content that is evacuated from the two organs: it is liquid from the bladder, from semiliquid to solid from the bowel and this is determined by the presence of bacteria originating from the colon microbiota, the most complex ecosystem in terms of microorganism concentration on the planet Earth. So, intestinal rehabilitation programs differ between bladder and bowel: bowel mangement considers drugs for improving propulsion of the colonic intraluminal content and assistence to rectal discharge, but also measures for guaranteing a regular volume and consistency of the fecal mass. Trans Anal irrigation have proven to be the best approach for restoring the physiologic features of defecations in these patients.

Keywords

Neurogenic bowel dysfunction Neurogenic bowel management Spinal cord injury Trans anal irrigation Intestinal rehabilitation Protocol for bowel management 

Notes

Acknowledgments

The authors are indebted to Dr. Cecilia Baroncini, Scientific Office of the Montecatone Rehabilitation Institute, for the secretarial assistance.

References

  1. 1.
    Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol. 2009;23:531–43.CrossRefGoogle Scholar
  2. 2.
    Bazzocchi G, Schuijt C, Pederzini R, Menarini M. Bowel dysfunction in spinal cord injury patients: pathophysiology and management. Pelviperineology. 2007;26:84–7.Google Scholar
  3. 3.
    Valles M, Mearin F. Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury. Dis Colon Rectum. 2009;52:1589–97.CrossRefGoogle Scholar
  4. 4.
    Salvioli B, Bazzocchi G, Barbara G, Stanghellini V, Cremon C, Menarini M, Corinaldesi R, De Giorgio R. Sigmoid compliance and visceral perception in spinal cord injury patients. Eur J Gastroenterol Hepatol. 2012;24:340–5.CrossRefGoogle Scholar
  5. 5.
    Burns AS, St-Germain D, Connolly M, Delparte JJ, Guindon A, Hitzig SL, Craven BC. Phenomenological study of neurogenic bowel from the perspective of individuals living with spinal cord injury. Arch Phys Med Rehabil. 2015;96:49–55.CrossRefGoogle Scholar
  6. 6.
    Patel DP, Elliott SP, Stoffel JT, Brant WO, Hotaling JM, Myers JB. Patient reported outcomes measures in neurogenic bladder and bowel: a systematic review of the current literature. Neurourol Urodyn. 2016;35:8–14.CrossRefGoogle Scholar
  7. 7.
    Costa M, Wiklendt L, Simpson P, Spencer NJ, Brookes SJ, Dinning PG. Neuromechanical factors involved in the formation and propulsion of fecal pellets in the guinea-pig colon. Neurogastroenterol Motil. 2015;10:1466–77.CrossRefGoogle Scholar
  8. 8.
    Vandeputte D, Falony G, Vieira-Silva S, Tito RY, Joossens M, Raes J. Stool consistency is strongly associated with gut microbiota richness and composition, enterotypes and bacterial growth rates. Gut. 2016;65:57–62.CrossRefGoogle Scholar
  9. 9.
    Bengmark S. Ecological control of the gastrointestinal tract. The role of probiotic flora. Gut. 1998;42:2–7.CrossRefGoogle Scholar
  10. 10.
    Quigley EMM. The enteric microbiota in the pathogenesis and management of constipation. Best Pract Res Clin Gastroenterol. 2011;25:119–26.CrossRefGoogle Scholar
  11. 11.
    Juul T, Bazzocchi G, Coggrave M, Johannesen IL, Hansen RBM, Thiyagaraian C, Poletti E, Krogh K, Christensen P. Reliability of the international spinal cord injury bowel function basic and extended data sets. Spinal Cord. 2011;49:886–92.CrossRefGoogle Scholar
  12. 12.
    Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol stool form scale in healthy adults and patients with diarrhea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44:693–703.CrossRefGoogle Scholar
  13. 13.
    Chumpitazi BP, Self MM, Czyzewski DI, Cejka S, Swank PR, Shulman RJ. Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designation. Neurogastroenterol Motil. 2016;28:443–8.CrossRefGoogle Scholar
  14. 14.
    Krogh K, Christensen P, Sabroe S, Laurberg S. Neurogenic bowel dysfunction score. Spinal Cord. 2006;44:625–31.CrossRefGoogle Scholar
  15. 15.
    Abrahamsson H, Antov S. Accuracy in assessment of colonic transit time with particles: how many markers should be used? Neurogastroenterol Motil. 2010;22:1164–9.CrossRefGoogle Scholar
  16. 16.
    Knudsen K, Fedorova TD, Bekker AC, Iversen P, Ostergaard K, Krogh K, Borghammer P. Objective colonic dysfunction is far more prevalent than subjective constipation in Parkinson’s disease: a colon transit and volume study. J Park Dis. 2017;7:359–67.Google Scholar
  17. 17.
    Corazziari E, Badiali D, Bazzocchi G, Bassotti G, Roselli P, Mastropaolo G, Lucà MG, Galeazzi R, Peruzzi E. Long term efficacy, safety, and tolerability of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut. 2000;46:522–6.CrossRefGoogle Scholar
  18. 18.
    Bazzocchi G. Polyethylene glycol solution in subgroups of chronic constipation patients: experience in obstructed defaecation. Ital J Gastroenterol Hepatol. 1999;31(Suppl.3):S257–9.PubMedGoogle Scholar
  19. 19.
    Bazzocchi G, Giussani C, Brigidi P, Turroni S. Effect of a symbiotic preparation on symptoms, stool consistency, intestinal transit time and gut microbiota in patients with severe functional constipation: a double blind, controlled trial. Tech Coloproctol. 2014;18:945–53.CrossRefGoogle Scholar
  20. 20.
    DeMicco MP, Clayton LB, Pilot J, Epstein MS, NOCT Study Group. Novel 1 L polyethylene glycol-based bowel preparation NER 1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest Endosc. 2018;87:677–88.CrossRefGoogle Scholar
  21. 21.
    Bazzocchi G, Giuberti R. Irrigation, lavage, colonic hydrotherapy: from beauty center to clinic? Tech Coloproctol. 2017;21:1–4.CrossRefGoogle Scholar
  22. 22.
    Parekh PJ, Burleson D, Lubin C, Johonson DA. Colon irrigation: effective, safe, and well-tolerated alternative to traditional therapy in the management of refractory chronic constipation. J Clin Gastroenterol Hepatol. 2018;2:1–5.CrossRefGoogle Scholar
  23. 23.
    Parè P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Can J Gastroenterol Hepatol. 2014;28:549–57.CrossRefGoogle Scholar
  24. 24.
    Miner PB Jr, Camilleri M, Burton D, Achenbach H, Wan H, Dragone J, Mellgard B. Prucalopride induces high-amplitude propagating contractions in the colon of patients with chronic constipation: a randomized study. Neurogastroenterol Motil. 2016;28:1341–8.CrossRefGoogle Scholar
  25. 25.
    Krogh K, Bach Jensen M, Gandrup P, Laurberg S, Nilsson J, Kerstens R, De Pauw M. Efficacy and tolerability of prucalopride in patients with constipation due to spinal cord injury. Scand J Gastroenterol. 2002;37:431–6.CrossRefGoogle Scholar
  26. 26.
    Roarty TP, Weber F, Soykan I, McCallum RW. Misoprostol in the treatment of chronic refractory constipation: results of a long-term open label trial. Aliment Pharmacol Ther. 1997;11:1059–66.CrossRefGoogle Scholar
  27. 27.
    Hawkyard CV, Koerner RJ. The use of erythromycin as a gastrointestinal prokinetic agent in adult critical care: benefits versus risks. J Antimicrob Chemother. 2007;59:347–58.CrossRefGoogle Scholar
  28. 28.
    Menarini M, Orlandi S, Geccherle A, Bocus P, Bazzocchi G. Efficacia della procedura di Irrigazione Trans Anale con il dispositivo Qufora-PMC nel trattamento della stipsi severa. Pelviperineologia. 2017;36:3–8.Google Scholar
  29. 29.
    Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, Media S, Laurberg S. Treatment of fecal incontinence and constipation in patients with spinal cord injury: a prospective, randomized, controlled, multicenter trial of transanal irrigation vs conservative bowel management. Gastroenterology. 2006;131:738–47.CrossRefGoogle Scholar
  30. 30.
    Midrio P, Mosiello G, Ausili E, Gamba P, Marte A, Lombardi L, Iacobelli BD, Caponcelli E, Marrello S, Meroni M, Brisighelli G, Leva E, Rendeli C. Peristeen transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study. Color Dis. 2016;18:86–93.CrossRefGoogle Scholar
  31. 31.
    Bazzocchi G, Poletti E, Avogadri A. L’irrigazione retrograda transanale per il bowel management del paziente con lesione midollare mediante dispositive a pressione costante: razionale e procedura per l’utilizzo del Peristeen. Pelviperineology. 2012;31:85–92.Google Scholar
  32. 32.
    Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, Media S, Laurberg S. Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury? J Spinal Cord Med. 2008;31:560–7.CrossRefGoogle Scholar
  33. 33.
    Emmanuel AV, Krogh K, Bazzocchi G, Leroi AM, Bremers A, Leder D, van Kuppevelt D, Mosiello G, Vogel M, Perrouin-Verbe B, Coggrave M, Christensen P. Consensus review of best practice of transanal irrigation in adults. Spinal Cord. 2013;51:732–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gabriele Bazzocchi
    • 1
    Email author
  • Mimosa Balloni
    • 1
  • Erica Poletti
    • 1
  • Roberta Manara
    • 1
  • Paola Mongardi
    • 1
  • Marica Vicchi
    • 1
  • Eugenia Fragalà
    • 2
  • Elena Demertzis
    • 3
  • Antonella Manzan
    • 3
  • Humberto Cerrel Bazo
    • 3
  1. 1.NeuroGastroenterology and Intestinal Rehabilitation Unit, Montecatone Rehabilitation Institute S.p.A.Imola (BO)Italy
  2. 2.Department of UrologyHospital G.B. Morgagni- L. Pierantoni of ForlíForlí-CesenaItaly
  3. 3.Spinal Unit, Ospedale Riabilitativo di Alta Specializzazione S.p.A.Motta di Livenza (TV)Italy

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