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Neurogenic bowel dysfunction
Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida.

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The gastrointestinal tract has a complex control that relies on coordinated interaction between muscular contractions and neuronal impulses. Faecal incontinence or constipation occurs when there is a problem with the normal bowel functioning; this could be for a variety of reasons. The normal defecation pathway involves contractions of the colon in order to help mix the contents, absorb water and propel the contents along the intestine. This results in the faeces moving from the colon to the rectum. The presence of stool in the rectum causes a reflexive relaxation of the internal anal sphincter, so the contents of the rectum can move in to the anal canal. This causes the conscious feeling of the need to defecate. At a suitable time our brain can send signals causing the external anal sphincter and puborectalis muscles to relax as these are under voluntary control and this allows defecation to take place.

Spinal cord injury, congenital defects like myelomeningocele that affect the spine and nervous system, and other neurological problems mostly affect the lower GI tract leading to symptoms of incontinence or constipation. However, the upper GI tract may also be affected and patients with neurogenic bowel often present with multiple symptoms. Research shows there is a high prevalence of upper abdominal complaints, for example a study showed that approximately 22% of SCI patients reported feeling bloated and about 31% of SCI patients’ experienced abdominal distension.

Signs and symptoms
Neurogenic bowel dysfunction can have an impact on a person's life as it often leads to difficulties with self-esteem, personal relationships, employment, social life and can also reduce a person's independence. There is also evidence from studies showing that faecal incontinence can increase the risk of depression and anxiety.

Spina bifida
Patients with Spina Bifida myelomeningocele have a neural tube that has failed to completely form. This is most commonly in the lower back area in the region of the conus medullaris or cauda equina. Nervous system lesions above the conus medullaris result in upper motor nerogenic bowel dysfunction leading to failure to evacuate the bowel, resulting in constipation or impaction. Lesions at or below the level of the conus medullaris result in lower motor nerogenic bowel dysfunction, resulting in failure to contain stool and thus fecal incontinence. This affects the bowel similarly to a spinal cord injury affecting the lower motor neuron resulting in a flaccid unreactive rectal wall and means the anal sphincter doesn't contract and close therefore leading to stool leakage. Most patients with spina bifida also have hydrocephalus. While hydrocephalus can result in intellectual deficits, [WE ARE LOOKING INTO WHETHER THE REFERENCE STATES THIS, AND TO PROVIDE UPDATED INFO] that may contribute to faecal incontinence.

Management
Management and treatment for neurogenic bowel dysfunction depends on symptoms and biomedical diagnosis for cause of the condition. General practitioners will often refer patients to gastroenterologist to effectively manage the neurogenic bowel dysfunction. Research has been conducted on a variety of therapy and treatments for neurogenic bowel dysfunction including: diet modification, laxatives, magnetic and electrical stimulation, manual evacuation of feces and abdominal massage, enemas, and pulsed irrigation evacuation (PIE). Efficacy studies for pulsed irrigation evacuation with PIEMED demonstrated favorable results, removing stool of 98% of patients who used it for ineffective bowel routine, symptomatic impaction, or asymptomatic impaction. In the most severe of cases of neurogenic bowel dysfunction induced fecal impaction, surgical interventions like colostomy are used to disrupt the dense mass of stool.

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