Pathophysiology Prevention and Management of Chronic Neurogenic Constipation in Adults
Science Journal of Clinical Medicine
Volume 2, Issue 4, July 2013, Pages: 122-128
Received: Jun. 1, 2013; Published: Jun. 30, 2013
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Authors
Jacek Hermann, Chair and Department of General Surgery, Gastroenterological Oncological Surgery and Plastic Surgery, Poznań University of Medical Sciences, Poznań, Poland
Sławomir Michalak, Chair and Department of Neurology, Poznań University of Medical Sciences, Poznań, Poland
Michał Dopierała, Chair and Department of General Surgery, Gastroenterological Oncological Surgery and Plastic Surgery, Poznań University of Medical Sciences, Poznań, Poland
Dariusz Tertoń, Chair and Department of Neurology, Poznań University of Medical Sciences, Poznań, Poland
Michał Drews, Chair and Department of General Surgery, Gastroenterological Oncological Surgery and Plastic Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Abstract
Neurogenic constipation occurs most commonly after spinal cord injury, in multiple sclerosis and in Parkinson`s disease. Slow colonic transit time is a major disorder. Patients also develop pelvic floor dysfunction. Spinal cord patients are unable to defecate voluntarily due to the loss of the rectal fullness sensation and they depend on the spinal reflexes. Obstructed defecation in upper motor neuron spinal cord injury and in Parkinson`s disease is a result of inability to relax the pelvic floor muscles, whereas in the lower type of injury it is due to hyporeactivity of the rectum. In multiple sclerosis it is a combination of lesions from different levels of the nervous system. In diagnosis, neurological and proctologic examinations are required followed by colonic transit time, defecography and anorectal manometry. Most of the patients respond positively on medical treatment. However, a small group of them requires surgical treatment in the form of either colostomy or ileostomy.
Keywords
Neurogenic Constipation, Pathophysiology, Prevention, Management
To cite this article
Jacek Hermann, Sławomir Michalak, Michał Dopierała, Dariusz Tertoń, Michał Drews, Pathophysiology Prevention and Management of Chronic Neurogenic Constipation in Adults, Science Journal of Clinical Medicine. Vol. 2, No. 4, 2013, pp. 122-128. doi: 10.11648/j.sjcm.20130204.11
References
[1]
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130: 1480-91.
[2]
Gabella G. Innervation of the gastroinestinal tract. Int Rev Cytol. 1979; 59: 129-193.
[3]
Gill RC, Cote KR, Bowes KL, Kingma YJ. Human colonic smooth muscle: Spontaneous contractile activity and response to stretch. Gut. 1986; 27: 1006-1013.
[4]
Woźniak W. Digestive Tract. Human Anatomy. Wrocław: Urban & Partner; 2001.
[5]
Devroede G, Lamarche J. Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man. Gastroenterology. 1974; 66(2): 273-80.
[6]
Meihoff WE, Kern F Jr. Bile salt malabsorption in regional ileitis, ileal resection and mannitol-induced diarrhea. J Clin Invest. 1968; 47(2): 261-267.
[7]
Phillips S.F., Edwards A.W. Some aspects of anal continence and defaecation. Gut. 1965; 6: 396-406.
[8]
Henry M.H., Parks A.G. The investigation of anorectal function. Hospital Update. 1980; 1: 29-41.
[9]
Shafik A., Ali Y.A., Afifi R. Is the rectum a conduit or storage organ? Int Surg. 1997; 82: 194-197.
[10]
Pedersen V, Müller PG, Biering-Sørensen F. Traumatic spinal cord injuries in Greenland 1965-1986. Paraplegia. 1989; 27(5): 345-349.
[11]
De Looze D, Van Laere M, De Muynck M, Beke R, Elewaut A. Constipation and other chronic gastrointestinal problems in spinal cord injury patients. Spinal Cord. 1998;36(1): 63-66.
[12]
Mac Donagh R, Sun W, Smallwood R. Anorectal function in patients with complete supraconal spinal cord lesions. Gut. 1992; 33: 1532-1538.
[13]
Devroede G, Lamarche J. Functional importance of extrinsic parasympathetic innervation to the distal colon and rectum in man. Gastroenterology. 1974; 66(2): 273-80.
[14]
Hinds JP, Eidelman BH, Wald A. Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology. 1990; 98(6): 1538-42.
[15]
Krogh K, Ostergaard K, Sabroe S, Laurberg S. Clinical aspects of bowel symptoms in Parkinson's disease. Acta Neurol Scand. 2008; 117(1): 60-64.
[16]
Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol. 2010; 8: 955-960.
[17]
Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radioopaque markers. Gut. 1969; 10: 842-7.
[18]
Evans RC, Kamm MA, Hinton JM, Lennard-Jones JE. The normal range and a simple diagram for recording whole gut transit time. Int J Colorectal Dis. 1992; 7: 15-17.
[19]
Mahieu P, Pringot J, Bodart P. Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol. 1984; 9: 247-51.
[20]
Mahieu P, Pringot J, Bodart P. Defecography: II. Contribution to the diagnosis of defecation disorders. Gastrointest Radiol. 1984; 9: 253-61.
[21]
Pucciani F, Ringressi MN. Obstructed defecation: the role of anorectal manometry. Tech Coloproctol. 2012; 16: 67-72.
[22]
Astarloa R, Mena MA, Sánchez V, de la Vega L, de Yébenes JG. Clinical and pharmacokinetic effects of a diet rich in insoluble fiber on Parkinson disease. Clin Neuropharmacol. 1992 Oct;15(5):375-80.
[23]
Cameron KJ, Nyulasi IB, Collier GR, Brown DJ. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Spinal Cord. 1996 May;34(5):277-83.
[24]
Müller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. Br Med J. 1988; 296: 615-7.
[25]
Sturtzel B, Mikulits C, Gisinger C, Elmadfa I. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors. J Nutr Health Aging. 2009; 13: 136-139.
[26]
Dipalma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007; 102: 1436-41.
[27]
Tramonte SM, Brand MB, Mulrow CD, Amato MG, O'Keefe ME, Ramirez G. The treatment of chronic constipation in adults. A systematic review. J Gen Intern Med. 1997; 12: 15-24.
[28]
Kienzle-Horn S, Vix JM, Schuijt C, Peil H, Jordan CC, Kamm MA. Comparison of bisacodyl and sodium picosulphate in the treatment of chronic constipation. Curr Med Res Opin. 2007; 23: 691-699.
[29]
Marlett JA, Li BU, Patrow CJ, Bass P. Comparative laxation of psyllium with and without senna in an ambulatory constipated population. Am J Gastroenterol. 1987; 82: 333-337.
[30]
Hiyama T, Yoshihara M, Tanaka S, Haruma K, Chayama K. Effectiveness of prokinetic agents against diseases external to the gastrointestinal tract. J Gastroenterol Hepatol. 2009; 24(4): 537-46.
[31]
Clinical practice guidelines: Neurogenic bowel management in adults with spinal cord injury. Spinal Cord Medicine Consortium. J Spinal Cord Med. 1998 Jul;21(3):248-93.
[32]
Koch SM, Melenhorst J, van Gemert WG, Baeten CG. Prospective study of colonic irrigation for the treatment of defaecation disorders. Br J Surg. 2008; 95(10): 1273-1279.
[33]
Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol. 2010; 105: 890-896.
[34]
Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336(8725):1217-1218.
[35]
Worsøe J, Christensen P, Krogh K, Buntzen S, Laurberg S. Long-term results of antegrade colonic enema in adult patients: assessment of functional results. Dis Colon Rectum. 2008;51(10):1523-1528.
[36]
Luther SL, Nelson AL, Harrow JJ, Chen F, Goetz LL. A comparison of patient outcomes and quality of life in persons with neurogenic bowel: standard bowel care program vs colostomy. J Spinal Cord Med. 2005; 28(5): 387-393.
[37]
Lombardi G, Nelli F, Mencarini M, Del Popolo G. Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury. Spinal Cord. 2011; 49(5): 629-36.
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