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Neurogenic Bowel
Upper Motor Neuron Lower Motor Neuron
UMN Features
  • suprasacral segment damage
  • defecation cannot be initiated by voluntary relaxation of the external anal sphincter
  • reflex-mediated colonic peristalsis
  • digital stimulation may be performed
Medications
  • Oral
    • Stool softeners and bulking agents
    • Stimulant agents and osmotic agents taken 8-12h before evacuation
  • Rectal
    • stimulant suppositories or mini-enemas trigger a reflex evacuation of the colon/rectum
  • References

    Kirshblum S, Nieves J, Clark D, Gonzalez P, Cuccurullo SJ, Luciano L. Physical Medicine and Rehabilitation Board Review. Cuccurullo SJ LJ, editor. 3 rd ed. New York, NY: Demos Medical; 2015. Chapter 7, Spinal cord injuries. p.551-620.

LMN Features
  • S2-S4 anterior horn cell or cauda equina damage
  • No reflex mediated colonic peristalsis
  • Slow stool propulsion coordinated by the intrinsically innervated myenteric plexus
  • Anal sphincter is typically atonic and prone to stool leakage
Medications
  • Oral
    • bulking agents (fiber) help produce a bulky formed stool
  • Rectal
    • Suppositories or mini-enemas are not helpful
  • References

    Gor RA, Katorski JR, Elliott SP. Medical and surgical management of neurogenic bowel. Curr Opin Urol 2016 Jul;26(4):369-375.

    Kirshblum S, Nieves J, Clark D, Gonzalez P, Cuccurullo SJ, Luciano L. Physical Medicine and Rehabilitation Board Review. Cuccurullo SJ LJ, editor. 3rd ed. New York, NY: Demos Medical; 2015. Chapter 7, Spinal cord injuries. p.551-620.