Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Neurogenic Bowel Dysfunction Medication

  • Author: Juan L Poggio, MD, MS, FACS, FASCRS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
 
Updated: May 26, 2016
 

Medication Summary

Drugs used for management of neurogenic bowel dysfunction (NBD) include laxatives and stool softeners aimed at stimulating peristalsis with subsequent loosening and expulsion of feces.

Next

Colonic stimulants

Class Summary

Colonic stimulants are used to promote peristalsis.

Bisacodyl (Dulcolax, Bisac Evac, Bisco-Lax)

 

Bisacodyl is a colonic laxative stimulant that acts by directly stimulating colonic mucosa to produce peristalsis. It is used for relief of constipation and irregularity. This agent is available in 10-mg tablets or suppositories.

Senna (Senokot)

 

Senna is a natural vegetable derivative that causes neuroperistaltic stimulation. It comes in tablet or syrup form and is available in combination with docusate sodium (Senokot-S).

Previous
Next

Hyperosmolar agents

Class Summary

Hyperosmolar agents are used for short-term treatment of constipation.

Sodium phosphate (Fleet enema)

 

Sodium phosphate is a purgative and laxative used in constipation and as a component of a bowel-cleansing regimen in preoperative patients.

Previous
Next

Bulking agents

Class Summary

Bulking agents absorb water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time.

Psyllium (Metamucil, Citrucel)

 

Psyllium contains natural fiber that acts to increase the content of feces and, at the same time, promotes bacterial growth. Its main uses are in chronic constipation, irritable bowel syndrome, and bowel management in cases of patients with hemorrhoids.

Previous
Next

Stool softeners

Class Summary

Stool-softening agents help keep stools soft to facilitate easy, natural passage.

Docusate sodium (Colace, Surfak)

 

Docusate sodium is a surface-active agent used in painful anorectal conditions and cardiac conditions where maximum ease of stool passage is desired. Therevac minienema is a combination of glycerin and docusate sodium in a polyethylene glycol (PEG) base; it has been shown to produce more rapid results than a bisacodyl suppository. Docusate is available in 100-mg capsules, 20 mg/5 mL syrup, and 200 mg/5 mL microenema.

Previous
Next

Osmotic agents

Class Summary

Osmotic agents promote bowel movement through osmotic action that holds water in the small intestine and colon.

Polyethylene glycol (PEG) solution (Miralax)

 

PEG solution is used for treatment of occasional constipation. In theory, there is less risk of dehydration or electrolyte imbalance with isotonic PEG than with hypertonic sugar solutions. The laxative effect is generated because PEG is not absorbed and continues to hold water by osmotic action through the small bowel and the colon, resulting in mechanical cleansing. PEG solution is supplied with a measuring cap marked to contain 17 g of laxative powder when filled to the indicated line. It may take 48-96 hours to produce bowel movement.

Previous
Next

Opioid antagonist

Class Summary

Use of a peripherally selective opioid antagonist may be considered for treating constipation in patients who have advanced illness necessitating long-term opioid analgesia and who are unresponsive to laxatives.

Methylnaltrexone (Relistor)

 

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that selectively displaces opioids from mu-opioid receptors outside the central nervous system (CNS), including those located in the gastrointestinal (GI) tract, thereby decreasing constipating effects. It is indicated for opioid-induced constipation in patients with advanced illness who are receiving palliative care when their response to laxatives has not been sufficient. Methylnaltrexone is available as a 12 mg/0.6 mL injectable solution for subcutaneous use.

Previous
 
Contributor Information and Disclosures
Author

Juan L Poggio, MD, MS, FACS, FASCRS Associate Professor of Surgery, Director of Robotic Colon and Rectal Surgery, Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine

Juan L Poggio, MD, MS, FACS, FASCRS is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Julie G Grossman, MD Resident Physician in General Surgery, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Medical Association, Academy of Spinal Cord Injury Professionals

Disclosure: Nothing to disclose.

Chief Editor

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Teresa L Massagli, MD Professor of Rehabilitation Medicine, Adjunct Professor of Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Acknowledgements

Medscape Reference thanks Dawn Sears, MD, Associate Professor of Internal Medicine, Division of Gastroenterology and Hepatology, Scott and White Memorial Hospital; and Dan C Cohen, MD, Fellow in Gastroenterology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine, for assistance with the video contribution to this article.

References
  1. Coggrave M, Norton C. Neurogenic bowel. Handb Clin Neurol. 2013. 110:221-8. [Medline].

  2. Gor RA, Katorski JR, Elliott SP. Medical and surgical management of neurogenic bowel. Curr Opin Urol. 2016 May 5. [Medline].

  3. Ash D. Sustaining safe and acceptable bowel care in spinal cord injured patients. Nurs Stand. 2005 Nov 2-8. 20 (8):55-64, quiz 66. [Medline].

  4. Benevento BT, Sipski ML. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther. 2002 Jun. 82 (6):601-12. [Medline]. [Full Text].

  5. Gurjar SV, Jones OM. Physiology: evacuation, pelvic floor and continence mechanisms. Surgery. 2011 Aug. 29 (8):358-61.

  6. Brading A, Ramalingham T. Mechanisms controlling normal defaecation and the potential effects of spinal cord injury. Weaver LC, Polosa C (eds). Progress in Brain Research. Philadelphia: Elsevier; 2006. 345-58.

  7. Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol. 2009. 23 (4):531-43. [Medline].

  8. Coggrave M. Management of neurogenic bowel. Br J Neurosci Nurs. 2005. 1:6-13.

  9. Pellat GC. Neurogenic continence. Part 1: pathophysiology and quality of ilfe. Br J Nurs. 2008 Jul 10-23. 17 (13):836-41. [Medline].

  10. Wiesel P, Bell S. Bowel dysfunction: assessment and management in the neurological patient. Bowel Continence Nursing. 2004. 181-203.

  11. Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol. 1996 Jan. 91 (1):33-6. [Medline].

  12. Nelson RL. Epidemiology of fecal incontinence. Gastroenterology. 2004 Jan. 126 (1 Suppl 1):S3-7. [Medline].

  13. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004 Apr. 99 (4):750-9. [Medline].

  14. Krogh K, Nielsen J, Djurhuus JC, Mosdal C, Sabroe S, Laurberg S. Colorectal function in patients with spinal cord lesions. Dis Colon Rectum. 1997 Oct. 40 (10):1233-9. [Medline].

  15. Glickman S, Kamm MA. Bowel dysfunction in spinal-cord-injury patients. Lancet. 1996 Jun 15. 347 (9016):1651-3. [Medline].

  16. Hinds JP, Eidelman BH, Wald A. Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology. 1990 Jun. 98 (6):1538-42. [Medline].

  17. Coggrave M, Norton C, Cody JD. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev. 2014 Jan 13. 1:CD002115. [Medline].

  18. Krogh K, Ostergaard K, Sabroe S, Laurberg S. Clinical aspects of bowel symptoms in Parkinson's disease. Acta Neurol Scand. 2008 Jan. 117 (1):60-4. [Medline].

  19. Doshi VS, Say JH, Young SH, Doraisamy P. Complications in stroke patients: a study carried out at the Rehabilitation Medicine Service, Changi General Hospital. Singapore Med J. 2003 Dec. 44 (12):643-52. [Medline]. [Full Text].

  20. Sonnenberg A, Tsou VT, Müller AD. The "institutional colon": a frequent colonic dysmotility in psychiatric and neurologic disease. Am J Gastroenterol. 1994 Jan. 89 (1):62-6. [Medline].

  21. Ozisler Z, Koklu K, Ozel S, Unsal-Delialioglu S. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regen Res. 2015 Jul. 10 (7):1153-8. [Medline]. [Full Text].

  22. Caruana BJ, Wald A, Hinds JP, Eidelman BH. Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology. 1991 Feb. 100 (2):465-70. [Medline].

  23. Yi Z, Jie C, Wenyi Z, Bin X, Hongzhu J. Comparison of efficacies of vegetable oil based and polyethylene glycol based bisacodyl suppositories in treating patients with neurogenic bowel dysfunction after spinal cord injury: a meta-analysis. Turk J Gastroenterol. 2014 Oct. 25 (5):488-92. [Medline]. [Full Text].

  24. Gordon M, Naidoo K, Akobeng AK, Thomas AG. Cochrane Review: Osmotic and stimulant laxatives for the management of childhood constipation (Review). Evid Based Child Health. 2013 Jan. 8 (1):57-109. [Medline].

  25. Coggrave M. Neurogenic continence. Part 3: Bowel management strategies. Br J Nurs. 2008 Aug 14-Sep 10. 17 (15):962-8. [Medline].

  26. Hoy NY, Metcalfe P, Kiddoo DA. Outcomes following fecal continence procedures in patients with neurogenic bowel dysfunction. J Urol. 2013 Jun. 189 (6):2293-7. [Medline].

  27. Gstaltner K, Rosen H, Hufgard J, Märk R, Schrei K. Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome. Spinal Cord. 2008 Sep. 46 (9):644-7. [Medline]. [Full Text].

  28. Lombardi G, Del Popolo G, Cecconi F, Surrenti E, Macchiarella A. Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord. 2010 Feb. 48 (2):154-9. [Medline]. [Full Text].

  29. Rasmussen MM, Kutzenberger J, Krogh K, Zepke F, Bodin C, Domurath B, et al. Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury. Spinal Cord. 2015 Apr. 53 (4):297-301. [Medline].

  30. Levitt M, Peña A. Update on pediatric faecal incontinence. Eur J Pediatr Surg. 2009 Feb. 19 (1):1-9. [Medline].

  31. Griffin SJ, Parkinson EJ, Malone PS. Bowel management for paediatric patients with faecal incontinence. J Pediatr Urol. 2008 Oct. 4 (5):387-92. [Medline].

  32. Emmanuel A. Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction. Spinal Cord. 2010 Sep. 48 (9):664-73. [Medline]. [Full Text].

  33. Christensen P, Andreasen J, Ehlers L. Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients. Spinal Cord. 2009 Feb. 47 (2):138-43. [Medline].

  34. [Guideline] Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke. 2005 Sep. 36 (9):e100-43. [Medline]. [Full Text].

Previous
Next
 
Administration of an enema.
Illustration of neural control of gut wall by sympathetic, parasympathetic and enteric nervous system. Courtesy of Wikimedia Commons.
Colonoscopy reveals diverticulosis (pockets within colon that can bleed or become infected). Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
Abdominal X-ray showing fecal impaction extending from pelvis upward to left subphrenic space and from left toward right flank, measuring over 40 cm in length and 33 cm in width. Image courtesy of Wikimedia Commons
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.