Inflammatory bowel disease-An enemy of neurogenic bowel management in patients with spinal cord injury.

Abstract

Neurogenic bowel dysfunction (NBD) affects up to 80% of spinal cord injury (SCI) patients, triggering multiple gastrointestinal symptoms. Basic bowel management (BBM) programs provide predictable and effective fecal elimination, being recommended in this population. Implementing BBM programs can be a clinical challenge, especially in the presence of pre-/co-morbid conditions, such as inflammatory bowel disease (IBD). Clinical assessment may be complex since neurological impairment can blur abdominal signs and symptoms. As such, it is crucial to assess IBD activity through laboratory biomarkers, endoscopic and/or cross-sectional imaging. When there is evidence of IBD remission, BBM programs can be started as in any other SCI patient with NBD. In the presence of active IBD, bowel management may be hampered by active luminal disease. In this setting, therapeutic optimization is warranted before starting BBM programs. Multidisciplinary approaches, including Physical Medicine and Rehabilitation and Gastroenterology, are critically important. This article is protected by copyright. All rights reserved.