Pathophysiology Prevention and Management of Chronic Neurogenic Constipation in Adults

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.