Constipation and fecal incontinence are two symptoms of bowel dysfunction. There may be a cause, like impaired innervation of the intestine due to disease or injury. There may also be no traceable cause of the bowel symptoms; this is then called functional constipation or functional fecal incontinence.
Functional bowel is widely prevalent and has a great impact on society. One review article this month highlights the prevalence, diagnosis and management of functional constipation in children. A recent review highlights bowel dysfunction due to neurological damage, and describes the characteristics that this may have. Neurological damage to the spinal cord may also cause other symptoms, such as autonomic dysreflexia (AD), which can occur during bowel management therapy. This may be life-threatening, as was demonstrated in a case report where the conclusion is that AD may be avoided if the correct bowel management therapy is chosen.
Summary of Publications
Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders.
https://www.ncbi.nlm.nih.gov/pubmed/28838787
Author and Origin
Bharucha AE, Rao SSC, Shin AS. USA
Summary
A review that highlights stepwise treatment possibilities for patients with defecatory disorders.
Conclusions
It is important to go through all the steps in conservative treatment before surgical solutions are
explored. There is a need for clinical trials comparing the different treatments.
Comments
A review from the US with treatment possibilities from conservative to surgical treatments. There is no
mention of transanal irrigation.
Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679675/
Author and Origin
Vaidyanathan S, Soni BM, Mansour P, Oo T.
UK
Summary
A case report describing a man with spinal cord injury (SCI) who suffered a fatal accident due to autonomic dysreflexia (AD) when performing manual evacuation of the bowel.
Conclusions
The fatal accident could have been prevented if the patient had been recommended to use other bowel
management therapies, such as transanal irrrigation or colostomy.
Comments
Case report concluding that AD during manual evacuation of bowel in a patient with SCI can be fatal.
Neural pathways for colorectal control, relevance to spinal cord injury and treatment: a narrative review.
https://www.ncbi.nlm.nih.gov/pubmed/29142293
Author and Origin
Callaghan B, Furness JB, Pustovit RV.
Australia
Summary
A review of the neural pathways that control the colon and how this relates to colorectal function after spinalcord injury.
Conclusions
In the future, drugs that affect propulsive contractions of the colorectum may provide augmentation of
non-pharmacological bowel management procedures.
Comments
A review of the neural pathways that control defecation.
Functional constipation in children.
http://www.sapj.co.za/index.php/SAPJ/article/view/2488
Author and Origin
Meyer JC, Mashaba T, Makhele L, Sibanda M.
South Africa
Summary
A review of functional constipation in children. It includes epidemiology, cause, diagnosis and management.
Conclusions
Functional constipation is very common in children and timely diagnosis is essential. It is also
important to consider management to be long-term.
Comments
A review of functional constipation in children.
Bowel and Bladder Dysfunctions in Multiple Sclerosis Patients with Lower Functional Handicap.
Author and Origin
Scaglia M, Haggqvist S, Lindholm E, Capobianco, Destefano I, Oresland T, Hultén L,Andresen O.
Sweden, Italy
Summary
An observational study of 276 patients with multiple sclerosis (MS). The study investigates prevalence and characteristics of bowel dysfunction.
Conclusions
One third of the MS patients had severe bowel problems and frequent urinary incontinence. This
had a significant impact on quality of life.
Comments
An observational study of bladder and bowel dysfunction in MS patients.
This blog post is an extract of the Science Alert from Dec 2017 (76040-USX-1712)
