Intended for healthcare professionals

Practice Uncertainties

What is the best way to manage neurogenic bowel dysfunction?

BMJ 2016; 354 doi: (Published 27 July 2016) Cite this as: BMJ 2016;354:i3931
  1. Doreen McClurg, professor of physiotherapy and the pelvic floor1,
  2. Christine Norton, professor of clinical nursing research2
  1. 1Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
  2. 2King’s College London School of Medical Education, Florence Nightingale School of Nursing and Midwifery, London, UK
  1. Correspondence to: D McClurg Doreen.mcclurg{at}

What you need to know

  • Constipation and faecal incontinence are common in patients with central neurological disease and may prove difficult to manage

  • Limited evidence and clinical expertise suggest that diet modification, oral laxatives, rectal stimulants, digital stimulation, manual evacuation of faeces, and abdominal massage are options that may be tried

  • Quality data to support these approaches are lacking, and trials are needed in mixed groups of patients to explore the efficacy of common approaches alone and in combination

A single episode of faecal incontinence can precipitate a fear of repetition and may lead to reduced social activity and isolation. Bowel dysfunction, faecal incontinence, and constipation have a prevalence of around 70% in people with central neurological disease such as Parkinson’s disease, stroke, multiple sclerosis, or spinal cord injury. Tools such as the Bristol Stool Chart have been developed to aid conversation about bowel dysfunction (fig 1). Constipation may lead to difficult evacuation, abdominal pain and bloating, haemorrhoids, anal fissures, rectal bleeding, prolapse, and autonomic dysreflexia. Hospital admission for impaction occurs more than twice as frequently as in healthy people. Management to ameliorate either incontinence or constipation risks precipitating the other. The condition is time consuming and arduous and causes anxiety to the patient and care givers.

Fig 1 Bristol Stool Chart

What is the evidence of the uncertainty?

Various approaches have been tried for faecal incontinence and constipation in these patients, but limited …

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