Management of fecal incontinence in adults with neurogenic bowel dysfunction

Abstract

Neurogenic bowel dysfunction can be classified according to the location of the lesion or disease and can be seen in patients with any central nervous system benign or neoplastic pathology. In the case of spinal cord lesions or disease, the level of the lesion and its complete or incomplete cord damage will determine the type of neurogenic bowel dysfunction. The dysfunction seen in patients with multiple sclerosis is thought to be multifactorial and can be affected by medications, mobility, and comorbidities aside from the disease itself. This chapter explains the management of fecal incontinence in patients with neurogenic bowel dysfunction for the advanced practice continence nurse. It addresses initial conservative strategies that include optimizing stool consistency and scheduled toilet regimes and techniques to assist with stool evacuation. Secondary interventions to be considered including pelvic floor muscle training, biofeedback, anal plugs and transanal irrigation are also discussed. The chapter reviews the important role of quality of life and practicality in management plan for fecal incontinence developed by the advanced practice continence nurse for these patients.