This document discusses neurogenic bowel dysfunction, which occurs when the bowel's normal functioning is disrupted by neurological damage or disease. It can cause constipation, diarrhea, or fecal incontinence. Common causes include spinal cord injury, stroke, or Parkinson's disease. Management involves regular bowel regimens to prevent accidents and complications like impaction. Approaches include diet, exercise, suppositories, manual evacuation, enemas, and oral laxatives. The goal is to establish a routine that empties the bowel and maintains quality of life.

2. Elimination of waste and undigested food in the form of
feces from the colon via the anus.
Facilitated by the enteric nervous system in interaction
with the central nervous system via the sympathetic and
parasympathetic system and neuropeptides.

5. Neurogenic bowel is a general term for a malfunctioning
bowel due to neurological dysfunction or insult resulting
from internal or external trauma, disease or injury.
 Sembelit (Constipation)
 Cirit-Birit (Diarrhoea)
 Faecal incontinence
 Flatus incontinence
 Hemorrhoids
 Abdominal distension/discomfort
TOO HARD…!!!

6.  Spinal cord injury
 Spina bifida
 Traumatic brain injury
 Stroke
 Cerebral palsy
 Parkinson’s Disease

7. ≥ T12 level ≤ L1 level
• Positive anal and bulbo-anal reflex
• Inability to effectively increase intra-
abdominal pressure
• Rectal hyperreactivity
• Loss of rectal sensation
• Loss of voluntary sphincter control
• Hypertonic external anal sphincter
• Anorectal dysynergy
• Fecal impaction in the proximal colon
• Absent anal and bulbo-anal reflex
• No reflex response to increased intra-
abdominal pressure
• Decreased rectal tone
• Reduced anorectal sensation
• Loss of voluntary sphincter control
• Absent external anal sphincter tone
• Rectal fecal impaction

8.  Reduce quality of life
 Burden to carer and time consuming
 Causes distress to patient (bowel accident)
 Patient less socialize at outdoor

9. BOWEL
MANAGEMEN
T

10.  Avoid bowel accident.
 Enable patient to do activities routinely with
fixed schedule bowel regimen.
 Prevent complications (impacted stool and
constipation).

11. - Arrange time ( morning / evening ) based on
patient’s preference.
- Adequate high fiber diet , fruits and water

12. - Put onto left lateral position.
- Abdominal massage
- Drinks plain water to stimulate ‘gastrocolic reflex’ 15-30
minutes prior .

13. A) Suppository
 Eg : Bisacodyl
 Make sure suppository directed towards the wall of
rectum
 Do manual evacuation prior to insertion

14. B) Manual Evacuation
 Use lumbricants and evacuate manually. Break and
remove hard stool if present.
 After remove the feces, may proceed with gentle digital
manual stimulation  stimulate peristalsis and relaxation
of anal sphincter
 Sweep the fingers around the rectal mucosa 15-30
seconds, may repeat 5- 10 minutes until feces removed.
 Used mainly in lower motor neuron spinal cord injury
patient ( eg : Cauda Equina syndrome ).

15. C) Enema
 Fast action
 Simultaneously done with manual evacuation to
ensure complete emptying.
D) Oral medications
 Laxative : liquid paraffin
 Osmotics : Syrup Lactulose
 Stimulant cathartics : T.Bisacodyl (Dulcolax)