Neurogenic Bowel Dysfunction in Patients with Spinal Cord Injury and Multiple Sclerosis—An Updated and Simplified Treatment Algorithm

Neurogenic bowel dysfunction (NBD) is a common condition in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). It usually entails constipation, difficult evacuation of the rectum, and fecal incontinence (FI); often in combination. The current treatment algorithm, or treatment pyramid, does not completely correspond to actual clinical practice, and the known and classical pyramid contains both treatments still in their experimental stage as well as several treatments which are not available at all treatment centers. The authors of this paper therefore propose a simplified version of the treatment pyramid, aiming to guide clinicians in treating NBD.

• 1
  The existing treatment pyramid includes experimental treatments and treatments not available at all centers, making it misaligned with clinical practice.
• 2
  The proposed simplified treatment algorithm focuses on commonly available treatments, starting with standard bowel management, followed by transanal irrigation (TAI), and surgery as the last stage.
• 3
  Individual and continuous assessment is essential for determining when to advance in the treatment pyramid, adding or changing treatment based on patient preference and local clinical resources.