Pharmacological Management of Neurogenic Bowel Dysfunction after Spinal Cord Injury and Multiple Sclerosis: A Systematic Review and Clinical Implications

J. Clin. Med., 2021 · DOI: 10.3390/jcm10040882 · Published: February 22, 2021

Spinal Cord Injury Neurology Gastroenterology

Simple Explanation

Neurogenic bowel dysfunction (NBD) is a common problem for people with spinal cord injury (SCI) and multiple sclerosis (MS), which seriously impacts quality of life. Pharmacological management is an important component of conservative bowel management. We found a stark discrepancy between the large number of agents currently prescribed and a very limited amount of literature.

Study Duration

Up to June 2020

Participants

Individuals with spinal cord injury (SCI) or multiple sclerosis (MS)

Evidence Level

Systematic Review

Key Findings

1
There was a small amount of literature in SCI, there was little to no literature available for MS.
2
There was low-quality evidence supporting rectal medications, which are a key component of conservative bowel care in SCI.
3
Polyethylene glycol-based bisacodyl suppositories produced faster outcomes than vegetable-based bisacodyl suppositories.

Research Summary

This study systematically examined the current literature on pharmacological agents to manage neurogenic bowel dysfunction of individuals specifically with SCI or MS. The review included twenty-eight studies and found a discrepancy between the large number of agents prescribed and the limited amount of literature, especially for MS. The authors provided clinical insights on treatments and medications in the form of three case study examples on patients with SCI or MS, based on literature findings and clinical experience.

Practical Implications

Clinical Practice

The clinical insights and case studies provide guidance for healthcare professionals on prescribing medication for NBD, emphasizing that it's part of a bowel program.

Treatment Strategies

The paper suggests starting with simple agents like magnesium hydroxide or PEG for constipation, and highlights the potential benefits of polyethylene glycol-based bisacodyl suppositories.

Future Research

The study identifies the need for matched control research, standardized bowel treatment training programs, and research on long-term effects of bowel medications.

Pharmacological Management of Neurogenic Bowel Dysfunction after Spinal Cord Injury and Multiple Sclerosis: A Systematic Review and Clinical Implications

Simple Explanation

Key Findings

Research Summary

Practical Implications

Clinical Practice

Treatment Strategies

Future Research

Study Limitations

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Pharmacological Management of Neurogenic Bowel Dysfunction after Spinal Cord Injury and Multiple Sclerosis: A Systematic Review and Clinical Implications

Simple Explanation

Key Findings

Research Summary

Practical Implications

Clinical Practice

Treatment Strategies

Future Research

Study Limitations

Your Feedback

Was this summary helpful?