Neurogenic bowel dysfunction

This presentation from an internal medicine academic meeting provides a comprehensive overview of neurogenic bowel dysfunction (NBD), focusing on spinal cord injury (SCI). The speaker, Dr. Aqeela Moosa, begins by defining NBD and emphasizing its significant impact on patients’ quality of life, including social isolation and loss of independence. She then explains the neuroanatomy and physiology underlying normal bowel function, highlighting the roles of the enteric, autonomic, and somatic nervous systems. The presentation distinguishes between upper motor neuron (reflexic) and lower motor neuron (areflexic) bowel patterns, which are crucial for management. Clinical assessment, including history and physical exam, is detailed, with emphasis on identifying autonomic dysreflexia, a life-threatening complication. Investigations such as abdominal X-ray, colonoscopy, and colonic transit studies are discussed. Management strategies are presented in a stepwise approach: conservative measures (diet, fiber, fluid, bowel scheduling), pharmacological options (laxatives, prokinetics), minimally invasive techniques (digital stimulation, transanal irrigation), and surgical options. The importance of a multidisciplinary approach is stressed throughout.