A Specific Remark on Neurogenic Bowel Disorder

Aleah Ahadi^*
*Correspondence: Aleah Ahadi, Department of Gastroenterology, Medical University of Ilam, Ilam, Iran, Email:

Editorial

Constipation and faecal incontinence are two symptoms of Neurogenic Bowel Dysfunction (NBD). These have a significant impact on quality of life and dignity. Bowel symptoms are common in people with chronic neurological disorders such as multiple sclerosis, spinal cord injury, and Parkinson's disease. Prior to the development of neurological symptoms, a thorough digestive history is obtained, including an examination of stool function. Objective assessments of NBD are available and useful for tracking response to what are frequently extremely personal and difficult-to-elicit symptoms. Conservative management begins with optimising nutrition and laxative use to establish an effective and regular bowel schedule. The gastrointestinal system is controlled in a sophisticated way that relies on the coordinated interaction of muscle contractions and neural impulses. Faecal incontinence or constipation occurs when the regular bowel function is disrupted for any number of causes. Normal defecation requires colon contractions to assist mix the contents, absorb water, and drive the contents along the intestine. As a result, faeces go from the colon to the rectum. When there is stool in the rectum, the internal anal sphincter relaxes reflexively, allowing the contents of the rectum to enter the anal canal. This results in the conscious awareness of the need to defecate.

Neurogenic bowel dysfunction can have an impact on a person's life since it frequently causes problems with self-esteem, personal connections, and social life, as well as reducing independence. Studies have also found that faecal incontinence increases the risk of sadness and anxiety. The intensity and level of the spinal cord lesion will have a large impact on bowel dysfunction produced by a spinal cord injury. Both sensory and motor capabilities are fully lost below the level of the lesion in severe spinal cord damage, resulting in a loss of voluntary control and sensation of the desire to defecate. An incomplete spinal cord injury occurs when there is still some sensation or motor function below the level of the damage. Colorectal dysfunction caused by a spinal cord injury can be divided into two types: upper motor neuron lesion and lower motor neuron lesion. Problems with the upper motor neuron in a neurogenic bowel cause a hypertonic and spastic bowel because the defecation reflex centre, which causes the involuntary contraction of rectum and anus muscles, remains intact. This disorder is associated with a number of symptoms, all of which are caused by a loss of myelin, the insulating coating that surrounds the neurons. This means that nerve signals are disrupted and sluggish, leading in fewer and more irregular muscle contractions and a longer colon transit time. There are two types of neurons involved in innervating the lower GI tract: the enteric nervous system, which is located within the gut wall, and the extrinsic neural system, which includes sympathetic and parasympathetic innervation.

The enteric nervous system governs gut motility directly, whereas extrinsic nerve routes influence gut contractility indirectly by changing enteric innervation. When the extrinsic nervous system is disrupted, one of these processes can be compromised. The somatic nervous system regulates conscious activities, which are voluntary motions. For example, the brain instructs the striated muscle of the external anal sphincter to contract by sending signals down the nerves innervating this muscle. It is critical to adequately diagnose neurogenic bowel dysfunction in order to properly manage it. This can be accomplished through a variety of approaches, the most frequent of which include taking a clinical history and performing physical tests such as abdominal, neurological, and rectal examinations. Patients can use the Bristol Feces Chart to assist them define and characterise the morphological aspects of their stool; this is helpful because it indicates the transit time. The colon transit time is an objective method used to assess colon motility and aid in diagnosis. An abdominal X-ray may also be useful in diagnosing this problem because it can show the distribution of the faeces as well as any abnormalities with the colon, such as a megacolon. Diagnosis methods may differ depending on whether the patient is incontinent or constipated [1-5].

References

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