title: Management of faecal incontinence and constipation in adults with central neurological diseases.
abstract: BACKGROUND
  People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine dividing line between the two conditions, with any management intended to ameliorate, one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base.
  
  
  OBJECTIVE
  To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system.
  
  
  METHODS
  We searched the Cochrane Incontinence Group Trials Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and all reference lists of relevant articles. Date of the most recent searches: May 2000.
  
  
  METHODS
  All randomised or quasi-randomised trials evaluating any types of conservative, or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction have also been considered.
  
  
  METHODS
  All three reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures.
  
  
  RESULTS
  Only seven trials were identified by the search strategy and all were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (two trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but not altered colonic transit time (one trial). Some rectal preparations to initiate defecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). The clinical significance of any of these results is difficult to interpret.
  
  
  CONCLUSIONS
  It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.
authors.affiliation: Division de Gastroenterologie & Hepatologie CHUV/pmu, PMU, 19 Rue Cesar-Roux, Lausanne, Switzerland. paulwiesel@hotmail.com
authors.forename: P H
authors.initials: PH
authors.lastname: Wiesel
authors.forename: C
authors.initials: C
authors.lastname: Norton
authors.forename: M
authors.initials: M
authors.lastname: Brazzelli
mesh_terms: D002493:Central Nervous System Diseases / Q000150:complications*; D020117:Cisapride / Q000627:therapeutic use; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D011620:Psyllium / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013119:Spinal Cord Injuries / Q000150:complications
chemical_list: D005765:Gastrointestinal Agents; D011620:Psyllium; D020117:Cisapride