title: Medical and surgical management of neurogenic bowel.
abstract: Neurogenic bowel dysfunction (NBoD) commonly affects patients with spina bifida, cerebral palsy, and spinal cord injury among other neurologic insults. NBoD is a significant source of physical and psychosocial morbidity. Treating NBoD requires a diligent relationship between patient, caretaker, and provider in establishing and maintaining a successful bowel program. A well designed bowel program allows for regular, predictable bowel movements and prevents episodes of fecal incontinence.
  
  
  
  Treatment options for NBoD span conservative lifestyle changes to fecal diversion depending on the nature of the dysfunction. Lifestyle changes and oral laxatives are effective for many patients. Patients requiring more advanced therapy progress to transanal irrigation devices and retrograde enemas. Those receiving enemas may opt for antegrade enema administration via a Malone antegrade continence enema or Chait cecostomy button, which are increasingly performed in a minimally invasive fashion. Select patients benefit from fecal diversion, which simplifies care in more severe cases.
  
  
  
  Many medical and surgical options are available for patients with NBoD. Selecting the appropriate medical or surgical treatment involves a careful evaluation of each patient's physical, psychosocial, financial, and geographic variables in an effort to optimize bowel function.
authors.affiliation: aDepartment of Urology, University of Minnesota, Minneapolis bGillette Lifetime Specialty Healthcare, St. Paul, Minnesota, USA.
authors.forename: Ronak A
authors.initials: RA
authors.lastname: Gor
authors.forename: Jenna R
authors.initials: JR
authors.lastname: Katorski
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
mesh_terms: D002431:Cecostomy / Q000379:methods*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D006801:Humans; D055496:Neurogenic Bowel / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome