Gastrointestinal Dysfunctions After Spinal Cord Injury

Damage to the spinal cord has a profound impact on the functions of the gastrointestinal tract. Upper gastrointestinal tract dysfunction following spinal cord injury (SCI) includes impairment of gastric motility, gastric emptying, and intestinal motility. Lower gastrointestinal dysfunction associated with SCI includes loss of voluntary control of initiation of defecation, lack of perception of need to defecate, increased transit time, constipation, incontinence, and fecal elimination problems. Bowel dysfunctions seen after SCI can be classified according to the level of the injury: upper motor neuron bowel syndrome (UMNBS) can be seen after the injury above the conus medullaris and lower motor neuron bowel syndrome (LMNBS) can be seen after the injury at the conus medullaris or cauda equina level. The UMNBS is characterized by increased tonic activity of colonic wall and external anal sphincter. Constipation and fecal retention are the main clinical presentations of UMNBS. LMNBS is characterized by decreased motility of colonic wall, atonic external anal sphincter and slow stool propulsion. Constipation and fecal incontinence are the main clinical presentations of LMNBS. A detailed clinical evaluation and an individual approach are required for a proper bowel management in SCI patients.