Neurogenic Bowel

Amiraslany A, Turnbull G, Mirkowski M, Short C, Knox K, on behalf of the MSBEST Team. (2020). Neurogenic Bowel. Multiple Sclerosis Best Evidence-Based Strategies and Treatment/Therapies for Rehabilitation. Version 1.0: p 1-35.

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This module provides a comprehensive overview of the available evidence for pharmacological and non-pharmacological interventions for neurogenic bowel rehabilitation in persons with multiple sclerosis

Key Points

  • Intrathecal baclofen may improve ease of care with neurogenic bowel management in select MS patients with severe lower limb spasticity who meet the criteria for baclofen pump implantation for spasticity indications.
  • Sacral neuromodulation may improve constipation symptoms in select persons living with MS.
  • Functional electrical stimulation applied to the abdominal muscles may improve gut motility in persons with MS.
  • Percutaneous posterior tibial nerve stimulation may improve bowel incontinence symptoms in a select group of people with MS.
  • Biofeedback may improve bowel symptoms in some people with MS. It remains unclear who may best respond to biofeedback treatment for improving bowel symptoms.
  • Transanal irrigation may improve constipation and fecal incontinence in persons with MS, with possibly a greater effect on fecal incontinence.
  • It is unclear if abdominal massage combined with advice on bowel management improves constipation more than advice alone in persons with MS.
  • Abdominal massage combined with advice on bowel management may improve the frequency of stool evacuations compared to advice alone.
  • Standing frames may not be beneficial for improving bowel frequency in persons with progressive MS, but may result in fewer new bowel related symptoms.
  • Orem's self care model may help to improve constipation in persons with MS.
  • Apitherapy may not improve bowel and bladder symptom severity ratings in persons with MS.
  • Reflexology may improve short-term constipation symptoms in persons with MS with lower levels of physical disability.
  • Hyperbaric oxygen treatment may not improve bowel and/or bladder symptoms in persons with MS.
  • Extracranial venous therapy may not improve bowel control in persons with MS.

2020 literature search