Whether you have been Googling your symptoms and stumbled upon it or you saw a medical provider who gave you the diagnosis, you may be wondering “What is neurogenic bowel?”

In this blog post we explain what neurogenic bowel syndrome is, how additional factors can impact our bowels, the common diagnoses associated with neurogenic bowel, and how pelvic floor physical therapy can help you manage your neurogenic bowel. 

What does neurogenic bowel mean?

Neurogenic bowel is an umbrella term used to describe any bowel condition that an individual may be experiencing due to a brain, spinal cord, and/or nerve problem/injury that impacts the nerves controlling and supporting colonic or gastrointestinal (GI) system function.

Our bowels function through a series of neural pathways and reflexes under a combination of voluntary and involuntary control. The gastrointestinal tract is additionally regulated by its own nervous system called the Enteric Nervous System. Further, our GI system communicates with the brain via our peripheral nerves and spinal cord, as well as with our pelvic floor muscles to coordinate bowel filling, storage, and emptying. If there is an injury or dysfunction anywhere along these pathways, this can impact the body’s ability to move, store, or empty feces. 

Our patients that suffer with neurogenic bowel often report:

• Fecal urgency (a strong need to go) and/or frequency
• Fecal incontinence (leakage of stool) associated with urgency (trying to get to the bathroom on time) or stress on the system (cough, laugh, sneeze, or with activity like standing up or walking)
• Constipation including irregular bowel movements, incomplete bowel movements, harder-to-pass stool consistency, as well as feeling the need to strain to empty

Bowel symptoms can be impacted by additional factors, such as: 

• Functional mobility- Are you able to safely get to the bathroom on time to empty?
• Arm, trunk, and lower body mobility and dexterity- Any difficulties or discomfort with removing clothing/pants, transferring to the toilet, or maintaining a seated position on the toilet or commode?
• Schedule constraints- How much time do you have to complete your bowel routine?
• Dietary changes- What does fluid and nutrition, including fiber, intake currently look like?
• Fatigue- Are symptoms of fatigue impacting your ability to get to the bathroom on time and safely?
• Medication side effects- Are you taking prescription medications such as certain antidepressants and opioid-based pain medications that can impact symptoms of constipation?

Symptoms of bowel dysfunction can also impact other parts of your day-to-day, including getting to work on time, exercising without leakage symptoms, and even sexual function and health. 

What diagnoses are associated with neurogenic bowel?

Neurogenic bowel symptoms can occur due to a number of neurological conditions, including but not limited to: 

• Traumatic and nontraumatic brain injury (TBI or stroke/CVA)- changes to the gut including constipation and fecal urgency are among the most common symptoms with a TBI or CVA. Those who experienced a traumatic injury may also have scar tissue from their injury and/or surgical procedures that can impact the recovery of the GI system
• Multiple Sclerosis (MS)- constipation and fecal leakage are frequently reported by those with MS with varying mobility, strength, and balance changes that can impact safety and comfort with a bowel routine
• Parkinson’s Disease (PD)- constipation is the most common symptom in both early and late stages of PD. Bowel routine can frequently be impacted by postural, mobility, and cognitive/mood changes.
• Spinal Cord Injury (SCI)- establishing and supporting a bowel program is important to those with any level of a spinal cord injury (traumatic or non-traumatic). Timing, toileting transfers and positioning, equipment use, and defecation mechanics all can play a role in a healthy bowel routine.
• Cerebral Palsy (CP) & Spina Bifida- constipation and fecal leakage is frequently reported by those affected by CP or Spina Bifida. Commonly, upper or lower extremity spasticity or muscle stiffness changes can impact toileting positioning safety. Caregiver education can be a helpful component to supporting bowel symptoms!

In addition to the listed diagnoses above, we at Pelvic Pride work with individuals navigating other neurologic conditions, including post-concussion syndrome, tethered cord, transverse myelitis, and Guillain-Barré syndrome (GBS), to name a few. Please feel free to give us a call for a free phone screening to learn if pelvic therapy is the right fit for you!

So how can pelvic therapy help with neurogenic bowel? 

Most folks may not realize pelvic health therapy can be helpful for the management of neurogenic bowel symptoms! Maybe you’re still experiencing chronic constipation after a traumatic brain injury, or noticing some unwanted leakage of bowel with a sneeze or during exercise or sexual activity. 

Your pelvic health therapist should focus on education regarding the root cause of your symptoms and treatment to best support your symptoms with a goal to maximize any intact sensation or motor function. This can include strategies for:

• Bowel routine support- such as suppository or enema use timing, toileting setup and positioning strategies, and fluid and intake recommendations
• Fall risk assessment- improving the ability to get to the bathroom on time and safely
• Caregiver education and training- teaching and working with your caregiver(s) how to best support you with your bowel routine
• Breathing exercises- learn how to improve defecation mechanics with your breath for improved pressure management
• Lumbo-pelvic mobility & strengthening- addressing the flexibility and stability of the muscles around your spine, hips, and pelvis for improved pelvic floor muscle tension, ability to get to the bathroom safely and on time, and comfort with toileting positioning 
• Pelvic floor muscle coordination training- building awareness of our pelvic floor muscles ability to contract, relax, and lengthen our anal sphincters in order to improve bowel emptying ability and bottom-up support to the bowel system, such as during movement and exercise (however dependent on the extent of the neurological involvement)
• Soft tissue mobilization, or hands-on external or internal pelvic floor work- addressing any lumbo-pelvic muscular or fascial tension or scar tissue impacting GI motility and bowel emptying

What are the results that someone can expect from pelvic PT?

Great question! Although a pelvic-neuro pelvic health therapist cannot revert, alter, or prevent any pathological nervous system changes due to a progressive or non-progressive neurological condition, our goal is to find treatment techniques and strategies that best support your bowel symptoms, help you improve your quality of life, and gain or maintain control over your GI functions!

Common results of pelvic PT include:

• Improved daily bowel habits and routine to address constipation
• Improved bowel leakage that may occur with daily tasks including functional mobility like transfers, walking, or trying to get to the bathroom on time
• Improved bowel frequency, urgency, and/or emptying ability
• Improved awareness and coordination of the lumbo-pelvic musculature, including pelvic floor, abdominals, spinal, and hip muscles, dependent on intact innervation of these muscles
• Improved scar tissue mobility and sensitivity if present following a traumatic event
• Improved overall knowledge of the anatomy and function of the nervous system (brain, spinal cord, and nerves) and connection with the GI system

It is likely that your pelvic PT will want to communicate with other members of your medical team, including gastrointestinal or neurology, to ‘quarterback’ your care via interdisciplinary collaboration for holistic support and care. Further, your medical team may incorporate additional testing or imaging to learn more about your symptoms (such as anorectal manometry testing to assess the function of the anal sphincters and rectal musculature) and discuss medication management for symptom support, such as prescription or over-the-counter suppositories or enemas for bowel routine management, medications that address spasticity, discomfort, or pain associated with nerves, as well as anxiety and depression.

Curious if you’d benefit from pelvic floor therapy for your neurogenic bowel symptoms?

Complete the questionnaire below to learn more about your current bowel routine and symptoms. A higher score can indicate that you will likely benefit from bowel routine support and from seeing a neuro-based pelvic health therapist!