Management of Fecal Incontinence in Adults with Neurogenic Bowel Dysfunction

Neurogenic bowel dysfunction is a common complication in patients with spinal cord injury, multiple sclerosis, and other neurological conditions, which includes fecal incontinence, constipation, and abdominal pain. This chapter explains the management of fecal incontinence in patients with neurogenic bowel dysfunction for the advanced practice continence nurse. Informed by a practical treatment algorithm based on best practice guidelines, this chapter addresses initial conservative strategies that include standard bowel management and transanal irrigation. Optional treatments, such as biofeedback and sacral neuromodulation, will be detailed. As well, surgical interventions for patients who fail to respond well to conservative treatment will be described. The aim is to provide an evidence-informed decision-making approach for the advanced practice continence nurse to consider in care of patients with neurogenic bowel dysfunction, including patient preferences and actions, research evidence, the clinical setting, and health care resources.