ABSTRACT

Digestive function is one of the greatest problems for people with spinal cord injuries, particularly control of evacuation. The term “neurogenic bowel” is an indication of the belief that bladder emptying and evacuation of the rectal contents are thought to be similar. There are many important differences between the two functions that make the respective pathophysiological mechanisms underlying the symptoms quite different. Firstly, the muscular wall of the bladder does not contain a complex neuronal network. Secondly, the contents of the bladder are liquid while bowel contents can range from liquid to solid. It is impossible to explain variations in the transport of intraluminal contents based on a single pathophysiological model such as hyporeflexia/hyperreflexia or reduced/increased rectal wall compliance. In spinal cord injury patients intestinal transport of intraluminal contents through the colon is increased and the lesion level is not predictive of the motor activity of the large bowel. It is misleading to talk about the diagnosis and treatment of voiding and evacuation as if they behave in similar ways due to a neurological lesion.