What is the best way to manage neurogenic bowel dysfunction?

A single episode of faecal incontinence can precipitate a fear of repetition and may lead to reduced social activity and isolation. Bowel dysfunction, faecal incontinence, and constipation have a prevalence of around 70% in people with central neurological disease such as Parkinson’s disease, stroke, multiple sclerosis, or spinal cord injury. Tools such as the Bristol Stool Chart have been developed to aid conversation about bowel dysfunction (fig 1). Constipation may lead to difficult evacuation, abdominal pain and bloating, haemorrhoids, anal fissures, rectal bleeding, prolapse, and autonomic dysreflexia. Hospital admission for impaction occurs more than twice as frequently as in healthy people. Management to ameliorate either incontinence or constipation risks precipitating the other. The condition is time consuming and arduous and causes anxiety to the patient and care givers.