Lower Urinary Tract and Bowel Dysfunction in Neurologic Disease

Jalesh N. Panicker, MD, DM, FRCP; Ryuji Sakakibara, MD, PhD, FAAN Autonomic Disorders p. 178-199 February 2020, Vol.26, No.1 doi: 10.1212/CON.0000000000000824
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PURPOSE OF REVIEW This article provides an overview of the clinical presentation, investigations, and treatment options for lower urinary tract and bowel dysfunction in patients with neurologic diseases.

RECENT FINDINGS The site of the neurologic lesion influences the pattern of lower urinary tract dysfunction. Antimuscarinic agents are first-line management for urinary incontinence; however, the side effect profile should be considered when prescribing them. β3-Receptor agonists are a promising alternative oral medication. Botulinum toxin injections into the detrusor have revolutionized the management of neurogenic detrusor overactivity.

Bowel dysfunction commonly presents as constipation and fecal incontinence. Gastrointestinal emergencies may arise, including intestinal pseudoobstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation.

SUMMARY Functions of the lower urinary tract and bowel are commonly affected in neurologic disease. Neurologists play an important role in assessing lower urinary tract and bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams.

Address correspondence to Dr Jalesh Panicker, Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom, j.panicker@ucl.ac.uk.

RELATIONSHIP DISCLOSURE: Dr Panicker has received personal compensation for speaking engagements from Astellas Pharma Inc and Wellspect HealthCare and receives research/grant support from the United Kingdom’s Department of Health National Institute of Health Research Biomedical Research Centres funding scheme and publishing royalties from Cambridge University Press. Dr Sakakibara reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Panicker and Sakakibara report no disclosures.

© 2020 American Academy of Neurology.