Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease

Table 1 Suggested pathogenesis of gastrointestinal disorders underlying Parkinson's disease

GI pathogenesis	Disorder
Peripheral neurotoxine action	Interstitial cells of Cajal involvement[18]
GI flora? Neurotropic viral pathogen	GI disorders[19]
GI flora? Helicobacter pylori	Modified l-dopa pharmacokinetics[102]
GI dysmotility: Early lesions in the enteric nervous system	GI dysfunction[11,163]
GI dysmotility: Disruption in parts of the CNS	Neurogenic dysphagia[54]
GI dysmotility: Lewy bodies in esophageal myenteric plexuses	Manometric abnormalities[97,98]
GI dysmotility: Reduction amplitude of peristaltic contractions	Decreased gastric motility[105]
GI dysmotility: Gastric pacemaker disturbances	Gastric dysrhythmias[106]
GI dysmotility: Loss of enteric dopaminergic neurons	Changes in colon motility[173]
Neurotransmitter dysfunction: Altered enteric nitrergic systems	Disturbed distal gut transit[95]
Neurohormone involvement: Neurotensin	GI disorders[103]
Levodopa	Altered oral phase of deglutition[96]
Monoamine dysfunction	Nonmotor symptoms[176]

GI: Gastrointestinal; CNS: Central nervous system.

Table 2 Suggested pathogenesis of gastrointestinal disorders underlying spinal cord injury, myelomeningocele and multiple sclerosis

Disease	GI pathogenesis	Disorder
Spinal cord injury	Abnormal rectosigmoid compliance	Fecal incontinence[73]
Myelomeningocele	Loss of recto-anal sensitivity
Multiple sclerosis	Loss of voluntary control of the external anal sphincter
Spinal cord injury Myelomeningocele Multiple sclerosis	Immobilization, abnormal colonic contractility, side effects of medication	Constipation[94]
Multiple sclerosis	Paradoxical puborectalis contraction	Constipation[94]
Multiple sclerosis	Bladder distension	Autonomic dysreflexia[56]
Myelomeningocele	Severe constipation	Ventriculoperitoneal shunt malfunction[87]
Myelomeningocele	Visceral hypersensitivity	Constipation and impaired rectal tone and response to food[88]
Myelomeningocele	Higher spinal level of cord lesion, completeness of cord injury and longer duration of injury	Severe neurogenic bowel dysfunction[20]
Spinal cord injury	Noxious stimulus	Autonomic dysreflexia[46]
Spinal cord injury	Manual emptying of rectal contents and gastric and bowel distension	Cardiovascular dysregulation[47]