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Thread: Lower Neurogenic Bowel

  1. #1

    Lower Neurogenic Bowel

    Is there a 'simple' layman explanation of lower neurogenic bowel?

  2. #2
    The correct term is "lower motor neuron" (LMN) bowel. There is also an "upper motor neuron" (UMN) bowel.

    These terms refer to the area of the nerve pathway that supplies the external anal sphincter (a voluntary muscle). The upper motor neuron includes the motor nerve in the brain and its axon reaching down the spinal cord to S2-4 inside the cord. The lower motor neuron is the motor nerve starting in the S2-4 part of the cord and sending its axon from the cord to the muscles of the pelvic floor through peripheral nerves (including the cauda equina).

    If the damage is to the first (UMN) nerve, there will continue to be reflex (spastic) activity of the anal sphincter muscle. This occurs with most spinal cord injuries. If there is damage to the second (LMN) nerve, no reflex arc can occur, so th anal sphincter muscle is flaccid. This occurs in cauda equina or conus injuries, but can also occur in those where cord infarction has occured higher in the cord.

    Peristalsis is the same for both, as this is an autonomic function, not a voluntary muscle function. Suppositories, which work on the peristalsis would therefore be used by both people with UMN and those with LMN bowels. Digital stimulation is used to relax the spastic sphincter, so is only appropriate for the UMN bowel.

    In either type, most people lack voluntary control of their anal sphincter.'

    'Hope this helps.

    (KLD)

  3. #3
    That does help some, but which one would define someone with a C5 injury, who does their BP at the same time everymorning with success, but then will have at least one accident per day either during the afternoon or evening? Or would it have anything to do with it? Should all laxitives and softeners be eliminated?

  4. #4
    I've seen C5's with a lower motor pattern but their injuries affected the blood supply to the spinal cord so that the cord died, so to speak, at the time of their injury. In your case, you may need to stop using some irritant or osmotic laxatives, or work harder at your bowel care in the morning. We'd need more details about what you're currently doing to make intelligent suggestions.

    RAB

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