Krogh Klaus, Christensen Peter
Neurogastroenterology Unit, Department of Hepatology and Gastroenterology V, Aarhus University Hospital, Norrebrogade 2, 8000 Aarhus C, Denmark.
Best Pract Res Clin Gastroenterol. 2009;23(4):531-43. doi: 10.1016/j.bpg.2009.04.012.
Constipation and faecal incontinence are common symptoms among patients with spinal cord injury (SCI), myelomeningocoele (MMC), multiple sclerosis (MS), Parkinson's disease (PD) and stroke. Faecal incontinence in SCI, MMC and MS is mainly due to abnormal rectosigmoid compliance and rectoanal reflexes, loss of rectoanal sensibility and loss of voluntary control of the external anal sphincter. Constipation in SCI, MMC and MS is probably due to immobilisation, abnormal colonic contractility, tone and rectoanal reflexes or side effects from medication. In PD, dystonia of the external anal sphincter causes difficult rectal evacuation and the loss of dopaminergic neurons in the enteric nervous system probably causes slow-transit constipation. Changes after stroke remain to be studied. Though dietary adjustments, oral laxatives, suppositories and other conservative treatment modalities are commonly used, evidence for their use in patients with central neurological disorders is scarce. For patients with severe symptoms trans-anal irrigation, the Malone appendicostomy or a colostomy can be recommended.
便秘和大便失禁是脊髓损伤（SCI）、脊髓脊膜膨出（MMC）、多发性硬化症（MS）、帕金森病（PD）和中风患者的常见症状。SCI、MMC和MS患者的大便失禁主要是由于直肠乙状结肠顺应性和直肠肛门反射异常、直肠肛门感觉丧失以及肛门外括约肌自主控制丧失。SCI、MMC和MS患者的便秘可能是由于活动受限、结肠收缩异常、张力和直肠肛门反射异常或药物副作用。在PD中，肛门外括约肌的肌张力障碍导致直肠排空困难，而肠神经系统中多巴胺能神经元的丧失可能导致慢传输型便秘。中风后的变化仍有待研究。虽然饮食调整、口服泻药、栓剂和其他保守治疗方法常用，但在中枢神经系统疾病患者中使用这些方法的证据很少。对于症状严重的患者，可推荐经肛门冲洗、马龙氏阑尾造口术或结肠造口术。
