Cotterill Nikki, Madersbacher Helmut, Wyndaele Jean J, Apostolidis Apostolos, Drake Marcus J, Gajewski Jerzy, Heesakkers John, Panicker Jalesh, Radziszewski Piotr, Sakakibara Ryuji, Sievert Karl-Dietrich, Hamid Rizwan, Kessler Thomas M, Emmanuel Anton
Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
University Clinic for Neurourology, Innsbruck, Austria.
Neurourol Urodyn. 2018 Jan;37(1):46-53. doi: 10.1002/nau.23289. Epub 2017 Jun 22.
Evidence-based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world-wide relevance.
To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009.
A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013.
The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management.
The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.
国际尿失禁咨询委员会（ICI）制定了基于证据的神经疾病和下肠道功能障碍管理指南。这些是全面的指南，旨在具有全球相关性。
根据2009年第四届ICI的建议更新神经源性肠道功能障碍的临床管理。
工作组成员进行了一系列证据审查和更新。所得指南在2012年欧洲泌尿外科学会会议上进行了咨询，并进行了修改，以得出基于证据的结论，并为2013年第五届ICI的科学报告提供建议。
本次综述是结论和建议的综合，包括神经源性肠道功能障碍初始和专科管理的算法。从脊髓损伤、多发性硬化症和帕金森病方面描述了病理生理学。评估需要详细的病史和临床评估、常规检查以及必要时的专科检查。治疗主要侧重于优化大便稠度和调节肠道排空以提高生活质量。症状管理包括促进良好习惯和协助大便排空的保守和干预措施，以及预防失禁。教育对于实现最佳肠道管理至关重要。
本综述在复杂的病理生理学和多样的证据基础背景下提供了一种务实的管理方法。
