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If your bowels or sphincters do not work effectively, you may begin to experience faecal incontinence, chronic constipation, or even both at the same time. Some of the relatively common but serious conditions that affect the function of the bowel include: Neurogenic bowel
Neurogenic bowel describes a lack of nervous control which prevents the bowel from functioning effectively. One cause of neurogenic bowel is spinal cord injury (SCI). The affect of a spinal cord injury on the function of the colon depends on the level of injury on the spinal cord and where the damage occurs. Damage to the lower part of the spinal cord often leads to excessive relaxation within the colon (flaccid colon), resulting in slow movement of faeces, constipation, faecal incontinence, and difficulty emptying. Control of the external anal sphincter may also be disrupted, increasing the risk of incontinence.
An SCI affects the bowel system – the severity of the dysfunction and its symptoms depends on where the injury occurs.
With a high SCI, (a tetraplegic injury) the general symptoms are: - slower movement of faeces, potentially leading to constipation
- hyperreflexia – many uncontrolled bowel contractions which lead to frequent evacuations
- low rectal capacity – the nerves react to only a small quantity of stool in the rectum, causing frequent evacuations
- reduced or no control of the external sphincter – this is due to communication between the sphincter and the brain becoming disrupted and this may lead to faecal incontinence
A low SCI (a paraplegic injury) often has the following symptoms: - slower movement of faeces, potentially leading to constipation in the colon
- increased rectal capacity – the nerves react only to a large quantity of stool in the rectum, again leading to constipation
- relaxed and overstretched lower bowels – an increased rectal capacity may overstretch the lower bowels (flaccid bowel), resulting in faecal incontinence and possibly mega colon
- reduced rectal contractions, making it difficult to fully empty the bowels
- reduced or no control of the external sphincter, leading to involuntary leakage of faeces
Other possible causes of neurogenic bowel include spina bifida, multiple sclerosis, and diabetes mellitus.
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a collection of conditions characterised by inflammation of the large and/or small intestine.
The two main types of IBD are ulcerative colitis and Crohn's disease. The two diseases are very similar. The main difference is that Crohn’s disease can occur anywhere along the digestive tract, while ulcerative colitis usually affects only specific areas of the colon and rectum. The inflammation usually causes abdominal pain and diarrhoea but may also cause constipation.
Cancer of the colon or rectum
Cancer of the colon or rectum describes the uncontrolled growth of cells that may cause bowel dysfunction. Some people have an inherited condition called familial polyposis, where large numbers of projecting, swollen and thickened areas of membrane called polyps, which develop on the inner lining of the colon. These polyps can eventually become cancerous.
Diverticulitis
When pressure in the colon increases, for example due to constipation, pouches called diverticulae can be formed. These pouches are very common in people over the age of 60 and for most, never cause any problems. However, sometimes the pouches become inflamed or infected causing pain, fever, diarrhoea and constipation.
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