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This resource is for clinicians working with people with spinal cord injuries (SCI) in acute, non-acute and community settings. It provides an introduction to neurogenic bowel management for adults with SCI.

Clinicians can find more information and guidance about:

  • how neurogenic bowel dysfunction presents in people with SCI
  • how to implement individualised bowel management plans.

What is neurogenic bowel?

Neurogenic bowel is a general term for a bowel dysfunction due to neurological damage resulting from trauma, disease or injury.

The majority of people with SCI, even those who can walk or who have very incomplete injuries, experience problems with faecal defecation, such as constipation, difficulty with evacuation and faecal incontinence.

In people with SCI, there are two distinct patterns of neurogenic bowel dysfunction:

  • Upper motor neuron or ‘reflex bowel’ syndrome
  • Lower motor neuron or ‘flaccid’ bowel syndrome

This guide outlines bowel management approaches for each type of dysfunction.


This is an update to the fact sheet, Management of the Neurogenic Bowel for Adults with Spinal Cord Injury, first published in 2002 and updated in 2005 and 2014. The original fact sheet was developed based on a systematic review of the literature and expert consensus.


The State Spinal Cord Injury Service (SSCIS) consulted with senior clinicians in NSW Spinal Cord Injury Units, to update this document according to contemporary research evidence and advances in neurogenic bowel management practices.

Literature search

A rapid review of Medline, Embase, Emcare and Cochrane was conducted in July 2022, to inform this update. Key search terms included: “spinal cord injury” OR “paraplegia” OR “quadriplegia and neurogenic bowel management”, “digital rectal examination”, “digital rectal stimulation”, “digital removal of faeces and transanal irrigation”.

Snowball searches were conducted from the reference lists of key articles.

Guideline review

This work was informed by clinical guidelines for SCI care developed by Spinal Cord Injury Rehabilitation Evidence (SCIRE)1 and the Consortium for Spinal Cord Medicine (Paralyzed Veterans of America)2.

Produced by: State Spinal Cord Injury Service

SHPN: (ACI) 221025

ISBN: 978-1-76023-375-4

Version:Trim: ACI/D22/50

  1. Coggrave M, Mills P, Eng JJ. Bowel dysfunction and management following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, et al. Editors. Spinal cord injury rehabilitation evidence Version 5. Vancouver, Canada. 2012. p. 1-48.
  2. Paralyzed Veterans of America. Publications: Clinical Practice Guidelines. Washington, DC: PVA [cited 22 Nov 2022].

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