OBJECTIVES:

We aimed to assess all available evidence on Neurogenic Bowel Disease (NBD) treatment in adults and providing clinical management guidance and recommendations.

METHODS:

PICOs and Questions (n=7) identified by an Expert Panel. Evidences from the PUBMED and EMBASE databases, limited to the English language and the Western countries (2009-2019) were retrieved. Health effects, patient values, preferences and resource use were assessed. Only RCTs, observational studies and systematic reviews on adult population (≥18 years) were analyzed. The study was conducted according to PRISMA guidelines and Cochrane recommendations. The effect size, if possible, was calculated for the interpretation of the outcomes, and evidence was assessed through the GRADE method.

RESULTS:

Thirty-one studies were included in qualitative synthesis. Evidence is generally scarce. Most of outcomes are narratively described. Most of studies are affected by risk of bias particularly by imprecision. Digital stimulation was effective at short-term follow-up. The pharmacological treatment choice needs to be balanced case by case considering clinical history, setting of use and bowel management protocol. According to only one RCT supporting evidence mainly in person affect by Spinal Cord Injury (SCI), trans-anal irrigation (TAI) improves QoL and patient independency with a significant reduction of time spent for defecation and daily bowel program. History of urinary infections predicts the choice of using TAI. Patient-reported efficacy of colostomy alone or in combination with other surgeries appears evident in terms of patient’s satisfaction and QoL over time. Nonetheless, peri-operative and late complications can occur and may result in reduced acceptability over time.

CONCLUSIONS:

Evidence is weak and mainly reported in SCI. The systematic use of assistive interventions does not reduce the need of conservative or invasive approaches. Studies are needed on the role of bowel management in protecting patients from complications secondary to NBD in long term follow-ups.