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There are a number of neurological diseases which have an effect on bowel function. This chapter provides an overview of gastrointestinal (GI) physiology, with reference to the hindgut and pelvic floor. It addresses the problems caused by common neurological diseases. The intra-abdominal GI tract is varied, and divided into the organs of stomach, small intestine and large intestine. Bowel dysfunction affects approximately 80% of those with spinal cord injury (SCI) and causes more of a problem than urinary and sexual dysfunction in a third of individuals with SCI. Neurological diseases such as SCI or MS frequently impair CNS control of the gut. The difference between the neural control systems for bowel and bladder is underlined by the differing effects of such diseases on the two systems. Supraconal SCI tends to cause difficulty with evacuation of feces in addition to fecal incontinence, but predominantly difficulty with urinary continence.
Ultrasound has the advantage of being able to visualise fluid-filled structures without the need for contrast medium. It can demonstrate soft tissue structures such as the kidney, bladder wall, urethral and anal sphincters and surrounding pelvic floor musculature. Use of the transabdominal, transvaginal, transrectal and transperineal approaches for ultrasound scanning allows for easy visualisation of different aspects of the lower urinary tract. Bladder diverticula are easily visualised with transabdominal ultrasound. Transvaginal ultrasound allows clearer visualisation of the bladder base, bladder neck, inferior border of the pubic symphysis and periurethral structures. Translabial ultrasound is used to demonstrate uterovaginal prolapse. Three-dimensional ultrasound offers new insights into the pelvic floor as it allows imaging of both the levator ani muscle hiatus and paravaginal support structures in axial and transverse planes. This gives access to transverse planes similar to magnetic resonance imaging.
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