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K59.2 – Neurogenic Bowel Dysfunction: Causes & Treatment
K59.2 is the ICD-10 code for neurogenic bowel dysfunction, a condition in which bowel control is impaired due to damage or disease of the nervous system.
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K59.2 is the ICD-10 code for neurogenic bowel dysfunction, a condition in which bowel control is impaired due to damage or disease of the nervous system.
What is K59.2?
The ICD-10 code K59.2 refers to neurogenic bowel dysfunction (NBD). This condition occurs when the normal nerve control of bowel movements and defecation is disrupted due to damage or disease affecting the nervous system. As a result, the bowel can no longer function in a coordinated, autonomous manner, which can significantly impact daily life and quality of life.
Causes
Neurogenic bowel dysfunction arises when the nerve pathways controlling the bowel are interrupted or impaired. Common underlying causes include:
- Spinal cord injuries (e.g., from accidents or surgery)
- Multiple sclerosis
- Parkinson's disease
- Spina bifida (a congenital malformation of the spine)
- Diabetes mellitus with autonomic neuropathy
- Stroke or other brain injuries
- Tumors pressing on the spinal cord or peripheral nerves
Symptoms
The symptoms of neurogenic bowel dysfunction depend on which nerves are affected and whether the injury involves the upper or lower motor neuron:
- Constipation: slowed bowel transit, infrequent bowel movements
- Fecal incontinence: involuntary loss of stool
- Bloating and abdominal cramps
- Difficulty with bowel emptying
- Absent or altered perception of the urge to defecate
Upper Motor Neuron Syndrome
Injuries above the sacral spinal cord (e.g., cervical or thoracic cord injuries) typically result in a spastic or reflexic bowel. The anal sphincter has increased tone, and bowel movements must be triggered using techniques such as digital rectal stimulation.
Lower Motor Neuron Syndrome
Injuries at or below the sacral spinal cord (e.g., cauda equina syndrome) result in a flaccid or areflexic bowel. The anal sphincter has reduced tone, which can lead to fecal incontinence.
Diagnosis
The diagnosis of neurogenic bowel dysfunction is established through a combination of assessments:
- Medical history and physical examination: review of symptoms, bowel habits, and underlying neurological condition
- Neurological examination: assessment of reflexes and nerve function
- Colonic transit study: measurement of bowel transit time using radiopaque markers
- Anorectal manometry: pressure measurement of the rectum and sphincter
- MRI or CT of the spine: imaging to identify nerve damage or tumors
- Defecography: imaging of the defecation process
Treatment
The goal of treatment for neurogenic bowel dysfunction is to achieve regular, predictable, and controlled bowel emptying, thereby improving the quality of life. Treatment is tailored to the underlying cause and severity of symptoms.
Conservative Management
- Bowel management program: scheduling fixed defecation times, often timed after meals to utilize the gastrocolic reflex
- Dietary adjustments: high-fiber diet and adequate fluid intake
- Digital rectal stimulation: manual stimulation of the rectum to trigger a bowel movement
- Manual evacuation: manual removal of stool when peristalsis is absent
- Enemas and suppositories: transanal irrigation to clear the lower bowel
Pharmacological Therapy
- Laxatives: e.g., macrogol, bisacodyl to support bowel emptying
- Prokinetics: medications to promote bowel motility
- Suppositories: e.g., glycerin or bisacodyl suppositories for local stimulation
Interventional and Surgical Options
- Transanal irrigation (TAI): regular flushing of the bowel via the anus with water
- Sacral nerve stimulation: electrical stimulation of sacral nerves to improve bowel function
- Stoma surgery: creation of a colostomy or ileostomy in severe cases
References
- World Health Organization (WHO): International Classification of Diseases, 10th Revision (ICD-10), K59.2 – Neurogenic bowel, not elsewhere classified.
- Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Practice & Research Clinical Gastroenterology. 2009;23(4):531–543. doi:10.1016/j.bpg.2009.04.012.
- Stiens SA, Bergman SB, Goetz LL. Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Archives of Physical Medicine and Rehabilitation. 1997;78(3 Suppl):S86–S102.
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