Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 488

Parkinson’s disease is associated with significant bowel dysfunction. More people with Parkinson’s complain of infrequent passage of stool (<3/week), difficulty passing stool, and loose stool than in the general population,³⁵ but without a greater prevalence of faecal incontinence than people of a similar age without Parkinson’s disease.³⁶ Similarly, multiple sclerosis is associated with a high prevalence of constipation and dysfunctional voiding, and half of those in a study in 1990 reported faecal incontinence in the preceding three months.³⁷ Treatments for muscle spasticity in MS, such as baclofen, are also associated with faecal incontinence and should be taken into account.³⁸ Only one in three young people with spina bifida report normal bowel function,³⁹ and with the passage of time, this group will become of interest to geriatricians.

Spinal cord injury, be it traumatic or (more commonly in older adults) metastatic, can commonly lead to faecal incontinence. A cord injury below T12 leads to a lower motor neuron syndrome or areflexic bowel due to impaired parasympathetic function and reduced peristalsis. By contrast, a cord lesion below T12 leads to increased anal tone and the inability to relax the external sphincter, resulting in faecal impaction.⁴⁰ A patient presenting with acute faecal incontinence should always raise the possibility of spinal cord injury. The impact of dementia and cognitive impairment is discussed in the section ‘Geriatric Syndromes’.