Constipation: a common problem in patients with neurological abnormalities

Constipation is a frequent complaint among patients with different neurolog ical diseases. This review provides a brief account of the numerous conditi ons affecting the central, peripheral and intrinsic (enteric) nervous syste ms in which constipation can be the only clinical manifestation or a compon ent of a complex syndrome, Recent neuropathophysiological acquisitions show that any structural or functional impairment of the intrinsic innervation of the gut, including both developmental (i.e., Hirschsprung's disease and intestinal neuronal dysplasia) and acquired (i.e., either degenerative or i nflammatory neuropathies) disorders, can be associated with constipation. C onstipation may also arise from derangements of the peripheral nervous syst em, including diabetes and primary chronic autonomic failure (pandysautonom ias). Finally, in the central nervous system, a wide array of disorders (po st-traumatic, degenerative, ischaemic or neoplastic) are recognized to dete rmine bowel dysfunction, ultimately leading to constipation. Further unders tanding of the fine pathophysiological mechanisms through which the intrins ic and extrinsic nerve supplies to the digestive system are involved in idi opathic constipation or in diseases generating this symptom will hopefully lead to a better treatment of this frequent pathological condition.