Fig. 5

Gut dysbiosis and intestinal alterations in SCI. Disruptions in the neurological systems together with systemic factors lead to a common complication of SCI designated NBD, characterized by constipation, fecal incontinence, altered metabolism and intestinal barrier dysfunction. NBD can be caused by and promote changes in gut microbiota composition, which in turn have a direct influence on the immune system, the psyche and the entire organism, acting as a major endocrine system disruptor. Other systemic factors, such as the use of certain drugs, diet or immobility, have a direct effect on the gut microbiota, influencing the reported changes. Collectively, deepening our understanding of these gut microbiota alterations can aid in understanding and ameliorating multisystem SCI progression. CNS Central nervous system; PNS Peripheral nervous system; ANS Autonomic nervous system; NBD Neurogenic bowel dysfunction; SCI Spinal cord injury; SCFA Short-chain fatty acid