Bowel dysfunction resulting in fecal incontinence and constipation is a common outcome of central neurological disease, associated with loss of voluntary control and altered autonomic function. Neurogenic bowel dysfunction has both psychosocial and pathophysiological consequences and is increasingly recognized as having a major negative impact on quality of life in individuals with central neurological trauma or disease. It is often a source of dependency, and appropriate provision of care in the community is an important issue. While the range of options for management of this problem is relatively narrow, structured intervention developed in collaboration with the patient, based on thorough clinical assessment, is effective. Intervention to manage bowel dysfunction from the earliest possible stage of disease-related change or following trauma promotes effective long-term management and must be accompanied by education of patients and their carers. Continuing evaluation of bowel management outcomes is essential in maintaining appropriate and effective management, which can provide continence, avoid constipation, reduce associated morbidity, and improve quality of life. Research interest in this important but often overlooked area of care is increasing but further work is needed to develop alternative management strategies, and improve outcomes and quality of life.