Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Abstract

Bowel dysfunction in patients with multiple sclerosis (MS) is highly prevalent. Constipation and fecal incontinence can coexist and alternate, impacting on the patient’s quality of life and social interactions, as well as burdening the caregivers. The cost for the health care providers is also significant, with increased number of hospital admissions, treatment-related costs, and hospital appointments. The origin is multifactorial, and includes alteration of neurological pathways, polypharmacy, behavioral elements, and ability to access the toilet. Every patient with MS should be sensitively questioned about bowel function, and red flag symptoms should prompt adequate investigations. Manipulation of life style factors and establishment of a bowel regime should be attempted in the first place, and if this fails, other measures such as biofeedback and transanal irrigation should be included. A stoma can improve quality of life, and is not necessarily a last-ditch option. Antegrade colonic enemas can also be an effective option, whilst neuromodulation has not proved its role yet. Effective treatment of bowel dysfunction improves quality of life, reduces incidence of urinary tract infection, and reduces health care costs.

Variant-to-Gene-Mapping Analyses Reveal a Role for the Hypothalamus in Genetic Susceptibility to Inflammatory Bowel Disease

“…The HPA axis is dysregulated in some MS patients, and hypothalamic lesions are correlated with the disease severity and outcomes. 59 , 60 , 61 MS is associated with neurogenic bowel dysfunction, 62 and recent studies have implicated a role for microbial breeches in intestinal barrier integrity in its pathogenesis. 63 , 64 Asthma also is characterized by a dysregulation of the HPA axis 49 and by breeches in respiratory epithelium barrier integrity leading to exacerbation of inflammatory responses.…”

Safety and Efficacy of Intermittent Colonic Exoperistalsis Device to Treat Chronic Constipation: A Prospective Multicentric Clinical Trial

“…The treatment options, however, are limited and often using, for example, laxatives increases the likelihood of fecal incontinence, and patients usually dislike taking additional medication. Transanal irrigation has also shown some efficacy but is not always continued ( 51 ). An option such as using the ICE treatment is an important addition in their overall management strategy that can be used as a stand-alone treatment or in combination.…”

Bladder and bowel incontinence in COVID‐19

“…Some of them include diplopia, ataxia, clonus, dysarthria, paraesthesia in hands and feet, hemiparesis, incoordination, weakness, unsteadiness, and hearing loss. 6,7 Demyelinating disorders have a wide range and are not limited to the cases mentioned. For example, acute demyelinating inflammatory polyneuropathy, the most common type of Guillain-Barré syndrome, has been reported as a complication in patients with To the best of our knowledge, inflammation, and demyelination in the pudendal nerve can lead to bladder and bowel incontinence.…”