Moderate-to-severe Bowel Problems Found in 14.5% of Patients

Moderate-to-severe bowel dysfunction was detected in 14.5% of adult people with multiple sclerosis (MS), an Italian study reports. The prevalence of bowel dysfunction was increased in women and in patients with progressive forms of MS, higher disability, older age, and longer disease duration.

Despite the prevalence of bowel dysfunction being lower than previously reported, the findings underscore the need for routine clinical examination for bowel dysfunction among MS patients so that tailored treatment is put in place to prevent its worsening.

The study “Prevalence and predictors of bowel dysfunction in a large multiple sclerosis outpatient population: an Italian multicenter study” was published in the Journal of Neurology.

Neurogenic bowel dysfunction (NBD) — the loss of normal bowel function due to a nerve problem — is frequent in people with MS. It is estimated that 39–73% of MS patients experience NBD, which manifests as fecal incontinence, slow intestinal transit, and chronic constipation.

NBD may be linked to bladder dysfunction, higher levels of disability, and long disease duration.

Now, a team led by researchers in Italy assessed the prevalence of NBD in 1,100 MS patients (mean age 44.2 years, 66% women) from nine different MS centers in the country.

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Participants completed the Italian version of the NBD questionnaire and the International Prostatic Symptoms Score (IPSS). The NBD questionnaire is composed of 10 questions with scores ranging from zero to 47, in which higher scores indicate more severe symptoms. Specifically, the scale distinguished four levels of severity of dysfunction: very minor (scores 0–6); minor (7–9); moderate (10–13); and severe (14–47).

IPSS is a seven‐question screening tool used to assess neurogenic bladder-associated symptoms. It was developed originally to assess prostate problems in men.

At the time of the questionnaires, 843 patients were under treatment with some type of disease-modifying therapy (DMT), while 254 (23.1%) were DMT-free. Additional therapies included antispastics, antidepressants, anxiolytics, medicines for bladder problems and pain, as well as physiotherapy.

The analysis revealed that 862 patients (78.4%) had very minor NBD symptoms, followed by 78 patients (7.1%) with minor symptoms, 75 patients (6.8%) with moderate symptoms, and 85 (7.7%) with severe NBD.

Overall, 14.5% had moderate-to-severe NBD, a lower prevalence when compared to previous review reports (ranging from 39–73%).

Compared to patients with minor or very minor NBD scores, those with moderate-to-severe symptoms were significantly older (mean age 43.7 years vs. 47.2), had MS longer (mean duration 10.9 vs. 12.7 years), and a higher frequency of progressive MS.

Also, patients with moderate-to-severe NBD had significantly greater disability compared to those with minor or very minor NBD, as shown by higher scores in the expanded disability status scale (EDSS, median score of 4 vs. 2).

The IPSSs also were significantly higher — indicative of worse function — in moderate-to-severe NBD (mean 21.5 vs. 8.9).

Further analysis revealed that NBD was significantly associated with the control of sphincters (ring-shaped muscles that regulate the opening or closing of passages in the body); ambulation scores of EDSS; IPSSs; and the use of neurogenic bladder therapies.

Male sex and the use of anti-spasm medicines seemed to reduce the risk for NBD.

Overall, this study suggests that “NBD symptoms might be less frequent in MS patients respect to previous reports,” the researchers wrote. However, “It is worthy to note that a prevalence of about 14% of moderate–severe NBD is quite significant in a population composed mainly by young, active, low-disabled MS patients,” they added.

As so, “a routine screening of bowel dysfunction in MS might allow early identification and management of patients suffering of these disabling symptoms,” the team suggested.