Be Proactive in Managing Bladder, Bowel Problems, Nurses Advise

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by Marta Figueiredo PhD |

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Bladder and bowel problems, which affect more than half of multiple sclerosis (MS) patients, should be assessed and monitored regularly to better adapt treatment plans and ultimately improve patients’ quality of life.

That is among recommendations of Jane Young and Joan Bradley, two nurses with experience in MS care and working at NHS Foundation Trust hospitals, in the U.K.

Young is a nurse consultant of the bladder and bowel service at Central and North West London (CNWL) NHS Foundation Trust, while Bradley is the lead nurse for MS and rehabilitation at Hillingdon Hospitals NHS Foundation Trust.

Their study, “Bladder and bowel management in multiple sclerosis,” was published in the British Journal of Neuroscience Nursing.

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

Bladder and bowel dysfunction due to neurologic damage are a common issue in people living with MS, a neurodegenerative disorder associated with abnormal immune responses in the central nervous system (brain and spinal cord).

Bladder problems, including urge and stress incontinence and failure to empty the bladder, are estimated to affect 49–92% of people living with MS. Bowel dysfunction has been reported in 39–73% of MS patients, and can manifest as fecal incontinence, slow intestinal transit, and chronic constipation.

From a patient’s perspective, “the psychological and physical distress they experience with bladder and bowel dysfunction are immense,” often posing “difficulties with travel and social life, because of the necessity to identify accessible toilets,” the nurses wrote.

Management of these problems may include pharmacological and non-pharmacological interventions, and treatment cost also is significant. Notably, a previous study showed that nearly one in every five MS patients are admitted to the hospital due to bladder or bowel issues.

Despite the importance of addressing these issues, health professionals “may delay doing so, owing to a lack of time, confidence or competence,” the researchers wrote.

Moreover, delays in patients’ disclosure also may occur, as bladder and bowel problems often are sensitive topics. Healthcare professionals should not assume that MS patients will mention these symptoms, particularly bowel dysfunction, voluntarily, and should ask about their routine bowel and bladder function early on.

This type of disclosure is more likely to happen with a clinician with whom patients are more comfortable with, and the nurses strongly recommend sensitivity when enquiring about bowel function, and including questions regarding any flag symptoms.

These include rectal bleeding, blood in stools, abdominal pain, not responding to treatment, change in bowel habit, weight loss, and iron-deficiency anemia.

The healthcare professionals also noted the importance of monitoring bowel routine, time spent on the toilet (where a mean of 30 minutes is not uncommon), stool consistency, and frequency of defecation.

Digital rectal examination should be a routine procedure, and female patients also should undergo vaginal examination to exclude rectocele. Rectocele is a bulging of the front wall of the rectum into the back wall of the vagina.

Notably, treatment of constipation and/or fecal incontinence “requires persistence, titration and engagement,” the researchers wrote, adding that “there is no quick fix or magic pill.”

Dietary or lifestyle changes, such as increasing fiber consumption or cutting caffeine or alcohol, may help, as well as laxatives and constipating agents. For those with evacuation difficulties due to rectocele or other muscle problems in that area, rectal interventions, such as suppositories or irrigation, should be considered, the nurses noted.

Notably, transanal irrigation (TAI), a procedure that helps empty the lower bowel by stimulating bowel movements through the introduction of a high volume of water, previously was shown to be effective at managing bowel problems, including in MS patients.

TAI may be administered by the patient or their caregivers, relatives, or community nursing teams, and can reduce the impact of constipation, the risk of fecal incontinence, and defecation time, subsequently improving patients’ quality of life.

“Supporting patients with challenging and complex needs requires strong working relationships between specialist services, such as between MS and bladder and bowel teams in the community,” the nurses wrote.

It is essential that “the approach to bladder and bowel management in patients with MS be proactive rather than reactive” and that “nurses ensure that patients are regularly reviewed and care plans are adjusted accordingly, which can, in turn, improve that patient’s long-term quality of life,” the nurses concluded.

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