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

Authors Preziosi G, Gordon-Dixon A, Emmanuel A

Received 1 March 2018

Accepted for publication 13 July 2018

Published 6 December 2018 Volume 2018:8 Pages 79—90

DOI https://doi.org/10.2147/DNND.S138835

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Thomas Müller


Giuseppe Preziosi, Ayeshah Gordon-Dixon, Anton Emmanuel

Gastro-Intestinal Physiology Unit, University College London Hospital, London, UK

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.

Keywords: neurogenic bowel dysfunction, multiple sclerosis, constipation, fecal incontinence

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