Pathophysiology and management of bowel dysfunction in multiple sclerosis.

Area of Science:

• Neurology
• Gastroenterology
• Rehabilitation Medicine

Background:

• Bowel dysfunction, encompassing constipation and fecal incontinence, affects up to 70% of multiple sclerosis (MS) patients, often coexisting.
• This dysfunction significantly contributes to psychosocial disability and impacts patients' ability to work, ranking third after spasticity and incoordination.
• Current bowel management strategies for MS patients are largely empirical, lacking robust evidence for efficacy.

Purpose of the Study:

• To review the current understanding of pathophysiological mechanisms of bowel dysfunction in MS.
• To emphasize the importance of thorough clinical assessment for constipation and fecal incontinence in MS patients.
• To propose evidence-based management options for bowel dysfunction in MS, based on expert consensus.

Main Methods:

• Literature review examining pathophysiological mechanisms of bowel dysfunction in MS.
• Analysis of clinical assessment strategies for constipation and fecal incontinence in MS.
• Consensus-based proposal of management possibilities in the absence of clinical trial data.

Main Results:

• Neurological effects in MS can impact bowel and pelvic floor function, contributing to dysfunction.
• Coexisting constipation and fecal incontinence are common in MS patients.
• Evidence supporting current general recommendations for bowel management in MS is limited.

Conclusions:

• A comprehensive understanding of MS-related bowel dysfunction requires exploring neurological and treatment-related factors.
• Standardized clinical assessment is crucial for diagnosing and managing bowel issues in MS.
• Consensus-based management strategies are proposed due to a lack of clinical trial data for MS bowel care.