Non-pharmacological interventions for fecal incontinence in people with multiple sclerosis: A scoping review

Fecal incontinence (FI) is a common but often underrecognized symptom in people with multiple sclerosis (MS), markedly impairing quality of life. Non-pharmacological strategies are recommended as first-line management; however, existing evidence remains limited and fragmented. This review aimed to map current evidence on such interventions and identify key gaps to inform future research.

A scoping review was conducted following the Joanna Briggs Institute's six-stage framework and reported according to PRISMA-ScR guidelines. Comprehensive searches were performed in PubMed, Web of Science, CINAHL, Scopus, and ScienceDirect, finalized in August 2025. Empirical studies investigating non-pharmacological management of FI in adults with confirmed MS were included. Two reviewers independently extracted and synthesized data using thematic analysis.

Fifteen studies met the inclusion criteria. The most frequently evaluated interventions were transanal irrigation (n=6) and biofeedback therapy (n=4), followed by posterior tibial nerve stimulation (n=2), sacral neuromodulation (n=2), pelvic floor physiotherapy (n=1), and behavioral programs (n=1). These interventions showed promise in reducing FI symptoms and improving quality of life. However, most studies were limited by small sample sizes, heterogeneous protocols, and non-MS-specific outcome measures. Thematic analysis identified four key domains: clinical effectiveness; factors influencing treatment response; feasibility and sustainability; and research limitations with future directions.

Non-pharmacological management of FI in MS appears safe, feasible, and potentially effective in improving symptoms and quality of life. Future research should adopt standardized protocols, MS-specific assessment tools, and long-term follow-up in larger samples. Integration of digital and home-based strategies may further enhance sustainability and accessibility of interventions.