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Pathophysiology and management of bowel dysfunction in multiple sclerosis

Wiesel, Paul H.a; Norton, Christinea; Glickman, Scottb; Kamm, Michael A.a

European Journal of Gastroenterology & Hepatology: April 2001 - Volume 13 - Issue 4 - p 441-448

The prevalence of bowel dysfunction in multiple sclerosis (MS) patients is higher than in the general population. Up to 70% of patients complain of constipation or faecal incontinence, which may also coexist. This overlap can relate to neurological disease affecting both the bowel and the pelvic floor muscles, or to treatments given. Bowel dysfunction is a source of considerable ongoing psychosocial disability in many patients with MS. Symptoms related to the bladder and the bowel are rated by patients as the third most important, limiting their ability to work, after spasticity and incoordination. Bowel management in patients with MS is currently empirical. Although general recommendations include maintaining a high fibre diet, high fluid intake, regular bowel routine, and the use of enemas or laxatives, the evidence to support the efficacy of these recommendations is scant. This review will examine the current state of knowledge regarding the pathophysiological mechanisms underlying bowel dysfunction in MS, outline the importance of proper clinical assessment of constipation and faecal incontinence during the diagnostic work-up, and propose various management possibilities. In the absence of clinical trial data on bowel management in MS, these should be considered as a consensus on clinical practice from a team specialized in bowel dysfunction.

aSt Mark's Hospital, London, UK; and bMultiple Sclerosis Unit, Central Middlesex Hospital, London, UK

Received 7 February 2000

Revised 20 June 2000

Accepted 30 August 2000

Correspondence to Prof. Michael Kamm, St Mark's Hospital, Watford Road, Harrow, Middx HA1 3UJ, UK Tel: +44 (020) 8235 4160; fax: +44 (020) 8235 4162

© 2001 Lippincott Williams & Wilkins, Inc.