Gastroenterology

Gastroenterology

Volume 98, Issue 6, June 1990, Pages 1538-1542
Gastroenterology

Prevalence of bowel dysfunction in multiple sclerosis: A population survey

https://doi.org/10.1016/0016-5085(90)91087-MGet rights and content

Abstract

An unselected outpatient population of 280 individuals with multiple sclerosis was surveyed to determine the prevalence of bowel dysfunction and to define their characteristics and their relationship to the nongastrointestinal manifestations of the disease. Constipation was present in 43%, was similar in frequency in both sexes, and was more common in patients, regardless of degree of disability, than in a control population. Frequency of constipation also correlated with duration of disease and genitourinary symptoms but did not correlate with use of any medications in mildly disabled patients. Fecal incontinence had occurred at least once in the preceding 3 mo in 51% of patients and once per week or more frequently in 25% of patients who were questioned in more detail with a follow-up questionnaire. Correlations of fecal incontinence with disability, duration of disease, and presence of genitourinary symptoms were similar to constipation. The prevalence of bowel dysfunction (constipation and/or fecal incontinence) in the multiple sclerosis population was 68%, and this manifestation was common even in mildly disabled subjects. Bowel dysfunction can be a source of considerable ongoing social disability in patients with multiple sclerosis. Further studies are needed to characterize the pathophysiology of this common disorder so that effective therapeutic strategies can be identified.

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    Autonomic dysfunction in MS is related to lesions in the periventricular region of the fourth ventricle of the brainstem and medulla (Adamec and Habek, 2013). Autonomic dysfunction results from both demyelination and also axonal loss (de Seze et al., 2001), affecting cardiovascular (66% of patients) (Acevedo et al., 2000; Mincu et al., 2015), bladder (97% of patients) (Haensch and Jörg, 2006), sexual function (80% of patients) (Tepavcevic et al., 2008), bowel (43% of patients) (Hinds et al., 1990), sleep (50% of patients) (Bamer et al., 2008), heat sensitivity (60–90% of patients) (Gallup et al., 2010) and also altered motor symptoms (e.g., fatigue) (thermoregulation). Hypothalamic lesions can result in both hyperthermia and hypothermia (Linker et al., 2006; White et al., 1996).

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Presented in part at the National Meeting of the American Gastroenterological Association, New Orleans, Louisiana, May 1988.

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