Pathophysiology and management of bowel dysfunction in multiple sclerosis

Author(s): Wiesel PH, Norton C, Glickman S, Kamm MA


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.

Similar Articles

Fatigue in MS is related to sympathetic vasomotor dysfunction

Author(s): Flachenecker P, Rufer A, Bihler I, Hippel C, Reiners K, et al.

"Is Fatigue in Patients with Multiple Sclerosis Related to Autonomic Dysfunction?" Clin Auto Res 10: 169-175

Author(s): Keselbrener L, Akselrod S, Ahiron A, Eldar M, Barak Y, et al.

"Clinical Screening of Autonomic Dysfunction in Multiple Sclerosis

Author(s): Hale LA, Nukada H, Du Plessis LJ, Peebles KC

Reflex control of immunity

Author(s): Tracey KJ

Combining beta interferon and atorvastatin may increase disease activity in multiple sclerosis

Author(s): Birnbaum G, Cree B, Altafullah I, Zinser M, Reder AT

Inhibitory role for GABA in autoimmune inflammation

Author(s): Bhat R, Axtell R, Mitra A, Miranda M, Lock C, et al.

Effects of sedatives on noradrenaline release from the medial prefrontal cortex in rats

Author(s): Kubota T, Hirota K, Yoshida H, Takahashi S, Anzawa N, et al.

Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin

Author(s): Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, et al.

The vagus nerve and nicotinic receptors modulate experimental pancreatitis severity in mice

Author(s): van Westerloo DJ, Giebelen IA, Florquin S, Bruno MJ, Larosa GJ, et al.

Local stimulation of alpha7 cholinergic receptors inhibits LPS-induced TNF-alpha release in the mouse lung

Author(s): Giebelen IA, van Westerloo DJ, LaRosa GJ, de Vos AF, van der Poll T

Physiologic and functional responses of MS patients to body cooling

Author(s): Ku YT, Montgomery LD, Lee HC, Luna B, Webbon BW