The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience

Abstract

Background: Bowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems.

Objectives: This study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue.

Methods: Questionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems.

Results and conclusions: Of 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS.

Fig 1. Causal directed acyclic graphs to determine variables that may need adjusting for in regressions designed to investigate the relationship between fatigue, level of disability (as measured by Expanded Disability Status Score), and bowel and bladder problems in people with Multiple Sclerosis.

Fig 1A investigates the impact of fatigue and level of disability on bowel and bladder function, while Fig 1B investigates the impact of bowel and bladder dysfunction on fatigue.

Fig 2

Expanded Disability Status Scale (EDSS) [17] scores of participants with Multiple Sclerosis plotted against A, Actionable Bladder Symptom Screening Tool (ABSST) [19] scores (n = 117) and B, Revised Faecal Incontinence Scale (RFIS) [21] scores (n = 135).

Fig 3

Individual participants’ Modified Fatigue Impact Scale (MFIS) scores plotted against A, Expanded Disability Status Scale (EDSS) scores (n = 135), B, Actionable Bladder Symptom Screening Tool (ABSST) scores (n = 117) and C, Revised Faecal Incontinence Scale (RFIS) scores (n = 135).