Pathophysiology and management of bowel dysfunction in multiple sclerosis

The prevalence of bowel dysfunction in multiple sclerosis (MS) patients is higher than in the general population. Up to 70% of patients complain of co nstipation or faecal incontinence, which may also coexist. This overlap can relate to neurological disease affecting both the bower and the pelvic flo or muscles, or to treatments given. Bowel dysfunction is a source of consid erable ongoing psychosocial disability in many patients with MS. Symptoms r elated to the bladder and the bower are rated by patients as the third most important, limiting their ability to work, after spasticity and incoordina tion. 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 evid ence to support the efficacy of these recommendations is scant. This review will examine the current state of knowledge regarding the pathophysiologic al 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 th e 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, Eur J Gastroenterol Hepatol 13:441-448 (C) 2001 Lippinco tt Williams & Wilkins.