Walking difficulties, vision problems and fatigue are well-known symptoms in patients with Multiple Sclerosis (MS). Bladder and bowel dysfunction are less known - or at least less discussed and addressed.
Bladder and bowel dysfunction often come together. The impact this can have on quality of life for people with MS is huge and can result in both anxiety, depression and social isolation.
Still, many find it difficult to talk about these issues and feel too embarrassed to mention it to a doctor or nurse. Due to the stigma surrounding these conditions they would rather choose to cope with their problems than trying to address them.
These issues aren't always high on every healthcare professional's agenda, which means this issue is not addressed for some people with MS. As a matter of fact, four out of ten patients have never been asked about bladder and bowel problems during their contact with healthcare professionals .1
Let's remove the stigma and start talking about bladder and bowel dysfunction.
Let 's take a closer look at bladder and bowel symptoms
The central nervous system controls both bladder and the bowel function and many people with MS suffer from combined dysfunction.
The neurological damage might be situated in the brain or spinal cord. The location determines what type of bladder and bowel symptoms occur. In some cases, bladder and bowel symptoms interact and aggravate each other.
In other words, people living with MS may suffer from separate bladder or bowel dysfunction co-existing bladder and bowel dysfunction or interacting bladder and bowel dysfunction.
Bladder and bowel interactions
Worse bladder symptoms often mean worse bowel symptoms,2 but they are rarely addressed together, even though it may be beneficial for the outcome. These are some examples of how bladder and bowel interact.
Urinary leakage due to constipation
Constipation can cause urinary urge incontinence and increased frequency due to mechanical pressure on the bladder.
Bladder and bowel functions are neurologically controlled in the same way, both centrally and locally.
Some medications for decreasing bladder symptoms may worsen bowel problems
A combined treatment approach
Therapies that relieve one condition often ease the other at the same time.3 4 5
For example, the number of urinary tract infections and urinary incontinence episodes may decrease significantly with the addition of a bowel management program for people with bladder dysfunction.3 6
A combined treatment approach will increase the chances of a better clinical outcome. Therapies that help people regain control of their bladder and bowel will significantly improve their quality of life.
Kerry is 49 years old and was diagnosed with MS in 2004.
At that time Kerry had chronic constipation, felt swollen, bloated and had gas and pain. Even as the symptoms took over her life, she didn’t relate them to MS - and no-one thought to examine her bowel.
She did the research herself and found the bowel therapy Transanal Irrigation (TAI).
Kerry was amazed at the impact TAI had on her combined bladder and bowel issues:
"I used to have a bladder issue and now I don't. I wasn't aware at the time that my bowels were affecting my bladder. When my bowel problems were solved my bladder seemed to function better as well"
This week is MS Awareness week (22-28 April), and this year the focus is ‘Move it for MS’ which is all about staying active with MS.
- Wang et al. Multiple sclerosis and related disorders. 2078;20:76-27.
- Preziosi et al. Eur. Gastroenterol. Hepatol. 2073;25(9):7044-7050.
- Radojicic et BJU lnt. 2078. doi: 70.7777/bju.74474
- Chen and Liao. Spinal Cord. 2075;53:204-208.
- Rasmussen et al. Ugeskr. Laeger. 2077;773(39):2472-2475.
- Radojicic etal. Pediatr. Ural. 2078. doi: 70.7076/j.Jpurol.2078.05.025