Nusrat et al. Anorectal Dysfunction in Multiple Sclerosis: A Systematic Review. ISRN Neurol. 2012;2012:376023. Epub 2012 Jul 29.
Background: Constipation and fecal incontinence are common in MSers. Despite their high prevalence and potential impact on overall quality of life, few studies have addressed anorectal dysfunction in MSers.
Aim: The goal of this work is to define the prevalence, pathophysiology, impact, and potential treatment of constipation and incontinence in MSers.
Methods: The PubMed database was searched for English language publications between January 1973 and December 2011. Articles were reviewed to assess the definition of the study population, duration, type and severity of MS, sex distribution, prevalence, impact, results of physiologic testing, and treatments.
Results: The reported prevalence of constipation and fecal incontinence ranged around 40%. Anorectal dysfunction significantly affected MSers with nearly 1 in 6 MSers limiting social activities or even quitting work due to symptoms. Caregivers listed toileting as a common and significant burden. The only randomized controlled trial showed a marginal improvement of constipation with abdominal massage. All other reports lacked control interventions and only demonstrated improvement in individuals with milder symptoms.
Conclusion: Anorectal dysfunction is a common manifestation in MS that significantly affects quality of life. Therapies are at best moderately effective and often cumbersome, highlighting the need for simple and more helpful interventions.
“Somebody was making the point in a comment yesterday that on average MS was not necessarily that bad and that in the modern era most MSers live with a good quality of life. This study demonstrates that if you look a little deeper than walking impairment, which is what the EDSS measures you find a lot of hidden disabilities that impact massively on QoL. Bowel and anorectal dysfunction is one of these.”
“Does the person who made that post yesterday know how embarrassing and socially isolating bowel dysfunction is for MSers? I look after several MSers who have become recluses because of this problem. Again it is better to prevent this problem than treat the consequences.”
“Anybody share my perspective?”