S1238 Medium-Term Outcome with Trans-Anal Irrigation for Neurogenic Bowel Dysfunction Is Related to Rectal Compliance

Abstract

Introduction: Bowel dysfunction is highly prevalent in patients with multiple sclerosis (MS) with a major impact on quality of life, regardless of disability status or disease duration. It is often associated with the failing of the other pelvic functions and its origin is unclear, whilst it is established that spinal cord involvement by MS is central to bladder dysreflexia. A similar mechanism could underlie constipation and incontinence and this study analysed their correlation with uro-genital dysfunction. Further clarification of the causes of bowel dysfunction in MS may contribute to improved treatment. Materials and methods: Data from 71 patients with MS (53 female, mean age 44, mean disease duration 78 months) attending a neuro-gastroenterology clinic were studied. 25 patients had relapsing remitting MS, 7 had primary progressive and 39 had secondary progressive disease. Severity of bowel, bladder and sexual dysfunction was quantified by a visual analogue scale and frequency by self-report of the proportion of time symptoms of dysfunction are present. Patients also completed the validated Neurogenic Bowel Dysfunction (NBD) questionnaire and Expanded Disability Status Scale (EDSS). Results: Whereas bladder dysfunction was related to disease duration (p=0.012), no such association existed for bowel dysfunction. Disease duration, gender and type of MS did not correlate with self-report of bowel dysfunction or NBD score. EDSS score was ≥ 5 (most severe) in 9 patients, ≤ 1 (mild) in 18 and 44 between 1.5 and 4.5. EDSS is significantly inversely correlated to NBD score (p=0.03) and self-reported bowel dysfunction (p<0.003). There was no relationship between EDSS and bladder dysfunction (p=0.25). NBD score correlated better with self-reported frequency of bowel dysfunction (p<0.03) than self-reported severity (p=0.07). Conclusions: Bowel dysfunction is not related to MS type or disease duration, in contrast to bladder dysfunction. In clinical assessment, the NBD questionnaire is complementary to, and not a replacement of, patient self-report. There is a relationship between disability status and bowel dysfunction but not bladder dysfunction; this suggests that bowel dysfunction may be related to disability factors as much as a direct neural mechanism.