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MS research update - Bowel symptoms - how common in MS? - 22 August 2012

Bowel symptoms can occur in MS and may include constipation, difficulties emptying the bowel and faecal incontinence, where there is a lack of control over bowel opening.

Bowel control is a very complex process that involves the coordination of many different nerves and muscles. If MS has affected parts of the nervous system that are involved in bowel control, then bowel problems may occur. Bowel symptoms can be managed with the right information and support, often from a specialist continence nurse or advisor.

This research project reviewed 40 years of previous research to examine how common bowel problems are in MS and their impact on daily life. Combining information from all the research papers, 1,975 people with MS and 217 controls were included in studies about constipation. Publications that focused on faecal incontinence include 16,072 people with MS and 441,017 controls. Most people with MS had moderate disease severity.

The analysis took two approaches. Firstly, examining all the research papers and secondly, looking only at the larger studies (more than 100 people). Results from the second approach are presented below but the full information is available using the "free full text" link at the end of this article.

The researchers found that different studies reported very different prevalence rates for constipation, ranging between two (18%) and four (43%) in every ten people with MS.

The data on faecal incontinence was even more varied, ranging from one in 30 (3.4%) people to half (51%) of participants. This variation may have been because the definition of faecal incontinence varied widely between studies and, in some studies, included involuntary loss of wind or stool just once.

Problems controlling the bowel limited the social activities of about one in six people in one study and could lead to people stopping work. Consequently, there was significant impact on the quality of life of the person with MS but also, in some cases, on those around them who helped with personal care.


This paper uses an approach where the results of a large number of previous studies are combined. If there is agreement between the studies, the analysis can provide more powerful evidence that the results are meaningful. If there is disagreement between studies, they can cancel each other out unless there is a clear reason for the difference, such as studying very different groups of people.

In this study, the research projects give a wide range of results making it difficult to interpret the overall figures when they are combined. In addition, it is not clear if the participants represented the whole range of people with MS including those who are not severely affected.

Nusrat S, Gulick E, Levinthal D, et al.
Anorectal dysfunction in multiple sclerosis: a systematic review.
ISRN Neurol. 2012;2012:376023.
Free full text of article

More about bowel symptoms

You can read more about bowel symptoms and continence services in the A to Z of MS, or order our book Managing your bowel. In addition, the MS Trust produced a report on bowel management to coincide with Bowel Independence Day in July 2014. 

Research by topic areas...

Symptoms and symptom management

Wright LJ.
Identifying and treating pain caused by MS.
J Clin Psychiatry. 2012 Aug;73(7):e23.

Maghzi AH, Minagar A.
Urinary tract infection in multiple sclerosis: a practical algorithm for a common problem.
Eur J Neurol. 2012 Aug 20. doi: 10.1111/j.1468-1331.2012.03833.x. [Epub ahead of print]

Braley TJ, Segal BM, Chervin RD.
Sleep-disordered breathing in multiple sclerosis.
Neurology. 2012 Aug 15. [Epub ahead of print]

Disease modifying treatments

Bhardwaj S, Coleman CI, Sobieraj DM.
Efficacy of statins in combination with interferon therapy in multiple sclerosis: A meta-analysis.
Am J Health Syst Pharm. 2012 Sep 1;69(17):1494-9.


Drulovic J, Bursac LO, Milojkovic D, et al.
MSQoL-54 predicts change in fatigue after inpatient rehabilitation for people with multiple sclerosis.
Disabil Rehabil. 2012 Aug 16. [Epub ahead of print]

Co-existing conditions

Marrie RA, Yu BN, Leung S, et al.
The incidence and prevalence of thyroid disease do not differ in the multiple sclerosis and general populations: a validation study using administrative data.
Neuroepidemiology. 2012 Aug 9;39(2):135-142. [Epub ahead of print]

Vitamin D

Kirbas A, Kirbas S, Anlar O, et al.
Investigation of the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis.
Acta Neurol Belg. 2012 Aug 16. [Epub ahead of print]

Psychological aspects

Cerasa A, Passamonti L, Valentino P, et al.
Cerebellar-parietal dysfunctions in multiple sclerosis patients with cerebellar signs.
Exp Neurol. 2012 Aug 7.[Epub ahead of print]

Physical activity

Huisinga JM, Schmid KK, Filipi ML, et al.
Persons with multiple sclerosis show altered joint kinetics during walking after participating in elliptical exercise.
J Appl Biomech. 2012 Jul;28(3):249-57.

Bone health

Bazelier MT, van Staa TP, Uitdehaag BM, et al.
A simple score for estimating the long-term risk of fracture in patients with multiple sclerosis.
Neurology. 2012 Aug 15. [Epub ahead of print]

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