SX12
Self-Reported Bladder and Bowel Symptoms in Multiple Sclerosis Patients
Nearly 75% of patients with multiple sclerosis (MS) experience lower urinary tract (LUT) symptoms (Fowler, 1997). Demyelination and inflammation, the hallmark features of MS, can affect the neural pathways between the central nervous system and bladder that control bladder function (McCombe, 2009). LUTS in patients with MS vary widely in type and severity, symptoms may be present early in the disease course and may even predate the diagnosis of MS (Nortvedt, 2007). Some patients are spared early symptoms, however, as MS progresses, bladder dysfunction affects the majority of patients (de Seze, 2007).
Objectives:
To phenotype MS patients with LUTS and correlate specific constellation of symptoms, as well as symptom severity with functional status. We tested the hypothesis that irritative LUTS occur across all ranges of age, durations of disease, and disability scores with moderate correlation and obstructive symptoms occur in patients with longer duration of disease, and those with higher disability scores with strong correlation.
Methods:
Patients with MS and LUTS, recruited from Urology and Neurology clinics at University of Pennsylvania, were queried regarding most bothersome urinary and bowel symptoms as well as the presence of irritative LUTS (urgency, frequency, incontinence), obstructive LUTS (e.g. incomplete bladder emptying, straining to void, hesitancy) or both. Correlation between the bladder sub score on multiple questionnaires [Functional Symptom Score (FSS) and the Medical, Epidemiological, and Social Aspects of Aging (MESA), Urogenital Distress Inventory (UDI), & International Consultation on Incontinence-Bowel (ICI-Q)] performed to assess the reliability of the FSS bladder/bowel subscore in assessing bladder symptoms. Health related quality of life was also assessed using SF-36 and compared to measures of voiding symptoms.
Results:
171 pre-screened, 32 enrolled (6 males, 26 females, 75% Caucasian, 25% African American), 45 average age and 13.7 average years with MS Diagnosis. Average years with LUTS = 8.5 years. Bladder symptoms: 58.7% irritative (69% experienced urinary frequency, urgency, urgency UI, and 59% nocturia); 42.3% obstructive (47% reported difficulty voiding and incomplete emptying).. Bowel function was reported as difficult, requiring straining (56%), and digital manipulation (15%). Despite reporting bothersome bladder and bowel symptoms, most patients reported their general health as “fair” “good” “very good” or “excellent.” [very good/excellent 28% (n= 9), good/fair in 50% (n=16)]. As to functional ability: 38% reported difficulty (a little/a lot) participating in moderate activity, 38% reported inability to climb one flight of stairs, and 16% were unable to bathe and dress themselves without aid.
Conclusions: Irritative and obstructive LUTS were common among patients with MS but did not discreetly fall into either category but rather a spectrum with varying degrees of each.