Does Poor Bowel Management Exacerbate Fatigue Symptoms in People with Multiple Sclerosis
Many people with Multiple Sclerosis (MS) experience bowel problems (around 50% MS-UK 2015), however it is often not spoken about as it appears too embarrassing to discuss. It can present as constipation and/or incontinence and is often associated with poor mobility due to closely linked nerve transmissions. It is safe to suggest that it is a 'hidden' symptom for a lot of people with MS. Try now to consider this alongside a further invisable symptom - fatigue. Around 80% of people with MSexperience fatigue symptoms daily (MS Society UK 2015). These can be minor: feeling tired after eating ranging to complete lassitude when ones 'get up and go' has left!
This study looks at the possible impact that poor bowel management has on fatigue symptoms and how the'embarrassing' symptom may affect the 'invisable' one?
To collect evidence of both of these symptoms in a small number of the MS population within a hospital caseload, and then to explore the relationship between the two symptoms, making recommendations in light of the results.
The study took the form of mixed data surveys and focus group. The sample size was 50 patients who completed the questionairres and a focus group of 6. The qualitative surveys were established tools: Bowel Dysfunction (NBD score, Krogh et al 2006), Fatigue Severity Scale (FSS, Knapp 1989) and the Epworth Sleepiness Scale (ESS, Johns 1991).
23% of responders reported a 'severe' NBD score, of which 80% of them recorded a >75% 'agree' result on the FSS.
47% of responders reported a high (>75% of a total possible ESS) score, and of this 47%, 95% recorded a >75% 'agree' result on the FSS
No significant correlation was noted in this small scale study, using these 3 surveys.
The focus group discussions revealed indirect relevance to, but still relating to poor bowel management and fatigue with reference to wider quality of life issues such as not going out, difficulty with shopping, limitations in mobility, lack of motivation to socialise with family and friends.
Both the NBD and ESS scores showed significant correlation to the FSS, although no significant direct correlation in quantitative results for all 3 surveys. It is however, evident that the patients do not suffer the symptoms in isolation.
In order to better understand the relationship between fatigue and poor bowel management, a larger scale study needs to be undertaken with a larger sample size, also taking into consideration the specific disease profile of the patient group, including a more focus groups and even perhaps the inclusion of a semi structured questionaire to ensure more specific information is obtained.