Implementation of Clinical Practice Guidelines and Education to Reduce Bowel Dysfunction in Multiple Sclerosis Patients

Background: Bowel dysfunction in multiple sclerosis is common, yet under-recognized and under-treated.

Objectives:  Educate MS patients about behavioral and dietary interventions that can improve bowel function.  Evaluate the outcomes of the educational intervention on bowel function after three months.

Methods: This was a prospective study that evaluated the effect of patient education and implementation of clinical practice guidelines on bowel function among multiple sclerosis patients using the Bowel Control Scale (BWCS). A convenience sample of adult MS patients in the Ochsner MS center was invited to participate. A sample size was estimated at 71 using G*Power 3.1, α = 0.05, Power = 0.80, and d = 0.3. The only requirements were that the individuals had a diagnosis of multiple sclerosis and reported presence of bowel dysfunction as an MS symptom. Every MS patient that was enrolled in the study was given an educational brochure, a bowel diary that was published in the conference proceedings of the 2011 consensus conference on elimination dysfunction in MS, and a brief counseling session with an MS certified nurse, focusing on behavior management, dietary changes, and use of reflexes to stimulate normal bowel movements. Each patient completed the BWCS at study initiation and termination. The outcome of improved bowel function was assessed by comparing mean scores on the Bowel Control Scale before the patients received the education and counseling by an MS certified nurse and after 3 months of implementation of this education.

Results: At study initiation, the mean score on the BWCS was 6.29. At study termination (3 months), the mean score on the BWCS was 5.12. This suggests an improvement in bowel function among the participants. A Wilcoxon test examined the results of the pre-intervention and post-intervention BWCS scores. A significant difference was found in the results (Z=-2.879, p <.05). Improvement in bowel function was seen in 60% of the sample, as evidenced by lower scores on the post-intervention BWCS. A higher score was seen in 20% of the sample, suggesting worsening of bowel function, and 20% had no improvement or worsening, as evidenced by the same BWCS score before and after the intervention.

Conclusions:  Patient education and counseling can lead to a significant improvement in the bowel function of patients with multiple sclerosis.