Occupational Therapy's Role in Bowel and Bladder Symptom Management in Multiple Sclerosis

Background: Bladder symptoms are reported by 80% of individuals living with Multiple Sclerosis (MS), and approximately 50% of the MS population report bowel symptoms. Evidence demonstrates a significant correlation between urinary symptoms and longer disease duration, increased physical disability, and reduced quality of life. Bowel dysfunction can lead to decreased quality of life and social isolation. Evidence has shown that early recognition and treatment of bowel and bladder dysfunction may reduce the severity of symptom progression and improve health-related quality of life.

Occupational therapists (OTs) address toileting and toileting hygiene in clinical treatment as a component of a person’s activities of daily living (ADLs). This includes positioning, care for continence needs, completion of intentional control of urination and bowel movements, and use of equipment/agents for bladder control. OT interventions that can be utilized to address this ADL include adaptive equipment training, pelvic floor training, relaxation techniques, bladder retraining, habit and routine management, and positioning.

Objectives: Describe OT intervention strategies for management of bowel and bladder dysfunction in patients with MS, and provide a descriptive case study with clinical outcomes to demonstrate how some of these strategies can be applied clinically.

Methods: The case study subject has participated in 14 OT sessions with expected discharge in the next month. Pt’s bladder symptom management is one priority of the plan of care. The Canadian Occupational Performance Measure (COPM), Multiple Sclerosis Quality of Life Inventory (MSQLI), and RAND Short Form-36 (RAND SF-36) are the outcome measures utilized at pre- and post-intervention.

Results: Pre-intervention outcome data includes the following: COPM overall performance score 5.4 and overall satisfaction score 4.4; RAND SF-36 subscores physical function 5, energy/fatigue 10, emotional well-being 76, social function 38, general health 20; and MSQLI scales MFIS 17, PDQ 5, BLCS 5, and BWCS 0. Post-intervention outcome measures will be collected upon re-assessment and discharge from OT services, and reported at the conference.

Conclusions: This case study highlights the strategies OTs can utilize to address management of bladder and bowel dysfunction for individuals living with MS, and demonstrates the benefits of OT interventions in improving engagement in toileting and toileting hygiene ADL routines.