Contributions
Abstract: EP1374
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background: Overall prevalence of bowel dysfunction symptoms is unknown in people with multiple sclerosis (PwMS). This is due to variations in definition and reticence of patients and clinicians to discuss them. Faecal incontinence is recognised as life changing whilst constipation is often dismissed as minor, but our findings report otherwise.
Methods: 237 PwMS were assessed for eligibility of a randomised controlled trial at 12 centres throughout the United Kingdom . Symptoms were recorded at the initial assessment visit whilst ano-rectal dysfunction tests were undertaken at one centre.
Results: 29 (12.2%) did not meet the inclusion criteria i.e. troublesome constipation, with a further 17 (7.1%) meeting the criteria, but were not randomised. 35 males and 154 females were recruited with a mean age of 52.3 years (SD 10.83), duration of MS 14.3 years (SD 9.18). 106(56.1%) reported having relapsing remitting MS, 59(31.2%) secondary progressive and 22 (11.6%) primary progressive, with 88 (46.6%) using unilateral or bilateral assistance to walk 20-100m. 71(37.6%) reported they had had constipation for more than 10 years, 82(44.4%) from 2-10 years and 34(28%) less than 2 years. 150(79.4%) reported severity of symptoms as moderate or severe. The primary symptom was bloating 162(85.7%), straining more than 50% of the time 123(59.3%), incomplete emptying more than 50% of the time 151(79.8%) and spending from 5 to 20 minutes per attempt at evacuation was found in 111 (59.1%) participants. Analysis of the ano-rectal sub-study indicated that 15(65.2%) had slow transit. 112 (59.3%) participants were passing stool 2-4 times per week.
Discussion: Constipation is not just infrequent passing of stool. Considerable time, effort and discomfort is associated and such questions need to be asked when assessing bowel dysfunction. Our qualitative data supported our quantitative findings in that often PwMS required significant time for toileting and were reluctant to leave home without going to the toilet or indeed use public toilets. Furthermore, bloating is embarrassing with some females being mistaken for being pregnant; incomplete evacuation is very uncomfortable, whilst overflow incontinence may not be recognised as a diagnostic symptom that may require hospitalisation.
Conclusion: Symptoms of constipation are multifactorial and awareness of the impact on quality of life needs to be raised so that effective and timely management can be implemented.
Disclosure: None
Abstract: EP1374
Type: ePoster
Abstract Category: Clinical aspects of MS - 7 MS symptoms
Background: Overall prevalence of bowel dysfunction symptoms is unknown in people with multiple sclerosis (PwMS). This is due to variations in definition and reticence of patients and clinicians to discuss them. Faecal incontinence is recognised as life changing whilst constipation is often dismissed as minor, but our findings report otherwise.
Methods: 237 PwMS were assessed for eligibility of a randomised controlled trial at 12 centres throughout the United Kingdom . Symptoms were recorded at the initial assessment visit whilst ano-rectal dysfunction tests were undertaken at one centre.
Results: 29 (12.2%) did not meet the inclusion criteria i.e. troublesome constipation, with a further 17 (7.1%) meeting the criteria, but were not randomised. 35 males and 154 females were recruited with a mean age of 52.3 years (SD 10.83), duration of MS 14.3 years (SD 9.18). 106(56.1%) reported having relapsing remitting MS, 59(31.2%) secondary progressive and 22 (11.6%) primary progressive, with 88 (46.6%) using unilateral or bilateral assistance to walk 20-100m. 71(37.6%) reported they had had constipation for more than 10 years, 82(44.4%) from 2-10 years and 34(28%) less than 2 years. 150(79.4%) reported severity of symptoms as moderate or severe. The primary symptom was bloating 162(85.7%), straining more than 50% of the time 123(59.3%), incomplete emptying more than 50% of the time 151(79.8%) and spending from 5 to 20 minutes per attempt at evacuation was found in 111 (59.1%) participants. Analysis of the ano-rectal sub-study indicated that 15(65.2%) had slow transit. 112 (59.3%) participants were passing stool 2-4 times per week.
Discussion: Constipation is not just infrequent passing of stool. Considerable time, effort and discomfort is associated and such questions need to be asked when assessing bowel dysfunction. Our qualitative data supported our quantitative findings in that often PwMS required significant time for toileting and were reluctant to leave home without going to the toilet or indeed use public toilets. Furthermore, bloating is embarrassing with some females being mistaken for being pregnant; incomplete evacuation is very uncomfortable, whilst overflow incontinence may not be recognised as a diagnostic symptom that may require hospitalisation.
Conclusion: Symptoms of constipation are multifactorial and awareness of the impact on quality of life needs to be raised so that effective and timely management can be implemented.
Disclosure: None