Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies

Figures & data

Table

• Straining during defecation • Hard or lumpy stools • Sensation of incomplete evacuation • Sensation of anorectal blockage or obstruction • Use of manual maneuvers to facilitate evacuation (includes digitation to the perineum) • Three or less defecations per week • Rarely has loose stools without the use of laxatives

Note: Data from Drossman.¹³

Figure 1 Rectoanal inhibitory reflex (RAIR).

Notes: Excitation peak: initial increase in the resting pressure is associated with sudden rectal distension. Excitation latency: duration from the point of excitation peak back to the baseline pressure. Point of maximum relaxation: lowest point of resting pressure secondary to reflex internal anal sphincter relaxation. Recovery time: the duration between maximum relaxation and the point at which the resting pressure recovers to two-thirds its baseline value. Total reflex duration: calculated as the duration from the point of the excitation peak to the point where two-thirds recovery is observed. Figure reproduced from Thiruppathy K, Roy A, Preziosi G, Pannicker J, Emmanuel A. Morphological abnormalities of the recto-anal inhibitory reflex reflects symptom pattern in neurogenic bowel. Dig Dis Sci. 2012;57(7):1908–1914. Copyright 2012 Thiruppathy et al.⁴⁷

Figure 2 Diagram showing the multifactorial origin of constipation.

Notes: Adapted from Preziosi G. Pathophysiology of Bowel Dysfunction in Multiple Sclerosis and the potential for targeted treatment [Doctoral thesis]. London, UK: University College London; 2014. Copyright 2014 Preziosi.⁸⁵
Abbreviations: FI, fecal incontinence; RAIR, rectoanal inhibitory reflex.

Figure 3 Diagram showing the multifactorial origin of fecal incontinence.

Notes: Adapted from Preziosi G. Pathophysiology of Bowel Dysfunction in Multiple Sclerosis and the potential for targeted treatment [Doctoral thesis]. London, UK: University College London; 2014. Copyright 2014 Preziosi.⁸⁵
Abbreviation: RAIR, rectoanal inhibitory reflex.

Figure 4 This diagram shows how important it is to tailor treatment, sometimes using a combination of interventions. A stepwise approach is recommended; however, it is paramount to engage patient and caregiver, to understand their preferences and adjust treatment accordingly.

DrossmanDAThe functional gastrointestinal disorders and the Rome III processGastroenterology200613051377139016678553

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ThiruppathyKRoyAPreziosiGPannickerJEmmanuelAMorphological abnormalities of the recto-anal inhibitory reflex reflects symptom pattern in neurogenic bowelDig Dis Sci20125771908191422427172

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PreziosiGPathophysiology of Bowel Dysfunction in Multiple Sclerosis and the potential for targeted treatmentDoctoral thesisLondon, UKUniversity College London2014

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