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CMSC INforMS: Sluggish Bowels May Increase Fatigue in MS

Sunday, June 05, 2016  
Posted by: Elizabeth Porco
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Addressing constipation, fecal incontinence might help, study suggests

NATIONAL HARBOR, Md. -- Sluggish bowels may be contributing to fatigue among multiple sclerosis (MS) patients, according to a small study presented here.

Patients who reported having severe bowel dysfunction were also very likely to report feeling fatigued, Emma Matthews, QN, of Northampton General Hospital in England, and colleagues reported in a poster at the Consortium of Multiple Sclerosis Centers annual meeting.

"People with MS have a very sluggish bowel and it takes a long time to get rid of all that toxic waste; they can go for 10 days or more" without having a bowel movement, co-author Kathy Franklin, QN, also of Northampton General, told MedPage Today. "We think there's a correlation between fatigue and having a bowel that's full of feces."

Although most MS patients experience bowel problems, "it is often not spoken about as it can be too embarrassing to discuss," the investigators wrote. "It can present as constipation and/or incontinence, and is often associated with poor mobility due to closely linked nerve transmissions. So we can safely say it is a hidden symptom for a lot of people with MS."


To address the issue, the researchers had 50 MS patients complete a questionnaire and worked with six patients in a focus group. The instruments used to gather data included the Neurogenic Bowel Dysfunction (NBD) scale; the Fatigue Severity Scale (FSS) to measure fatigue; and the Epworth Sleepiness Scale (ESS) to measure sleepiness.


The researchers found that 23% of participants reported having a "severe" NBD score; of those, more than 80% had an "agree" result >75% of the time on the FSS. In addition, of the 47% of respondents who scored high (>75% of the total possible points) on the ESS, 95% also had a >75% "agree" result on the FSS.


In the focus group, participants discussed issues indirectly related to bowel management and fatigue, including quality-of-life issues like shopping, not going out, limited mobility, and lack of motivation for socializing with family and friends.

"Although [there was] no significant direct correlation in quantitative results for all three surveys, it is evident that the patients do not suffer the symptoms in isolation," the authors wrote. To explore this relationship further, a larger study should be undertaken using a larger sample group; that study should take into account the group's disease profile, the authors said in their poster.


Matthews said the results suggest that "Good bowel management for people with MS will hopefully help with their MS fatigue symptoms and make their quality of life better."


Edward Fox, MD, PhD, of Round Rock, Texas, who was not involved with the study, said that the concept makes sense. "We've gotten the sense before that it's not just fatigue due to MS, it's fatigue due to a multitude of medical issues that could be going on," he said. "This is one of many factors that can lead to patients feeling like they have poor energy, and decreased daily activities."


In addition, the study "also ties into the discussions going on right now with the microbiome," he continued. "The bacteria we have in our gut plays an enormous role in our immune function. Eighty percent of lymphocytes are in our GI tract, so our immune system reacts to what we eat. Those foods that lead to poor bowel habits likely are leading to greater fatigue and other symptoms as well."


Standard treatments for sluggish bowel in MS patients include encouraging exercise and fiber consumption; if those treatments prove ineffective, physicians can then escalate to medication and, if that doesn't work, move on to anal irrigation, Matthews said.


As a possible alternative treatment for sluggish bowel, the researchers are now involved in a multi-center, double-blind trial of abdominal massage to help encourage transit, Franklin said. "Hopefully we can decrease the amount of medication somebody's taking and make them feel better at the same time."

Matthews and co-authors disclosed no relevant relationships with industry.

By Joyce Frieden

MedPage Today

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