According to a recent study, bowel symptoms in people with multiple sclerosis (MS) are underreported to clinicians partly because patients are reluctant to discuss their symptoms with them.
Instead of having a direct dialogue with a healthcare provider, a self-reported survey called Neurogenic Gastrointestinal Dysfunction (NBD) may assist people be screened for gastrointestinal problems.
Validated questionnaires may be more useful for diagnosing gastrointestinal problems than in-person consultations, claim researchers. “NBD scores seem to be a straightforward discriminant screening tool and are simple to use in clinical practice.”
Bowel problems are experienced by about 2/3 of MS patients.
Bowel symptoms, which can include constipation, infrequent bowel movements, difficulty defecating, diarrhea, or a decreased capacity to control bowel motions, affect about two-thirds of MS patients. These problems can significantly diminish quality of life by causing pain, discomfort, and a reduced capacity for work and social activities.
Nevertheless, despite advice, medical staff rarely take action to identify these symptoms early in the course of MS or to assist patients in managing their gastrointestinal problems. Additionally, because some people view the subject as stigmatizing, patients occasionally find it difficult to discuss their gastrointestinal issues with their doctors.
The goal of the study was to determine how frequently MS patients fail to disclose their bowel symptoms to a doctor. The team was lead by experts at the University of Rouen Normandy in France. Additionally, they looked at the frequency and type of bowel symptoms generally as well as the causes of patients seeking colon care.
369 adult MS patients who were either enrolled in the MS Healthcare Network and recruited via email (248 patients) or who were seen in an outpatient clinic (121 patients) were included in the analysis. Patients were required to answer questions about the severity of their constipation, their digestive symptoms, and their stool. Additionally, they were questioned about the length of their gastrointestinal symptoms, whether they had sought medical attention for them, what kind of care they had received, and from whom.
Prior to taking part in the study, participants had, on average, nine years since receiving their MS diagnosis. In comparison to those recruited from the network, those recruited from the outpatient clinic were often younger, resided more frequently in metropolitan areas, had been diagnosed earlier, and had a lower level of disability, all of which are indicators of better access to care and earlier diagnoses and treatments.
In 47% of cases, there is at least one bowel symptom.
174 patients (or 47%) said they had at least one bowel symptom, most frequently constipation, fecal incontinence, or the inability to control bowel movements. However, 66 (41%) of the 161 respondents who provided information on symptom management claimed they did not notify a healthcare professional of their problems.
The most prevalent excuse offered for not reporting gastrointestinal problems, according to the researchers, was a refusal to address the issue with a doctor and a preference for self-management.
About one third of the 59% of people who sought medical attention for gastrointestinal symptoms were taking or had taken medication for their symptoms, typically laxatives or medications to treat diarrhea. The majority of these patients consulted a general practitioner.
According to statistical calculations, people with gastrointestinal problems for five years or more were substantially more likely to go to the doctor than people with symptoms for less time. There were no additional factors linked to consulting a doctor for gastrointestinal symptoms management.
The researchers next looked at whether people with bowel issues who needed management might be found using the NBD self-reported questionnaire. Ten multiple-choice questions on symptoms of constipation and fecal incontinence are included in the test, which rates patients according to four categories: very minor symptoms (scores of 0–6), minor symptoms (scores of 7-9), moderate symptoms (10–13), and severe symptoms (scores of 14 or higher).
Among the 329 individuals who responded to the questionnaire, 81.4% reported very minor symptoms, 7% minor symptoms, 6.7% moderate symptoms, and 4.9% severe symptoms. These scores had a strong correlation with incontinence, constipation, and the general prevalence of gastrointestinal symptoms. Additionally, they were generally greater in the network group, where the disease was more advanced.
Symptoms of a bowel infection 4.6 times more in women with MS
The researchers discovered that a score of two or above on the NBD questionnaire could distinguish between individuals with and without bowel symptoms with an 86% accuracy. A score of at least two was consistently found to be a strong predictor of bowel symptoms.
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Other characteristics that indicated the occurrence of these symptoms included being a woman, visual impairments, a history of digestive issues, having MS for a longer period of time, and having irregularly shaped faeces. The biggest risk factor was gastrointestinal symptoms, which were 4.6 times more likely in women.
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Overall, the findings indicate that the NBD score may be used in clinical practice to detect bowel symptoms, thus avoiding scenarios where “the patient doesn’t talk, and the doctor doesn’t ask,” according to the research.