Preziosi, G; (2014) Pathophysiology of Bowel Dysfunction in Multiple Sclerosis and the potential for targeted treatment. Doctoral thesis , UCL (University College London).

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Abstract

Bowel symptoms (constipation and/or faecal incontinence) affect the vast majority of patients with multiple sclerosis (MS), but the pathophysiology is unclear and treatment remains empirical. The primary hypothesis of this thesis is that involvement of the spinal cord by the disease is central to the development of bowel symptoms, and this is tested in the first two studies: 1. A study of the overlap in prevalence of bladder symptoms in patients with MS and bowel symptoms. 2. A study of rectal compliance, as an important reflection of both the gut’s neural tone and its ability to hold content, in comparison to patients with supraconal spinal cord injury and normal controls. The secondary hypothesis is that residual spinal cord function can represent a potential target of treatment, and this is tested in studies 3 and 4: 3. A prospective observational study of bowel biofeedback in symptomatic MS patients. 4. A prospective observational study of transanal irrigation in symptomatic MS patients. Study 1 shows that the prevalence of bladder symptoms – determined by spinal cord disease - is higher in patients with bowel symptoms than in the general population of MS sufferers. The second study shows that rectal compliance - as an index of the spinal reflex activity regulating autonomic rectal function – is altered in patients with MS according to the clinical degree of spinal cord involvement by the disease. A similar pattern is followed for symptoms of constipation, but not faecal incontinence. The two treatment studies showed that: Biofeedback improves bowel symptoms and 5-seconds-endurance squeeze pressure. Improvement of sphincter pressure could be the result of behavioural changes, inducing physiological changes through residual efferent pathways in the spinal cord. Transanal irrigation is effective to treat bowel symptoms in patients who fail biofeedback.

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