In Multiple sclerosis (MS) the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of the body.
It is estimated that over 2.3 million individuals are living with MS and its complications worldwide, but treatments can help and modify the course of the disease and manage symptoms.
The degree of symptoms differs among individuals, but up to 95% of the MS population will suffer from bladder issues and incontinence (Peyronnet et al. Reviews in Urology 2019). Also, effects on the bowel are common and affect up to 70% of people with MS (Preziosi et al. Degenerative Neurological and Neuromuscular Disease 2018). Constipation and/or bowel leakage may be one of the first presenting symptoms of MS. There are solutions available to aid this.
The spinal cord plays a central role in bladder and bowel function. When MS damages the myelin, messages between the brain and the section of the spinal cord that controls the bladder and bowel can be interrupted, resulting in bladder and bowel dysfunction.
The areas of the central nervous system that control the urinary system are situated in the lower part of the brain and the lower part of the spinal cord. Messages are transmitted between the brain and the urinary system along the nerves that make up the spinal cord.
The bowel function is controlled by the brain and spinal cord, as well as the bowel’s own nervous system: the enteric nervous system, which coordinates movements, secretion and absorption of the content in the bowel. Bowel dysfunction in MS is similar to bowel dysfunction in spinal cord injuries and is called neurogenic bowel dysfunction (NBD). The precise mechanism underlying NBD in MS is not known, but lesions in the brain and the spinal cord has been shown to:
NBD causes constipation, fecal incontinence and time-consuming bowel care. Constipation may also complicate bladder emptying and increase frequency of urinary tract infections (link to the UTI blog post to be published later this spring). It is not only the damages to the nerve signals that affect the bowel function in MS, medications and reduced ability to move also have an impact on the bowel function.
Even though the problems experienced by MS patients are very individual, the majority of patients will experience issues with urination. For people with MS, it is particularly important to continue with prescribed bladder emptying treatments in the same way over time. The progression of the disease can be very unpredictable, making proper urination harder in some periods, and easier in others. But even a small amount of residual urine can lead to urinary tract infections. This in turn has been shown to potentially cause new attacks or the return of an attack that had previously receded.
For people with enough dexterity to handle a catheter, self-catheterization with a disposable LoFric catheter is a safe and convenient way to empty the bladder. The procedure is performed in similar manners as going to the bathroom to empty the bladder, but using a disposable catheter discarded after urination. This method for emptying the bladder regularly is called intermittent catheterization (IC) and it’s effective whether you have problems storing urine or emptying the bladder.
Intermittent catheterization (IC) involves inserting a LoFric catheter (a plastic tube) into the bladder regularly to drain the urine. The procedure helps the bladder empty completely which has several benefits, e.g. reducing the risk of receiving a urinary tract infection because of residual urine in the bladder. When the bladder is empty, the catheter is removed and discarded in the bin. Most people learn how to self-catheterize very quickly after being shown by a nurse or urotherapist. The procedure is as quick as going to the toilet in the usual way and with a little training, it only takes a few minutes.
Even if it may feel a little bit challenging in the beginning, it does not hurt. As with any new technique, practice makes perfect. Thousands of women, men and children around the world use self-catheterization every day. It also prevents the risk of kidney damage and urinary tract infections.
People with MS rank bowel problems as the third most bothersome symptom after fatigue and mobility issues. This is not surprising due to the embarrassing nature of the symptoms and that bowel symptoms affects their daily activities and social interactions. Actually, bowel symptoms are one of the primary causes of inability to work for people with MS, after spasticity and incoordination.
Bowel symptoms are correlated to disability and disease duration, but people with low disability and short illness can also have bowel symptoms. In fact, severe constipation can be one of the first presenting symptoms of MS.
It’s common in MS patients with bowel problems, both constipation or bowel leakage affects about 50% of MS patients at some point and is an continuous symptom in one out of four. It may sound strange but constipation and bowel leakage coexistent and alternates in many people affected by MS.
The time spent on bowel care is an important contributing factor to reduced quality of life since many affected by MS plan their lives around their bowel and have to spend a lot of time in the bathroom. In fact, some might hardly ever leave the house because of repeated attempts to empty their bowel and fear of accidental bowel leakage.
Bowel irrigation, also known as Transanal irrigation (TAI), has been shown to be an effective treatment to bowel problems. It does not only improve symptoms of constipation and reduce accidental bowel leakage, but also reduces the time spent on bowel care as well as need of healthcare. People with MS using TAI have fewer hospital admissions and physician’s visits than before using TAI as well as fewer urinary tract infections.
Transanal irrigation (TAI) or bowel/rectal irrigation is a therapy that effectively empties the bowel by instilling water. This is performed using the Navina bowel irrigation system with a rectal catheter or cone to get water into the bowel. The water may then start the bowel movements (peristalsis) and empties the lower part of the bowel. This therapy can save a lot of time and reduce frustration when conservative methods (e.g. food, life style advice etc) do not give the desired results.
What are the benefits of Navina bowel irrigation?
Education and personalization are key to success in bowel irrigation, and training is very important when you start. Prepare and give yourself time to change habits, both mentally and physically, and the bowel to adapt to your new routines. You also need time to find your optimal treatment parameters. It is important to have realistic expectations of what Navina bowel irrigation can do for you and how long it may take to achieve satisfactory results. A commitment of up to 4–12 weeks may be necessary in order to stabilize the bowel and to develop a good, individualized bowel routine.
Give it time. It is worth it!
In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.The body can repair the damage to the myelin sheet, but it’s not perfect. The resulting damage reveals lesions and scars, and this is where the name comes from, Multiple sclerosis, multiple scars.
We don’t know what causes MS, but there are certain factors that may increase the risk or trigger the onset. MS can occur at any age, but it mostly makes its first appearance in people of ages between 20-40. A low exposure of Vitamin D and sunlight has been shown to increase the risk of developing MS. This may be why people of Northern European decent are among the highest risk of developing MS globally. Other factors correlated to an increased risk are overweight, smoking, inflammatory diseases and a variety of viruses. Women are up to three times as likely as men to develop MS. The risk for MS in the general population is 0.5% and increases to 1% if a parent or sibling has it.
Symptoms of a relapse usually come on over 24 to 48 hours, last for a few days to a few weeks and then improve in the region of 80 to 100%. Common symptoms include loss of vision in an eye, loss of power in an arm or leg and numbness in one or more limbs. Studies show that up to 95% of the MS population will experience urinary incontinence and about 70% will suffer from constipation and/or fecal incontinence. By increased knowledge about treatment options and symptom relief, we can considerably improve quality of life!
There's no cure for the disease, however, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms. The best thing to do when living with MS is to find a trusted interdisciplinary medical team that can help you monitor and manage the conditions. There are many options to help you live a full life. Further down in this text we will guide you to the available solutions that could help you manage and take control of your bladder and bowel.
Bladder and Bowel Interaction
Bladder and Bowel dysfunctions often come together. The impact these dysfunctions have on the quality of life for people with neurogenic diseases.
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