CoChat
Sign Up
Cited by 42Multiple Sclerosis Research StudiesUrinary Bladder and Prostate ResearchGastrointestinal motility and disorders

The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: a single centre experience

Open access
Lin, Sophia D., Butler, Jane E., Boswell-Ruys, Claire L., Hoang, Phu, Jarvis, Tom, Gandevia, Simon C., McCaughey, Euan J.·2019·PLOS ONE
DOI 10.1371/journal.pone.0222731PMC PMC6752850
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Bowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems. OBJECTIVES: This study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue. METHODS: Questionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems. RESULTS AND CONCLUSIONS: Of 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0222731

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Bowel symptoms are common across multiple sclerosis disease phenotypes.

    “and bowel symptoms are common across disease phenotypes.”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Lin et al., 2019

    The Results (Bowel dysfunction; page unavailable) report constipation in 48.9% and faecal incontinence in 31.9% of respondents, supporting that bowel symptoms are common in this MS cohort. The Discussion (page unavailable) says the cohort included different disease phenotypes, but the paper does not report bowel-symptom frequency by phenotype, so it does not establish that symptoms are common across them. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In multiple sclerosis, constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction.

    “Constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction and can significantly impair quality of life (Almeida et al., 2019; Hinds et al., 1989; Lin et al., 2019).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Lin et al., 2019

    The Results report frequent bladder problems, functional constipation, and faecal incontinence in the surveyed MS population, while the Introduction says bowel and bladder problems can reduce quality of life. However, the paper does not report how often those conditions co-occur in the same individuals or identify evacuation disorders as a measured condition. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In multiple sclerosis, constipation, fecal incontinence, and evacuation disorders can significantly impair quality of life.

    “Constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction and can significantly impair quality of life (Almeida et al., 2019; Hinds et al., 1989; Lin et al., 2019).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Lin et al., 2019

    The Introduction says MS-related constipation and faecal incontinence are among bowel and bladder problems that can decrease quality of life. The Results > Bowel dysfunction reports both conditions in the surveyed MS population. Our copy does not specifically address evacuation disorders or establish that these conditions often co-occur with bladder dysfunction. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In multiple sclerosis, both slow transit and defecatory dyssynergia contribute to bowel symptoms.

    “Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Lin et al., 2019

    The Introduction (page not provided) says MS-related demyelinating lesions can cause slow colonic transit. The Results > Bowel dysfunction links constipation and faecal incontinence with disability, but the paper does not identify defecatory dyssynergia or report anorectal manometry or transit testing; its Methods > Study tools describes symptom-based measures instead. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In multiple sclerosis, bowel symptom severity often tracks neurologic disability.

    “Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Lin et al., 2019

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 32

  1. [3]Compston A, Coles A. Multiple sclerosis. The Lancet. 2008; 372(9648): 1502– 17. 18970977
  2. [5]Amarenco G, de Sèze M, Ruffion A, Sheikh Ismael S. Clinical and urodynamic evaluations of urinary disorders in multiple sclerosis. Annals of Physical and Rehabilitation Medicine. 2014; 57(5): 277– 87. 10.1016/j.rehab.2014.05.006 24980885 · DOI
  3. [6]Betts CD, Mellow MT, Fowler CJ. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. Journal of Neurology, Neurosurgery &amp; Psychiatry. 1993; 56(3): 245. PMC1014855 8459239
  4. [7]Hinds JP, Eidelman BH, Wald A. Prevalence of bowel dysfunction in multiple sclerosis: a population survey. Gastroenterology. 1990; 98(6): 1538– 42. 10.1016/0016-5085(90)91087-m 2338192 · DOI
  5. [8]Preziosi G, Emmanuel A. Neurogenic bowel dysfunction: pathophysiology, clinical manifestations and treatment. Expert review of gastroenterology & hepatology. 2009; 3(4): 417– 23. 19673628
  6. [9]Simmons RD, Tribe KL, McDonald EA. Living with multiple sclerosis: longitudinal changes in employment and the importance of symptom management. Journal of Neurology. 2010; 257(6): 926– 36. 10.1007/s00415-009-5441-7 20084515 · DOI
  7. [10]DasGupta R, Fowler CJ. Bladder, bowel and sexual dysfunction in multiple sclerosis. Drugs. 2003; 63(2): 153– 66. 10.2165/00003495-200363020-00003 12515563 · DOI
  8. [11]Khan F, Pallant JF, Shea TL, Whishaw M. Multiple sclerosis: prevalence and factors impacting bladder and bowel function in an Australian community cohort. Disability and rehabilitation. 2009; 31(19): 1567– 76. 19848557
  9. [12]Hennessey A, Robertson N, Swingler R, Compston D. Urinary, faecal and sexual dysfunction in patients with multiple sclerosis. Journal of neurology. 1999; 246(11): 1027– 32. 10.1007/s004150050508 10631634 · DOI
  10. [13]Wollin J, Bennie M, Leech C, Windsor C, Spencer N. Multiple sclerosis and continence issues: an exploratory study. British Journal of Nursing. 2005; 14(8): 439– 46. 10.12968/bjon.2005.14.8.17926 15924024 · DOI
  11. [14]Chia Y-W, Fowler CJ, Kamm MA, Henry MM, Lemieux M-C, Swash M. Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. Journal of neurology. 1995; 242(2): 105– 8. 10.1007/bf00887825 7707085 · DOI
  12. [15]Khan F, McPhail T, Brand C, Turner-Stokes L, Kilpatrick T. Multiple sclerosis: disability profile and quality of life in an Australian community cohort. 2006; 29(2): 87– 96. 10.1097/01.mrr.0000194393.56772.62 16609318 · DOI
  13. [16]Higginson IJ, Hart S, Silber E, Burman R, Edmonds P. Symptom prevalence and severity in people severely affected by multiple sclerosis. Journal of palliative care. 2006; 22(3): 158 17058754
  14. [17]Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983; 33(11): 1444–. 10.1212/wnl.33.11.1444 6685237 · DOI · Paper page
  15. [18]Bates D, Burks J, Globe D, Signori M, Hudgens S, Denys P, et al Development of a short form and scoring algorithm from the validated actionable bladder symptom screening tool. BMC Neurology. 2013; 13(1): 78. 23837535 PMC3728236
  16. [19]Burks J, Chancellor M, Bates D, Denys P, Macdiarmid S, Nitti V, et al Development and validation of the actionable bladder symptom screening tool for multiple sclerosis patients. International journal of MS care. 2013; 15(4): 182– 92. 10.7224/1537-2073.2012-049 24453782 PMC3883018 · DOI
  17. [20]Jongen PJ, Blok BF, Heesakkers JP, Heerings M, Lemmens WA, Donders R. Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points. BMC Urology. 2015; 15(1): 106. 26498107 PMC4619527
  18. [21]Rome Foundation. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. 2006. 17203570
  19. [22]Sansoni J, Hawthorne G, Fleming G, Marosszeky N. The Revised Faecal Incontinence Scale: A Clinical Validation of a New, Short Measure for Assessment and Outcomes Evaluation. Diseases of the Colon & Rectum. 2013; 56(5): 652– 9. 23575406
  20. [25]Fisk JD, Ritvo PG, Ross L, Haase DA, Marrie TJ, Schlech WF. Measuring the Functional Impact of Fatigue: Initial Validation of the Fatigue Impact Scale. Clinical Infectious Diseases. 1994; 18(Supplement_1): S79– S83. 8148458
  21. [26]Mills RJ, Young CA, Pallant JF, Tennant A. Rasch analysis of the Modified Fatigue Impact Scale (MFIS) in multiple sclerosis. Journal of Neurology, Neurosurgery &amp; Psychiatry. 2010; 81(9): 1049. 20547635
  22. [27]Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics. 2009; 42(2): 377– 81. 10.1016/j.jbi.2008.08.010 18929686 PMC2700030 · DOI · Paper page
  23. [28]Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: Suprapubic catheter versus other methods: A scoping review. 2013; 32(7): 944– 51. 10.1002/nau.22356 23192860 · DOI
  24. [29]Lekka E, Lee LK. Successful Treatment with Intradetrusor Botulinum-A Toxin for Urethral Urinary Leakage (Catheter Bypassing) in Patients with End-Staged Multiple Sclerosis and Indwelling Suprapubic Catheters. European Urology. 2006; 50(4): 806– 10. 10.1016/j.eururo.2005.12.015 16413661 · DOI
  25. [30]Nortvedt MW, Riise T, Myhr KM, Landtblom AM, Bakke A, Nyland HI. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Multiple Sclerosis Journal. 2001; 7(4): 231– 5. 10.1177/135245850100700404 11548982 · DOI
  26. [31]Nortvedt M, Riise T, Frugaård J, Mohn J, Bakke A, Skår A, et al Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Multiple Sclerosis Journal. 2007; 13(1): 106– 12. 10.1177/1352458506071210 17294618 · DOI
  27. [32]Kos D, Kerckhofs E, Nagels G, D'Hooghe MB, Ilsbroukx S. Origin of Fatigue in Multiple Sclerosis: Review of the Literature. Neurorehabilitation and Neural Repair. 2007; 22(1): 91– 100. 10.1177/1545968306298934 17409388 · DOI
  28. [33]Cincotta MC, Engelhard MM, Stankey M, Goldman MD. Fatigue and fluid hydration status in multiple sclerosis: A hypothesis. Multiple Sclerosis Journal. 2016; 22(11): 1438– 43. 10.1177/1352458516663854 27542703 PMC5156578 · DOI
  29. [34]Crayton H, Heyman RA, Rossman HS. A multimodal approach to managing the symptoms of multiple sclerosis. Neurology. 2004; 63(11 suppl 5): S12. 15596731
  30. [35]Schwartz CE, Coulthard-Morris L, Zeng Q. Psychosocial correlates of fatigue in multiple sclerosis. Archives of Physical Medicine and Rehabilitation. 1996; 77(2): 165– 70. 10.1016/s0003-9993(96)90162-8 8607741 · DOI
  31. [36]Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Multiple Sclerosis Journal. 2001; 7(5): 340– 4. 10.1177/135245850100700511 11724451 · DOI · Paper page
  32. [37]Béthoux F. Fatigue and multiple sclerosis. Annales de Réadaptation et de Médecine Physique. 2006; 49(6): 355– 60. 16757056

Cited by

Sorted by citations

Authors
Lin, S. D., Butler, J. E., Boswell-Ruys, C. L., Hoang, P., Jarvis, T., Gandevia, S. C., & McCaughey, E. J.
Affiliations
UNSW Sydney (AU)
Corresponding author
McCaughey, Euan J.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-09-19
Volume
14
Issue
9
Pages
e0222731
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0222731
PMC
PMC6752850
OpenAlex
W2974867589
Cited by
42
References
0
Citations by year
2026: 8 · 2025: 5 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 8
FWCI
2.94
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • National Multiple Sclerosis Society (PP-1804-30637)
  • National Health and Medical Research Council (APP1122932)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
multiple sclerosis, bowel dysfunction, bladder dysfunction, fatigue, fecal incontinence, constipation, disability severity, symptom frequency, quality of life
MeSH terms
Adult, Aged, Aged, 80 and over, Australia, Urinary Bladder, Fatigue, Fecal Incontinence, Female, Humans, Intestines, Male, Middle Aged, Multiple Sclerosis, Quality of Life, Surveys and Questionnaires

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review