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Bowel dysfunction in Multiple Sclerosis

Multiple Sclerosis (MS) is an inflammatory and demyelinating progressive autoimmune disorder that affects approximately 2.5 million people worlwide. 

Aims

To investigate the neuropathological basis of the bowel dysfunction in MS.

It affects nerve pathways in the brain and spinal cord, and is characterized by inflammation, focal demyelination and plaque formation within the CNS, axonal injury and neuronal loss.  

The majority of patients with MS experience bowel dysfunction over the course of their illness, which dramatically impact on their quality of life.  Constipation was reported in 67-69% of MS patients.  Considering that constipation affects 2%-20% of the population, it is clear that bowel dysfunction is far more prevalent in MS patients than the general population.  23.4% of patients state that bowel symptoms were the first symptoms of MS, and it has been reported to predate diagnosis in many cases, and may be an early symptom of the disease. 

Constipation in MS can be caused by scattered demyelinating lesions in the brain and in the spinal cord, and consequently plaques affecting the autonomic pathways, which has influence on bowel function or by gliosis and neuronal loss in the enteric nervous system.  Although bowel programmes are part of routine management for many SCI patients, the same approach has not been adopted in MS.  The current therapies for bowel dysfunctions are few, symptom-related, and experimental.  An explanation of the neuropathological basis of the bowel dysfunction in MS is needed, since it will lead to the improvement in current therapies of this disorder.  

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