Neurogenic bowel dysfunction in multiple sclerosis: clinical determinants and its association with bladder dysfunction in a multicenter study.

Abstract

To determine the prevalence and severity of NBD in MS and to identify clinical factors associated with moderate-to-severe bowel dysfunction. Multicenter, prospective, cross-sectional study. Twelve tertiary MS centers. A total of 975 patients with MS. Not applicable MAIN OUTCOME MEASURES: Bowel dysfunction was assessed using the NBD score, and bladder symptoms were evaluated using the Neurogenic Bladder Symptom Score (NBSS). Moderate-to-severe NBD was defined as an NBD score ≥10. Associations between NBD and clinical variables were examined using univariate analyses and multivariable logistic regression. The mean age was 39.7±11.4 years, and 72.5% were female. Moderate-to-severe NBD was identified in 6.8% of patients. Higher NBD severity was associated with older age, longer disease duration, and greater disability (all p<0.01). In multivariable analysis, Expanded Disability Status Scale (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.13 to 1.60; p=0.001) and NBSS total score (OR, 1.08; 95% CI, 1.06 to 1.10; p<0.001) were independently associated with moderate-to-severe NBD, whereas age, sex, disease duration, and MS subtype were not. Moderate-to-severe NBD affects a notable proportion of patients with MS and is independently associated with disability level and bladder dysfunction. These findings highlight the importance of integrated assessment of bowel and bladder symptoms and support routine screening, particularly in patients with higher disability.