The hidden burden of bowel dysfunction in multiple sclerosis: Impact on urinary incontinence, psychological symptoms, fatigue, sleep, and quality of life

Abstract

Background: Neurogenic bowel dysfunction is a frequent but often underrecognized problem in patients with multiple sclerosis (MS) and may contribute to disability and reduced quality of life.

Objective: The aim of this study was to determine the prevalence and severity of bowel dysfunction in patients with MS using the validated Neurogenic Bowel Dysfunction (NBD) score and to evaluate its associations with urinary dysfunction, anxiety, depression, fatigue, cognitive function, sleep quality, and quality of life.

Methods: Patients aged ≥18 years with MS who fulfilled the 2017 revised McDonald criteria were included. This cross-sectional study prospectively collected questionnaire and clinical assessment data, while CSF findings were retrospectively obtained from patient records. Neurogenic bowel dysfunction was assessed using the NBD score. Clinical and psychosocial parameters were evaluated using validated questionnaires. Neurological disability was assessed with the EDSS.

Results: A total of 107 patients with MS were included. The mean NBD score was 4.56 ± 5.68, and most patients had very minor bowel dysfunction. Higher NBD scores were significantly associated with older age, higher disability level, urinary symptoms, fatigue severity, and lower physical quality-of-life scores. No significant associations were found with disease duration, anxiety, depression, cognitive function, sleep quality, or the mental health component of quality of life. Patients with progressive MS had significantly higher NBD scores than the relapsing-remitting MS group.

Conclusion: Neurogenic bowel dysfunction is common in patients with MS, even at mild levels, and is associated with disability, urinary symptoms, fatigue, and reduced physical quality of life. These findings suggest that bowel dysfunction reflects multisystem involvement and should be routinely assessed in the clinical evaluation of patients with MS.

Ercan MB, Kocer B, Cetin H. The hidden burden of bowel dysfunction in multiple sclerosis: Impact on urinary incontinence, psychological symptoms, fatigue, sleep, and quality of life. Mult Scler Relat Disord. 2026 Aug;112:107306. doi: 10.1016/j.msard.2026.107306. Epub 2026 Jun 5. PMID: 42263352.