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SCI & MS

Reprinted from PN/Paraplegia News May 2014

Spinal-cord injury (SCI) and multiple sclerosis (MS) both have substantial effects on the central nervous system.

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SCI and MS each have different attributes, but they also share some similar traits including impaired mobility, urinary bladder dysfunction and bowel dysfunction.

Impaired Mobility

People with SCI and MS are highly likely to suffer impaired mobility, but those with MS tend to accumulate that disability more slowly and in an unpredictable waxing and waning manner.

Despite recent advances in treatment, a significant proportion of people with MS will have decreased mobility of a progressive nature. Eventually, they’ll require the use of assistive devices and wheelchairs similar to those with SCI.

A comprehensive multidisciplinary team, such as those provided at the SCI centers in the Department of Veterans Affairs and the model systems of the private sector, is essential to ensuring that an individual plan is developed to best meet the needs of the person with SCI or MS.

The goals are to maximize independence and minimize secondary complications such as pressure sores, shoulder injuries and social isolation.

Through this coordinated type of care, the function and quality of life of people with SCI and MS can be significantly improved.

Bladder Issues

Urinary bladder dysfunction is quite common in both SCI and MS.

Again, these symptoms tend to come on more slowly and have greater tendency to change over time in people with MS than those with SCI. However, a set of questions should be asked of all those with SCI and MS to properly assess for the presence of bladder dysfunction and help guide a diagnostic work-up and develop a treatment plan.

The ultimate goal of the treatment plan is to preserve kidney function, the most devastating, long-term complication of bladder dysfunction in SCI and MS. Common symptoms of bladder dysfunction in SCI and MS include: increased frequency of urination (especially at night), increased urgency to urinate, inability to avoid leaking of urine during stress or once the urge is felt, difficulty getting started on trying to urinate, incomplete emptying of the bladder or need for “double voiding” to get full emptying and leaking after voiding.

People with MS are more likely to be unaware of subtle symptoms of bladder dysfunction and more likely to suffer delays in development of an effective bladder management program. When no formal urinary investigation is completed, up to 73% of those with MS may be treated inappropriately.

A baseline urodynamic study (UDS) is probably needed in most to determine the exact nature of the bladder dysfunction (e.g., spastic vs. hyporeflexic bladder). Treatments with medications, catheters or surgical procedures vary for the different types of bladder dysfunction.

An annual evaluation with blood work and imaging studies, such as a kidney ultrasound and/or nuclear renal function studies, is highly recommended to diagnose potential complications of bladder dysfunction.

An individualized bladder management program is essential to decrease the potential complications of urinary tract infections, kidney stones, bladder cancer and kidney failure.

Bowel Dysfunction

Bowel dysfunction is also a common manifestation of both SCI and MS.

While those with SCI will tend to have this problem at the onset of their injury, people with MS once again may have a subtle and progressive onset of their symptoms.

For both groups, there is a predilection for bowel dysfunction to occur in those persons with bladder dysfunction. However, up to 1/3 of those with MS with bladder dysfunction may not report any symptoms of bowel dysfunction.

The most frequent complaint of bowel dysfunction in both groups is constipation, but fecal impaction and incontinence are also common. For people with MS, while urinary incontinence may be prevalent, bowel incontinence is less commonly a significant complaint.

Factors contributing to constipation are numerous, but foremost are the neurologic dysfunctions of decreased gastrointestinal motility and loss of gastrocolic reflexes.

Pelvic floor and rectal sphincter muscular spasticity can prohibit defecation despite the preservation of the urge to defecate. Inadequate hydration and inadequate dietary fiber also play a major role in worsening bowel dysfunction for both groups.

Finally, many medications prescribed to people with SCI and MS contribute to worsening of bowel dysfunction. Anticholinergic medications used to treat bladder dysfunction and tricyclic antidepressants and narcotic analgesics used to treat pain are the most common. Muscle relaxants used to treat spasticity can also contribute to decreased gastrointestinal motility and cause constipation.

Strategies to avoid constipation and fecal incontinence include increasing hydration and dietary fiber, use of stool softeners and osmotic/cathartic agents and decreasing constipating medications where possible.

Establishment of a regular, timed-elimination bowel care program is frequently necessary to avoid constipation and accidents. Use of scheduled digital rectal stimulation, combined with stimulant agents such as bisacodyl suppositories or docusate mini-enemas is crucial for many of those with SCI and MS.

When all else fails, elective colostomy may be considered for selected individuals with bowel dysfunction that doesn’t respond adequately to medical measures.

Get the Right Help

SCI and MS have very different causes and courses of the overall experience for people.

For many, the problems will eventually overlap and have a similar effect on daily functioning. It’s important for people with these complications to seek care at a center with a multidisciplinary team specializing in the care of persons with SCI and MS.

 

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