Relationship Between Bowel/bladder, and Sexual Dysfunction With Health-Related Quality of Life in Women With Multiple Sclerosis (MS).


 Background: Bladder, bowel, and sexual dysfunction are among common complications in patients with multiple sclerosis (MS). These complications could affect the quality of life. The goal of this study is to assess bowel, bladder, and sexual dysfunction and quality of life in married women with MS. Methods: One hundred and twenty-seven married women with MS were enrolled. They fill the valid and reliable Persian version of the Female sexual function index (FSFI), SF-36, Bladder Control Scale (BLCS), and The Bowel Control Scale (BWCS). Results: Mean age and disease duration were 38±7.9 and 8.4±6.5 years, respectively. There was significant negative correlation between SF-36 and BWCS (r=-0.25, p=0.001) and BLCS (r=-0.36, p=0.001) and significant positive correlation between FSFI and SF-36(r=0.27, p=0.004). There was a significant negative correlation between age and total FSFI (r=-0.34, p<0.001) and also between EDSS and FSFI (r=-0.21, p=0.01). By considering 26.55 as the cut-off point of FSFI, we found that women with sexual dysfunction had a more impaired quality of life and more bowel control problems. Linear regression analysis showed that EDSS and BLCS are independent predictors of SF-36. Conclusion: Bowel/bladder and sexual dysfunction have negative impacts on the quality of life in women with multiple sclerosis.


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Methods: One hundred and twenty-seven married women with MS were enrolled. They fill the 23 valid and reliable Persian version of the Female sexual function index (FSFI), Bladder 24 Control Scale (BLCS), and The Bowel Control Scale (BWCS).

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Results: Mean age and disease duration were 38±7.9 and 8.4±6.5 years, respectively. There was 27 significant negative correlation between SF-36 and BWCS (r=-0.25, p=0.001) and BLCS (r=-28 0.36, p=0.001) and significant positive correlation between FSFI and p=0.004). 29 There was a significant negative correlation between age and total FSFI (r=-0.34, p<0.001) and 30 also between EDSS and FSFI (r=-0.21, p=0.01). 31 By considering 26.55 as the cut-off point of FSFI, we found that women with sexual dysfunction 32 had a more impaired quality of life and more bowel control problems. Linear regression analysis 33 showed that EDSS and BLCS are independent predictors of SF-36.

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Different factors are considered to play role in decreasing QOL in these patients such as bladder, 47 bowel and sexual dysfunction which occur any time during the disease course(2-4).

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The prevalence of bladder dysfunction is between 50-80% and near 96% of MS patients will 49 have bladder dysfunction after 10 years of disease onset(2, 4-6). Location of the plaques and 50 lower extremity pyramidal tract findings are important factors in developing bladder 51 dysfunction(5).

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Bowel dysfunction is reported in 40-68% of MS patients (7-9) and constipation, diarrhea, 53 impaction, and incontinence are different forms of bowel problems in MS cases.

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Bowel dysfunction has a negative impact on QOL in these patients(3).

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Sexual dysfunction (SD) is one of the concerns in women with MS which is ignored in most 56 countries due to cultural and religious issues. The prevalence ranges from 27-95% and a recent 57 meta-analysis estimated the pooled prevalence as 55%(10-12). Physical, psychological, pain, 58 spasticity, fatigue, body image, and medications play role in sexual dysfunction occurrence(5).

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Literature showed that patients with SD had lower scores on all the subscales of MSQOL(13).

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There are little studies regarding bowel, bladder and sexual dysfunction and quality of life in 61 Iranian women with MS. So, we designed this study to assess bowel, bladder and sexual 62 dysfunction and quality of life in these women.  The SF-36 questionnaire consists of 36 questions in eight aspects. All questions are scored on a 82 scale of 0-100. Physical functioning, role limitations due to physical health, role limitations due 83 to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and 84 general health are eight subscales and higher the score, the better quality of life(15).

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The Bladder Control Scale (BLCS) is a structured, four-item, self-reported questionnaire and 87 three of these items are scored on a Likert scale from 0 (not at all) to 4 (daily), and the fourth 88 item (during the past 4 weeks, how much have bladder problems restricted your overall lifestyle) 89 is scored from 0 (not at all) to 10 (severely). The total score ranges between 0-22 and higher the 90 score, higher bladder control problems(16).

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The Bowel Control Scale (BWCS) includes five items measuring bowel dysfunction. Four of 92 these items are scored on a Likert scale from 0 (not at all) to 4 (daily), and the fifth item (during 93 the past 4 weeks, how much have bowel problems restricted your overall lifestyle) is scored from 94 0 (not at all) to 10 (severely). Total score ranges between 0-26, higher the score, greater bowel 95 control problems(16).   There was significant negative correlation between age and total FSFI (r=-0.34, p<0.001) and 126 also between EDSS and FSFI (r=-0.21, p=0.01).

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By considering 26.55 as the cut-off point of FSFI, we found that women with sexual dysfunction 129 had more impaired quality of life and more bowel control problems (table 3). Linear regression analysis showed that EDSS and BLCS are independent predictors of SF-134 36 (Table 4). findings as well as Gumus ans Gava(23,24,26,27).

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The most impaired parts of SD in MS women are desire and arousal which could be based on 169 psychological difficulties in these women as they suffer from depression, anxiety and fatigue

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There was a significant negative correlation between SF-36 and BWCS (and BLCS and a 174 significant positive correlation between FSFI and SF-36.

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Linear regression analysis also demonstrated that EDSS is a strong negative predictor of SF-36, 176 and bladder score is another negative predictor.

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This could show that bladder dysfunction should be considered in patients with MS more and 178 more.

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This study had some strength. We evaluated SD, bowel and bladder dysfunction simultaneously 180 and we also considered quality of life.  195 We obtained permission from patients in the consent form to publish their information without 196 mentioning their names.