Bladder and Bowel Management in Adolescents and Young Adults with Multiple Sclerosis Since Childhood: Is Bowel Management Overlooked? A Case Series

Highlights: What are the main findings? In our cohort of adolescent/young adult patients with multiple sclerosis since childhood and urological manifestations, 66% manifested bowel symptoms (predominantly constipation). A specific bowel management questionnaire showed an overall fair management, with a quality of life score poorer among those patients non-adherent to therapy. What are the implications of the main findings? Early identification of bowel dysfunction using non-invasive methods, such as questionnaires, is essential to optimize bowel management. Early diagnosis and treatment can allow for less invasive therapy, increasing adherence to bowel management, and could allow for a better quality of life. Background/Objectives: Multiple sclerosis (MS) is a chronic, demyelinating, inflammatory, and degenerative disease of the nervous system that may present in childhood or adolescence, defined as Pediatric-Onset Multiple Sclerosis (POMS). Among its diverse clinical manifestations, neurogenic bowel dysfunction (NBD), including chronic constipation and fecal incontinence, represents a distressing condition with a substantial impact on quality of life (QoL). Despite its clinical relevance, the evidence on bowel dysfunction in pediatric MS remains limited. The objective of this case series was to evaluate bowel dysfunction and its management in a pediatric MS cohort, and to assess whether it is associated with QoL. Methods: We reported the data on the urological and bowel conditions and on the quality of life of our pediatric patients affected by MS and urological dysfunction. We considered MS patients with urinary symptoms who were referred to our department between January 2019 and January 2024, only including individuals with symptoms onset before 18 years of age. In our series, the demographic and clinical data were reviewed, and patients were re-evaluated via telephone interview at least one year after initiation of treatment. The International Consultation on International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Pediatric Bowel Management Scoring Tool (PBMST), and Pediatric Quality of Life Inventory (PedsQL, young adults’ version) were used to assess urinary and bowel function and related QoL outcomes. Results: Six patients (four females, two males; median age 14.5 years) were included. Bowel symptoms were reported in four cases (66.6%), predominantly constipation. The PBMST scores indicated overall fair bowel management, while the mean PedsQL score was 62.8/100, with poorer scores observed for the non-adherent patients. Conclusions: Bowel dysfunction constitutes an underrecognized but clinically significant manifestation in pediatric MS. Its early identification and adherence to a structured bowel management program seems to be crucial for optimizing symptom control and preserving quality of life. Standardized questionnaires represent effective, non-invasive tools for assessment and longitudinal monitoring.