Can Multiple Sclerosis (MS) cause bladder dysfunction, fecal incontinence, sexual anhedonia, numbness and tingling of lower extremities, occasional balance issues, weakness in calf muscles, and difficulty rising from the floor?

From the Guidelines

Yes, multiple sclerosis (MS) can cause all of the symptoms mentioned: bladder dysfunction, fecal incontinence, sexual anhedonia, numbness and tingling of lower extremities, occasional balance issues, weakness in calf muscles, and difficulty rising from the floor. As an autoimmune disease affecting the central nervous system, MS causes damage to the myelin sheath protecting nerve fibers, disrupting communication between the brain and the rest of the body, and leading to a wide range of neurological symptoms 1. The symptoms can be attributed to the following:

• Bladder and bowel problems: MS affects the neural pathways controlling these functions, as seen in patients with neurogenic lower urinary tract dysfunction (NLUTD) where onabotulinumtoxinA is recommended to improve bladder storage parameters and decrease episodes of incontinence 1.
• Sexual dysfunction: results from damage to nerves involved in sexual response.
• Numbness, tingling, weakness, and balance problems: stem from impaired nerve signal transmission to the limbs and coordination centers. It's crucial to consult a neurologist for proper diagnosis, as these symptoms can also be caused by other conditions, and early diagnosis and treatment with disease-modifying therapies can help manage symptoms and potentially slow disease progression. Key considerations for management include:
• Treatment of NLUTD with onabotulinumtoxinA, which has been shown to improve quality of life measures and decrease episodes of incontinence in patients with MS 1.
• Addressing sexual dysfunction and other symptoms through a comprehensive treatment plan.
• Regular follow-up with a neurologist to monitor disease progression and adjust treatment as needed.

From the Research

Multiple Sclerosis Symptoms

• Bladder dysfunction: affects 75% of people with multiple sclerosis (MS) 2, producing symptoms of urgency, frequency, and urge incontinence (due to bladder overactivity and incomplete emptying) 3, 4
• Fecal incontinence: prevalence of up to 50% in MS patients, with limited advances in treatment 3, 4
• Sexual dysfunction: high levels of sexual dysfunction in MS patients, including hypoactive sexual behavior, erectile dysfunction, and lack of sexual interest 3, 4, 5
• Numbness and tingling of lower extremities: not directly mentioned in the provided studies, but MS is known to cause a wide range of neurological symptoms
• Occasional balance issues: not directly mentioned in the provided studies, but MS can cause balance and coordination problems
• Weakness in calf muscles: not directly mentioned in the provided studies, but MS can cause muscle weakness and spasms
• Difficulty rising from the floor: not directly mentioned in the provided studies, but MS can cause mobility and balance problems

Management and Treatment

• Bladder dysfunction: treatment options include anticholinergic medication, intravesical treatments, and neuromodulation 6, 4
• Fecal incontinence: biofeedback retraining is an effective treatment in some patients with MS complaining of constipation or fecal incontinence 3
• Sexual dysfunction: treatment options include pro-erectile agents, such as sildenafil citrate, and newer phosphodiesterase 5 inhibitors 4