The Study of the Correlation between Constipation and Fatigue in Patients with Multiple Sclerosis
AbstractFatigue and constipation are among the most common factors in multiple sclerosis patients. From the perspective of Persian Medicine, constipated patients are prone to fatigue and we suspected that this problem in patients with multiple sclerosis becomes more severe. The Rome III questionnaire is a valid instrument that measures the existence and severity of constipation and FSS is a scale to assess the scale of fatigue. The objective was to assess if there is an association between constipation and fatigue symptoms in patients with multiple sclerosis. Hence, 355 patients with multiple sclerosis participated in this study. Patients were divided into a constipated or non-constipated group and compared to determine the association between constipation and fatigue scores. It was seen that the level of fatigue and depression in the constipated group was significantly higher than those without constipation (P value < 0.001). According to the observed association between constipation and fatigue, and traditional Persian Medicine theories, constipation can lead to fatigue; patients with constipation had worse scores on the FSS questionnaires and future studies should assess if the treatment of constipation with suitable laxative drugs in multiple sclerosis patients leads to a reduction of fatigue.
Rejdak K, Jackson S, Giovannoni G. Multiple sclerosis: a practical overview for clinicians. Br Med Bull 2010;95:79-104.
Zahednasab H, Mesbah-Namin SA, Sahraian MA. Relationship between NF_kB1-94 ins/del ATTG polymorphism and susceptibility of MS in Iranian MS patients. Neurosci Lett Letters 2013;545:46-49.
Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in multiple sclerosis. Arch Neurol 1988;45:435-437.
Yusuf A, Koshi L. A qualitative review of the neurological under pinning of fatigue in multiple sclerosis. J Neurol Sci 2013;330:4-9.
Bakalidou D, Giannopoulos S, Stamboulis E. Effect of seasonal fluctuation of ambient temperature on fatigue in multiple sclerosis patients living in attica, Greece. J Clin Neurosci 2014;21:1188-1191.
Thelen J M, Lynch GS, Bruce AS. poly pharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance. J Psychosom Res 2014;76: 400-404.
Andreasen AK, Stenage E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Mult Scler Journal 2011;17:1041-1054.
Bol Y, Duits AA, Hupperts RMM. The psychology of fatigue in patients with multiple sclerosis: A review. J Psychosom Research 2009;66:3-11.
Mills RJ, Young CA. A medical definition of fatigue in multiple sclerosis. QJM 2008;101:49-60.
Induruwa I, Constantinescu CS, Gran B. Fatigue in multiple sclerosis. A brief review. J Neurol Sci 2012;323:9-15.
Ziemssen T. Multiple sclerosis beyond EDSS: depression and fatigue. JNS 2009;277:37-41.
Branas P, Jordan R, Fry-Smith A. Treatments for fatigue in multiple sclerosis: a rapid and systematic review. HTA 2000;4:1-61.
Geoffrey L. Sheean NM, Rothwell JC, Miller DH, Alan J. An open-labelled Brain, 1998;121:967-975.
De Seze J, Stojkovic T, Gauvrit JY. Autonomic dysfunction in multiple sclerosis: cervical spinal cord atrophy correlates. J Neurol 2001;248:297-303.
Hinds JP, Eidelman B, Wald A. Prevalence of bowel dysfunction in multiple sclerosis. J Gastroenterol 1990;98:1538-1542.
Gulick EE. Bowel management related quality of life in people with multiplesclerosis: psychometric evaluation of QOL-BM measure. IJNS 2011;48:1066-1070.
Wiesel PH, Norton C, Roy A. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. JNNP 2000:69:240-243.
Winge K, Rasmussen D, Werdelin LM. Constipation in neurological diseases. J Neurol Neurosurg Psychiatry 2003;74:13-19.
Avicenna H. The Canon in Medicine. Institute of Al-A’lami Li Al-Matbooat. Beirut 2005.
Hamedi SH, Jokar A, Abbasian A. Viewpoints of Iranian Traditional Medicine (ITM) about Etiology of Constipation. J Gastro int Dig Syst 2012;S8:005.
Krupp LB, LaRocca NG, Muir-Nash J. The Fatigue Severity Scale: Application to patient with Multiple Sclerosis and Systemic Lupus Erythematosus. Arch Neurol 2008;46,1121-1123.
Ziino C, Ponsford J. Measurement and prediction of subjective fatigue following traumatic brain injury. JINS 2005;11:416-425.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry1961;4:561-571.
Longstreth GF, Thompson WG, Chey WD. Functional bowel disorders. J Gastroenterol 2006;130:1480-1491.