A handful of seemingly unrelated conditions may be more connected than one might think. Sexual dysfunction, constipation, depression, cystitis, and urinary tract infections are common enough in individuals with multiple sclerosis (MS) before and after its diagnosis that researchers believe the issues could be precursor symptoms to the autoimmune disease.
The findings, discovered by a team at the Paris Brain Institute in France, were published in the December 2023 issue of Neurology Journals.
In a case-control study, researchers examined electronic health records from the United Kingdom and France, looking for associations between 113 diseases and symptoms in just over 20,000 patients five years before and after their MS diagnosis. The associations were compared to 54,790 individuals without MS, 30,477 with Crohn’s disease, and another 7,337 patients with lupus. Crohn’s and lupus are also autoimmune diseases.
The Symptoms May Be Common in Other Autoimmune Disorders
In the first round of analysis, the researchers narrowed down the initial 113 conditions to 12 that seemed associated with patients’ MS. In addition to the five conditions suspected to be prodromal—or indicative of the onset of an illness or disease—the team recognized that MS patients often suffered from epilepsy and recurrent seizures, limb pain, dizziness and giddiness, headache, malaise, and fatigue.
Upon deeper examination, the team determined five symptoms occurred with higher frequency than the others. In patients from the UK, the research team noted that 91.2 percent had intestinal disorders, while 92.4 percent of the French patients had constipation. Close to every patient from both the UK and France—98.8 percent and 97.9 percent, respectively—was diagnosed with a urinary tract disorder. These diagnoses were determined after the patients had been diagnosed with MS.
When the team looked at the patients before their MS diagnoses, the characteristics were similar.
“All health conditions considered to be associated with MS diagnosis in the pre-diagnosis analysis were also associated with MS diagnosis in the post-diagnosis analysis,” the researchers wrote. They also pointed out that rates of pre-diagnosis symptoms were higher in men than women, especially for urinary tract infections.
When comparing associations of the health conditions associated with MS to those of lupus and Crohn’s disease, the research team found that depression, sexual dysfunction, cystitis, and urinary tract infections occurred more often in patients with MS. Still, the associations were weak, implying the conditions may not be specific to MS. They also noted that constipation was more common among those with Crohn’s disease, a type of inflammatory bowel disease. Compared to lupus, the research team found no health condition was “significantly associated” with it more than the other disorders.
While the researchers noted the five symptoms they found to be commonly associated with MS are also associated with other autoimmune diseases and, therefore, are not likely to serve as prodromes for MS, the study’s results can serve as a basis for improving early diagnoses, especially in certain high-risk populations with familial forms of MS.
What Is MS?
MS is a chronic autoimmune disease affecting the central nervous system. It is often unpredictable and affects individuals differently, which is why the markers of associated symptoms are so important, researchers noted. Some people with MS suffer mild symptoms, while others lose their ability to see or communicate clearly. Other common symptoms include red-green color distortion, pain with movement, and pins-and-needles sensations.
However, diagnosing MS takes time, as no specific test is designed for it. A physician will take a patient through a battery of neurological exams to test mental, emotional, and language functions, movement and coordination, vision, balance, and use of the five senses. Additionally, an individual may have an MRI, cerebral spinal fluid analysis, and blood tests.
According to Johns Hopkins Medicine, an MS diagnosis standard is met when an individual has experienced two attacks within at least one month and has more than one area of damage to the central nervous system myelin. The myelin acts like a layer of insulation for the brain and spinal cord, allowing electrical impulses to travel quickly along nerve cells. If the myelin is damaged, the impulses slow.
The National Multiple Sclerosis Society states that nearly 3 million people worldwide live with MS, with almost 1 million living in the United States. The estimate suggests that someone is diagnosed with MS every five minutes.
The disease typically affects adults between the ages of 20 and 50, although it can occur in young children and older adults. MS occurs three times more often in females than males, suggesting hormones might play a role in how susceptible an individual is to developing it.