Bladder, Bowel, Sexual Problems Common, Patients Report
Frequent bladder, bowel, and sexual problems were reported by people with Huntington’s disease, a study reveals.
“Given this frequency, it is important for health care providers to recognize these symptoms and account for them in the overall treatment and management of patients with [Huntington’s disease] as they would other functional deficits,” the researchers noted.
Uncontrolled jerking movements, loss of cognitive ability, and psychiatric problems are hallmark symptoms of Huntington’s disease. The condition is caused by a faulty huntingtin (HTT) gene, leading to the production of an abnormally long huntingtin protein that forms clumps in the nervous system, particularly the brain, and causes damage to nerve cells.
Damage in Huntington’s also can affect the nerves and muscles controlling the bladder, bowel, and sexual function. However, little is known about bladder and bowel impairment in people with the condition, and sexual function is presented mainly in the context of psychiatric manifestations.
Researchers based at the University of Washington invited 48 people diagnosed with Huntington’s (54.2% male), ranging in age from 25–78, to complete a series of questionnaires related to bladder, bowel, and sexual function.
“In this study, we aimed to further understand the frequency of concomitant bladder, bowel, and sexual dysfunction in persons with [Huntington’s disease] through patient-reported questionnaires,” the team wrote.
Participants underwent clinical assessments and scored them based on the Total Functional Capacity (TFC) scale, part of the Unified Huntington’s Disease Rating Scale (UHDRS) to measure disease stage. Urinary symptoms were reported by patients using the Lower Urinary Tract Symptoms (LUTS) tool, while lower bowel symptoms and sexual function each were documented with 11-item questionnaires.
Overall, 45 participants (93.8%) reported at least one symptom related to bladder, bowel, and sexual impairment. Signs in all three areas were reported by 19 (39.6%) patients, 13 (27.1%) described impairment in two systems, and 13 (27.1%) in only one. The remaining three (6%) did not report symptoms.
Participants who reported bladder, bowel, and sexual impairment symptoms were more likely to have a longer disease duration and lower functional capacity than patients reporting no symptoms.
Urinary symptoms were frequent, with 42 (87.5%) reporting at least one urinary sign either sometimes, often, or always. The most common symptoms were incontinence, or leakage, in 34 (70.8%), frequency of urination in 30 (62.5%), the urgency to urinate in 28 (58.3%), and waking up at night to urinate (nocturia) was reported by 25 (52.1%).
The frequency of any bladder symptoms appeared to increase with disease progression. Although there was a trend of increased bladder symptoms from early to late disease, there was a mixed trend of symptom progression during the mid-stage of illness.
Lower bowel symptoms were common, with 29 (60.4%) reporting some form of bowel impairment. Constipation was found in 21 (43.7%), chronic diarrhea in 12 (25%), and nine noted at least one to four bowel accidents per month. Eighteen (37.5%) said they strained during bowel movements, 12 (25%) reported pain, 18 (37.5%) described a feeling of not emptying, and 15 (31.2%) participants disclosed unsuccessful defecation.
Most defecated at least once every one to two days, with eight (16.7%) reporting two times or less per week. As with urination, lower bowel symptoms were more common with increasing stages of the disease.
Most female and male respondents said they were interested in sex (83.3%), had a sexual partner (68.8%), and about half (47.9%) said they had been sexually active in the past six months. Sexual problems were described by 17 (35.4%), while 29 (60.4%) reported no problems. However, in the more detailed second section of the questionnaire, 10 (five men, five women) said they had difficulty reaching orgasm.
Patient-reported contributing factors to sexual problems included chronic illness, fatigue, medications, psychological issues, and partner incompatibility. The most common factors affecting sexual activity over the previous six months were self- and partner-health problems, conflict in the relationship, and lack of privacy.
Sexual problems increased with disease progression from the early to mid-stages, with no participants reporting sexual activity in the late stages of Huntington’s. Overall, men said sexual activity was more important than did women, but women reported a higher degree of sexual enjoyment. Interest in sex remained high at all disease stages regardless of sexual problems or the status of sexual partners.
The team also examined medication use, as Huntington’s therapies, such as antipsychotics, antidepressants, anti-seizure medications, and benzodiazepines (tranquilizers), can affect bladder, bowel, and sexual function.
The majority (79%) were taking therapies known to affect these symptoms. Medications specific to Huntington’s were used by 36 (75%). Twenty (41.7%) were taking antipsychotics, 29 (60.4%) said they used antidepressants, six used (12.5%) anti-seizure medications, and two (4.2%) reported anti-anxiety therapies.
Four (10.4%) patients regularly used medications for bladder symptoms and two (4.2%) for diarrhea. Ten (20.8%) said they used the occasional, regular, or long-term stool softeners, laxatives, or fiber supplements.
Notably, nine of 10 participants that did not use medications reported at least one bladder, bowel, and sexual problem, suggesting that “it is unlikely that medication is the only factor driving pelvic organ dysfunction in this study,” the researchers wrote.
“In conclusion, there is a high frequency of concomitant bladder, bowel, and sexual symptoms in persons with [Huntington’s disease],” the authors wrote. “The pervasiveness of this symptomatology suggests that [Huntington’s disease] pathophysiology [disease process] is a major contributing factor.”