Neurogenic gastrointestinal, urinary, and sexual dysfunction in multiple sclerosis: a multidisciplinary framework for clinical practice

Neurogenic gastrointestinal, urinary, and sexual symptoms are highly prevalent in people with multiple sclerosis and substantially impair quality of life, daily functioning, and psychosocial well-being. Despite their frequency and clinical relevance, management remains fragmented across specialties, the close interrelationship among these symptoms is often overlooked, and clinicians lack a pragmatic framework adaptable to different healthcare settings. This review translates current evidence into a pragmatic model of care tailored to the realities of European clinical practice and heterogeneous healthcare resources, helping neurologists and multidisciplinary teams identify needs, prioritize interventions, and optimize management. Because these disturbances are multifactorial and closely interconnected, assessment requires a structured, proactive approach integrating symptom screening, contributing factors, and individual patient needs. Early recognition and individualized multidisciplinary treatment are essential to prevent complications and reduce symptom burden. By promoting structured assessment, rehabilitation, patient education, and coordinated care, this framework may reduce variability in management and improve patient-centered outcomes across diverse healthcare settings.