Depression at follow-up and associated social determinants among isiZulu-speaking South Africans: evidence from the National Income Dynamics Study.

One in 6 people in the UK live with a neurological condition []. In many neurological conditions, bladder, bowel and sexual function symptoms are present [], sometimes presenting prior to the neurological diagnosis []. Despite this, bladder, bowel and sexual symptoms are often not recognised as neurological in origin and are overlooked when formulating a diagnosis. The limited mention of bladder, bowel or sexual symptoms in the “Suspected Neurological Conditions” NICE guidelines 2019 [] summarises the lack of recognition that bladder, bowel or sexual dysfunction could be neurological in nature. Previous research has explored the experiences of people living with neurogenic bladder, bowel and sexual function after having been diagnosed [–], in chronic neurological disease such as multiple sclerosis, Parkinson’s disease and spinal cord injury. Despite less common neurological conditions, such as multiple systems atrophy and progressive supranuclear palsy also having known neurological bladder, bowel and sexual dysfunction [] there is no research to our knowledge exploring their experiences. Moreover, there is a research gap that exists in understanding how the recognition of bladder, bowel and sexual dysfunction as part of the process of reaching a neurological diagnosis varies, let alone appreciating that these are neurogenic and should be treated as such. Subsequently, care for these neurogenic bladder, bowel and sexual dysfunction is often delayed and fails to reflect the needs of the patient []. Evidence suggests that individuals presenting with atypical initial symptoms of neurological disease, which may include a predominant picture of bladder, bowel, or sexual dysfunction, are more likely to experience diagnostic delays when compared to those presenting with motor, sensory or cognitive symptoms []. Bladder, bowel and sexual domains are included within disease-specific, quality of life questionnaires, such as the non-motor symptom questionnaire for PD [], the Multiple Sclerosis Quality of Life Questionnaire (MS-QOL) [] evidencing that there are opportunities for bladder bowel and sexual dysfunction symptom management once diagnosed.