Bowel problems with MS are relatively common, with 68 percent of multiple sclerosis patients reporting some type of bowel dysfunction. Typically, MS patients suffer from constipation more than bowel incontinence, since the bowel is more often affected by the brain failing to relay messages that it is time to have a bowel movement, leading to constipation. However, in the case of bowel incontinence, reduced sensation in the rectum or reduced control of the anus can lead to a lack of ability to control bowel movements.
For people who suffer from MS and bowel incontinence, this can lead to embarrassing, uncomfortable situations, discourage outdoor activities, and reduce their quality of life.
How bowel problems with MS are assessed
Specialists who treat multiple sclerosis not only seek to slow the progression of the disease, but also work to improve quality of life for people with MS and symptoms such as bowel incontinence. To address bowel problems with MS, doctors usually begin with an assessment that helps identify what exactly is causing the problem.
Patients will usually be asked to recount their experiences with bowel incontinence over a period of time in order to determine its progression. Early assessment efforts may ask patients to keep a journal of their bowel movements, recording how often and to what degree bowel incontinence is experienced. Getting a better perspective on the problem is the first step in treating it.
From here, a specialist may also use several diagnostic tests to determine bowel function, such as an anorectal manometry test, which uses a small tube or balloon to measure the pressure the anus can exert. An endosonography can also be performed, which uses an ultrasound to determine if there has been any structural damage to the sphincter muscles. The entire excretory system can also be x-rayed using a test called a defecography to determine if both the rectum and sphincter are functional.
MS and bowel incontinence: treatment
When it comes to bowel problems with MS, patients do not simply have to settle for living with issues such as bowel incontinence. Doctors are able to offer several treatment options that can significantly improve the condition.
The least invasive step that physicians often try first is an adjustment in diet and the establishment of a bathroom schedule. By avoiding foods high in fiber, as well as caffeine, dairy products, chocolate, alcohol, spicy food, and artificial sweeteners, MS patients can often gain better control of their bowel function. Similarly, a routine of trying to go to the bathroom 20 to 30 minutes after a meal can help empty the bowel on the patient’s own timeline, avoiding leakage or loss of bowel control.
If these minimally invasive steps are not effective, doctors may opt to prescribe medication. Because constipation is also a significant problem in MS, laxatives can sometimes lead from constipation to incontinence. As a result, a specialist may readjust these medications to find an optimal equilibrium.
Over-the-counter drugs such as loperamide (known in the U.S. by its brand name, Immodium) may also be suggested, or even prescription codeine phosphate in more serious circumstances.
Doctors may also teach patients techniques for washing the lower bowel using enemas and suppositories, as well as sphincter exercises to strengthen muscle control when appropriate. The most invasive options include surgery, and are usually a last resort for addressing bowel problems with MS.
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