Bowel problems in MS
Fact-checked by Bowel problems such as incontinence and constipation are common in people with multiple sclerosis (MS), affecting as many as 7 in 10 patients at some stage in their disease.
These symptoms may feel frustrating or embarrassing, and can substantially interfere with daily life. But a range of medications, interventions, and practical strategies can help improve bowel control and support quality of life.
How MS can lead to bowel issues
In MS, the immune system launches inflammatory attacks against healthy tissue in the brain and spinal cord, interfering with the communication between the nervous system and other parts of the body.
When the nerves that communicate with the digestive system are affected, the body may be unable to interpret signals from the bowels indicating the need for a bowel movement, or the muscles needed to move waste through the body may not respond adequately to brain signals, leading to bowel issues.
When the loss of bowel control is caused by a nerve problem, people have what’s known as neurogenic bowel dysfunction.
Beyond nerve damage, other factors, including certain medications, reduced physical activity, lack of hydration, and poor dietary habits, can also worsen bowel control in MS. MS symptoms such as spasticity and fatigue can also be factors.
Common bowel problems in MS
The most common bowel symptoms in MS are:
- constipation, in which stool becomes hard and difficult to pass, resulting in fewer bowel movements than usual, often accompanied by abdominal bloating and discomfort
- incontinence, marked by stool leakage and accidents
Constipation in MS may result from weakness or poor coordination of the intestinal muscles needed to move fecal matter toward the anus. It can also occur when MS reduces sensation in the rectum, making it harder to recognize the urge to empty the bowel. This symptom is estimated to affect as many as 70% of people with MS.
Bowel incontinence in MS may arise when the muscles around the anus can no longer be voluntarily controlled, or when reduced rectal sensation prevents a person from noticing the need to use the bathroom. As many as 50% of people with MS experience at least one bowel accident during the course of their disease.
Some people may also experience diarrhea. MS and diarrhea are not usually directly connected, but loose stools can occur due to certain medications, infections, or as a consequence of severe constipation.
Recognizing the signs and getting help
Bowel symptoms can feel embarrassing, which may keep some people from mentioning them during medical appointments. But talking openly with a doctor about any changes in usual bowel habits is key to identifying the cause early and starting the right management plan.
To better understand the problem, a healthcare provider may:Â
- collect a comprehensive medical history
- perform a physical and rectal exam
- ask the patient to keep a bowel diary to track bowel movements and stool consistency and identify potential triggers or patterns
There are many possible causes for bowel problems, some of which may be serious. Patients should seek immediate medical care if they notice the following red flag symptoms:
- blood in the stool
- unexplained weight loss
- persistent and severe abdominal pain
- fever, chills, or vomiting accompanying bowel symptoms
- severe and prolonged diarrhea or constipation
Practical steps to manage bowel issues
After a thorough assessment, a healthcare team will recommend an MS bowel management program tailored to each person’s symptoms and needs. This may include lifestyle changes and adjustments in bathroom habits, medications, or more advanced specialist treatments.
These interventions can improve gut health, support regular bowel movements, and reduce the impact of bowel symptoms on daily life.
Basic lifestyle and bathroom habits
Lifestyle changes and adjustments to bathroom routines are among the first strategies used to help improve gut motility in MS and make bowel movements more regular. Common approaches include:
- increasing fiber intake
- drinking more fluids
- eating regularly
- exercising regularly
- adopting a squatting position while on the toilet or practicing abdominal massaging to stimulate bowel movements
- doing pelvic floor exercises to strengthen the anus muscles
- establishing a fixed daily bathroom regimen to help the bowel develop a predictable routine
Medications
In some cases, oral medications may be recommended to relieve constipation or manage incontinence when lifestyle adjustments aren’t enough. These may include:
- stool softeners or laxatives, such as docusate, psyllium, and bisacodyl, for MS constipation treatment
- antidiarrheal medications, such as loperamide and bismuth subsalicylate, to manage loose stools and diarrhea
If oral medications don’t work to relieve MS constipation symptoms, a rectal suppository or enema may be needed to quickly empty the bowels.
Specialist options
For patients whose bowel issues persist despite standard interventions, there are more advanced approaches that may be included in a tailored MS bowel management program:
- Transanal irrigation, also called rectal irrigation, involves introducing warm water into the rectum to help empty the bowels.
- Biofeedback for bowel incontinence uses sensors to help patients understand and control the muscles involved in bowel movements.
If all other approaches fail, a person may need to undergo surgery. This can include a colostomy, in which a surgeon creates an opening in the abdomen through which stool exits the body, or an antegrade continence enema, which involves pushing water into the bowels through a surgically created abdominal opening.
Helpful tips for daily life
Caring for someone with MS bowel issues can take a toll on daily life, but there are some bowel care tips that can make life easier for patients and caregivers.
- Keeping an open dialogue with the MS care team and loved ones provides practical and emotional support for coping with MS incontinence and constipation.
- Developing a simple and sustainable routine, including a balanced diet for bowel health in MS, adequate hydration, regular physical activity, and dedicated time for bowel movements, can help with the day-to-day. Tools like diaries or logs can aid in tracking patterns and progress.
- Planning for unexpected bowel issues when away from home, by carrying essential supplies such as a change of clothes, wipes, pads or diapers, and medications, can make trips or travel easier. Checking ahead for accessible toilets can also help.
Because bowel problems in MS may evolve over time, patients should regularly revisit their care plan with their MS care team, discussing what is and isn’t working and seeking help whenever new or worsening bowel issues arise.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
