A to Z of MS Bowel problems

Types of bowel problems in MS

Bowel control problems are common in people with multiple sclerosis. The two most common bowel problems encountered by people with MS are faecal incontinence and constipation and people will sometimes experience a combination of the two.

Bowel control is extremely complex, involving a delicate coordination of many different nerves and muscles. In order to control bowel actions, it is necessary to be aware of the need, or 'call to stool'. This awareness occurs when the faeces move into the rectum causing the rectum to expand and send messages via the sensory pathways of the need to evacuate. At this point the finely tuned nerve endings are able to differentiate between whether the stool is solid, liquid or wind. However in MS the messages are often either lost or incomplete, leaving a situation in which it may be difficult to differentiate between the calls.

Constipation

Constipation is the passage of hard stools, less frequently, than the individual's usual own bowel pattern.

Factors that increase the risk of constipation include: reduced fluid intake, reduced mobility, reduced call to stool and defecation difficulties. Drugs routinely prescribed for people with MS may also contribute to the problem, particularly anticholinergics, used to treat bladder problems, and antidepressants. Management requires a bowel assessment to identify what might be causing the problems. The assessment will look at the individual's bowel habits, fluid intake, diet, the appearance of the stool and issues around access to a toilet.

For many people, bowel problems can be at least improved by:

drinking at least two litres of fluid a day
increasing fibre in the diet
being as active as possible
developing a regular time of day for opening the bowels (the urge is strongest about half an hour after a meal and in the morning)

If necessary, there are several types of medication used to treat constipation including laxatives and suppositories. Enemas are only used if no other medication is working as overuse can lead to the bowel becoming dependent and not working properly without them.

Faecal incontinence

Whilst a lack of control of when stools are passed is a very distressing symptom, it is not uncommon. It can result from damage to the coordination of the bowel mechanism caused by MS or diarrhoea from overuse of laxatives. Faecal incontinence can also be a by-product of constipation, with poorly formed stools overflowing around impacted stool.

A bowel assessment is usually the first step in treatment as this can identify the cause of problems. If the incontinence is due to the effects of MS, there are bowel inhibiting medications that can be used to support the development of regular bowel habits. Containment products are also available, both over the counter and on prescription.

References

Dasgupta R, Fowler CJ.
Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies.
Drugs 2003;63(2):153-166.
abstract

Sonnenberg A, et al.
The "institutional colon": a frequent colonic dysmotility in psychiatric and neurologic disease.
American Journal of Gastroenterology 1994;89(1):62-66.
abstract

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