Many people with multiple sclerosis experience bowel problems. One of the possible problems is occasional faecal incontinence, where control of the bowel is lost. Fear of having a bowel accident can be very worrying.  

There are many successful approaches to treating and managing episodes of bowel incontinence. Health professionals, including your MS specialist nurse, GP and continence services can work with you to find the solutions that work for you. For some people this can involve trying a number of different approaches.   

What is bowel incontinence?

Bowel incontinence (also called faecal incontinence) is a lack of control over when your bowels open and this can result in leakage and accidents.   

What causes bowel incontinence?

Bowel accidents can happen in multiple sclerosis for a variety of reasons. The most common cause is constipation, when a hard plug of impacted stool builds up your rectum and loose, watery, diarrhoea like fluid can pass around it and leak out.

Bowel incontinence can also be caused by reduced sensation in your rectum which means that the need to empty the bowel is not recognised. Control of the anal sphincter (the valve which controls the opening and closing of the rectum) can also be impaired. If the stool becomes loose for any reason (over use of laxatives, too much dietary fibre, or gastrointestinal infections causing diarrhoea) bowel incontinence is more likely because it is difficult to feel and control the loose stool.

How many people have bowel accidents?

Studies suggest that as many as five out of ten people with MS experience a bowel accident at some time. They are more common in people who have mobility problems as reaching a toilet quickly may be difficult.

What can I do if I have bowel incontinence?

Get in touch with a health professional even if you may feel awkward talking about bowel problems. All health professionals should understand that MS can have an impact on how the bowel works so don't be shy in raising this. Your MS nurse, GP or continence advisor are all experienced in dealing with these problems and should be able to put you at your ease. Although health professionals might tend to use more medical language, such as faeces or stool, using poo or number 2s is fine. Use the language you feel most comfortable with.

If only I had discussed this with someone sooner it would have saved years of uncertainty, worry, loss of dignity and freedom.

Hospitals and local primary care services also have a continence advisor, or continence nursing service, that deals specifically with bladder and bowel problems. In some areas you may be able to contact continence services directly, or else your MS specialist nurse or GP can make a referral.

Get to know your bowels, keeping a diary can give you an overview of how your bowel problems affect you over time. You can share it with your health professionals to demonstrate your bowel patterns. Write down what you had to drink, eat, any medication you take and when you go to the toilet, along with any problems with emptying your bowels or episodes of leakage or incontinence.

Try pelvic floor exercises as these may strengthen the muscles around the anus and allow you greater control. In MS nerve damage can result in weakness to the pelvic floor (the sheet of muscles that form the 'floor' to the pelvis and support the bladder and bowel) as messages to the muscles are impaired. Both men and women can do pelvic floor exercises. You can find out more about pelvic floor exercises from NHS Choices

How is bowel incontinence managed?

The aim of treatment for bowel incontinence is to regain control over when you open your bowels. There are a number of approaches and it may take some time and a combination of strategies to find out what works for you.

Biofeedback retraining

This is a technique available in some specialist centres. It aims to retrain your awareness about bowel opening, diet and fluid intake. Your continence advisor can help you with this.

Think of it as bowel physio, you change the muscles you use and strengthen them to come to the rescue!

Transanal irrigation

This uses warm tap water introduced into the bowel via the anus using a catheter or cone whilst you sit on the toilet. The water helps to wash stool out of the bowel and encourages the muscles in the bowel to contract and push the stool out. Assessment and training is essential before using transanal irrigation.

I don't have to worry about accidents or about not being able to go out for fear of being too far away from a toilet

Surgery

For a few people with MS surgery may be an option when bowel incontinence is having an unacceptable effect on quality of life and cannot be improved in any other appropriate way. Surgery offered is usually a colostomy. This involves bringing the end of the bowel out through the wall of the abdomen, so waste is collected in a special bag. This can be a very positive choice for some people but it needs to be carefully discussed with your surgeon and continence advisor or MS specialist nurse.

So I now have a bag stuck to my abdomen - a small price to pay to be totally continent

Products that can help

Pads and pants

When other ways of improving continence have been tried, pads and pants can help to deal with faecal incontinence. There is a wide variety of discreet products available and organisations and websites that can help you to choose what might be most appropriate for you.

Anal plugs

This is like a tampon and is easily inserted into the rectum to help to control leakage of stool. The plug can be left in place for up to 12 hours after which it is easily removed. It is important that you are assessed by your continence nurse or appropriate healthcare professional before you try it.

The plug has given me so much more confidence to go out more often. I know I am not going to leak, it has been brilliant for me

References

  • Coggrave M, et al. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD002115. Full article
  • National Institute of Care and Excellence Faecal incontinence: the management of faecal incontinence in adults. London: NICE; 2007. Full guideline
  • Nusrat S, et al. Anorectal dysfunction in multiple sclerosis: a systematic review. International Scholarly Research Notices Neurology 2012;2012:376023. Summary

Last updated: 26 September 2015
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