Bowel dysfunction, particularly constipation, is not uncommon in MS. Less frequently, or even just as isolated events, diarrhea or even bowel incontinence can occur. These symptoms can usually be managed by good habits related to diet, bowel schedule, fluid intake, and activity, as well as through medication. As a new symptom, it is very important that any change in bowel function should be evaluated by a physician to rule out non MS causes of the symptom.
Constipation
Bowel dysfunction in MS most commonly presents as constipation. Constipation in MS is caused by interruption of neural pathways which influence internal and external anal sphincters, as well as the normal function of the gut. Decreased mobility and activity can aggravate this condition, as can poor hydration. A regular pattern of elimination can be encouraged and bowel retraining is possible. Strategies toward this aim include increased intake of fluid, and establishing a regular time for defecation 20 to 30 minutes after a meal, at the same time each day. Along with added fluid intake, supplementary fibre and bulk forming agents may be helpful as well as stool softeners. Laxatives should be used only as a last resort as they tend to become less effective over time, requiring greater dosages to achieve the same results.
Bowel Diarrhea and Incontinence
Fecal incontinence can be the result of impaction with overflow of bowel contents around obstruction. The treatment for this is first to eliminate the obstruction (enema and digital disimpaction, may be necessary) and then to address the underlying cause, namely constipation. When it occurs in the absence of constipation and obstruction, reviewing diet to eliminate spicy and irritating foods may be helpful. As with any change in bowel activity, other causes of bowel dysfunction not related to MS should be ruled out by a qualified physician.
Key Healthcare Professionals:
Family physician, MS nurse, nutritionist, pharmacist or if required, a gastroenterologist
Symptom Management:
Any change in bowel habit should be assessed to rule out non-MS causes, and age appropriate bowel screening should be done.
Most people can develop an improved bowel performance within 3-4 weeks of introduction of the suggested interventions. 'Normal' bowel function is not defined by a daily bowel movement but rather by a regular routine that is under one’s control.
Pharmacologic interventions should be used as a last resort and can include both bulk and fiber agents, stool softeners, as well as lubricants, and stimulants.
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