Multiple Sclerosis and Constipation

People with MS may suffer from bowel problems at some point in their lives. There are two main bowel problems that MS patients can suffer with; constipation is the most common affecting around 50% and faecal incontinence affecting about 30-50%. These problems can also be linked to one another. When stool becomes impacted uncontrollable bowel leakage can occur around it.

MS often leads to mobility problems, the muscles around the abdomen become weak either by a result of MS or as a lack of exercise. The common reasons behind constipation are; reduced mobility, reduced fluid intake, defecation difficulties and also some drugs that are prescribed for people with MS.

Symptoms of constipation

MS patients may experience one or a combination of the below symptoms;

  • Infrequent bowel movements
  • Hard pellet stool
  • Straining
  • Bloating
  • Abdominal pain
  • Sense on incomplete bowel evacuation
  • Excessive wind

Causes of constipation in MS patients

Constipation may develop if MS interferes with the anal sphincter muscles and the nerves in the anus used to sense stool. It has been found that people with MS can have reduced ability to squeeze their anal sphincter muscles, for example, and diarrhoea or loose stool is harder to hold if your muscles are weak.

Some medication commonly associated with MS can cause constipation, such as medication for overactive bladder, anti-spasticity drugs for muscle stiffness and spasms and anti-depressants.

Over the counter drugs can also affect the bowel including multivitamins containing iron. If constipation is experienced it might be worth discussing all your medications with your GP to see if alternatives can be taken.

Maintaining a healthy bowel

Bowels are affected by diet, fluid intake, exercise and by MS itself. You can maintain good bowel health by eating a balanced diet with lots of fibre, drinking between 1.5-2 litres (6-8 glasses) of fluid a day, avoiding too much caffeine and alcohol and taking some exercise.

For you to be able to control your bowels, you need to be aware of the need to empty your bowels, however, the message to go to the toilet is often lost or scrambled in MS, making it difficult to determine a need to empty the bowels at the right time.

If you find it difficult to empty your bowels there are some steps that you can follow which could help ease the problem:

  • Try to eat 5 portions of fruit and vegetables and 2 portions of fibrous foods such as wholemeal bread or cereals each day
  • Experiment and identify foods that stimulate your gut – fruit is often good for this.
  • Visit your GP for advice about how to combat bowel problems, your GP may recommend you visit a Continence Nurse or Advisor
  • Increase your fluid intake
  • Look at the medication that you are taking as some medication can cause constipation – however you may not be able to manage without the medication
  • Review your toilet position, the correct toilet position and posture is important to ensure you empty your bowels correctly
  • Pelvic floor exercises – these exercises can help you to gain better control of your bowel and bladder. These exercises are recommended to anyone who suffers from bladder and/or bowel problems not just people with MS. You’re GP or Continence Nurse / Advisor can advise you further about pelvic floor muscle exercises.
  • If you are experiencing bowel incontinence and constipation it might be worthwhile establishing a regular bowel emptying routine which makes accidents at other times less likely. This is especially helpful if you need assistance to get to the bathroom and help is not always available. Encouraging your bowel to open regularly also helps to avoid constipation. Establishing a bowel management routine is best done working with an appropriate healthcare professional.

Further information

Before seeing you GP about your symptoms, it would be useful to keep a Bowel Diary for a week or so before your appointment. You will need to record data such as food and drink consumed any bowel movements or accidents and medications etc. This information will help your GP make a diagnosis and could highlight an underlying cause of the constipation.

This information has been provided in association with the MS Society. If you require further information or support, please contact the MS Society on;

MS Society Website or MS Helpline 0808 800 8000

The MS Trust also has a useful webpage on how people with MS can deal with bladder and bowel problems called practical guides.

If you are concerned about your bowel problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.