Multiple Sclerosis (MS) is a chronic neurological condition affecting the brain, spinal cord, and optic nerves. It results from the immune system mistakenly attacking the protective myelin sheath covering nerve fibers. This damage disrupts the flow of information within the brain and between the brain and the body. While MS manifests in various ways, bowel issues are a common and often challenging symptom experienced by many individuals living with the condition.
Understanding Common Bowel Issues
Constipation is the most frequently reported bowel problem among people with MS, affecting up to 70% of individuals. This condition involves difficulty passing stools, infrequent bowel movements (fewer than three per week), or a feeling of incomplete emptying after a bowel movement. Constipation can lead to abdominal cramping, bloating, and general discomfort.
Bowel urgency describes a sudden, strong need to have a bowel movement that is often difficult to delay. This sensation can be distressing and may lead to anxiety. Fecal incontinence, the involuntary leakage of stool, is another challenging symptom in MS.
Diarrhea, while less common than constipation, can also affect individuals with MS. Sometimes, diarrhea may alternate with periods of constipation, creating an unpredictable pattern of bowel habits. These varied bowel problems highlight the complex impact of MS on the digestive system.
How Multiple Sclerosis Impacts Bowel Function
Damage to the central nervous system directly disrupts the nerve signals that control bowel function. Myelin loss in the brain and spinal cord interferes with communication between the brain and the intestinal tract, affecting bowel motility and sensation. This disruption often involves the autonomic nervous system, which regulates involuntary bodily functions like digestion.
Muscle weakness and fatigue, common symptoms of MS, can also impair bowel function. Abdominal muscles play a role in expelling stool, and their weakening can make bowel movements more difficult. Reduced physical activity due to MS symptoms can further slow the movement of waste through the digestive system.
Certain medications prescribed for MS symptoms, such as those for bladder issues or spasticity, can have constipation as a side effect. For instance, some anticholinergic drugs used for bladder control can slow gut motility. Other MS symptoms like difficulty swallowing (dysphagia) or extreme fatigue might indirectly influence dietary choices, potentially leading to lower fiber and fluid intake, which impacts bowel health.
Effective Management Strategies
Dietary adjustments are often the first line of defense for managing bowel issues in MS. Increasing fiber intake through foods like fruits, vegetables, whole grains, and legumes can help soften stools and promote regular bowel movements. Adequate fluid intake, aiming for around 6-8 glasses of water daily, is also important to prevent dehydration and aid stool passage.
Lifestyle modifications play a significant role in managing bowel symptoms. Establishing a regular bowel routine, such as attempting a bowel movement at the same time each day, can train the bowel to be more predictable. Responding promptly to the urge rather than delaying can prevent constipation from worsening. Regular physical activity, even light exercise as tolerated, can stimulate bowel motility.
Medications can be considered under medical guidance when dietary and lifestyle changes are insufficient. Over-the-counter options include bulk-forming agents like psyllium, which add mass to stool, and stool softeners to make stool easier to pass. Osmotic laxatives, such as polyethylene glycol, draw water into the bowel to soften stool. For more severe cases, prescription medications that stimulate bowel contractions or suppositories and enemas may be used.
Pelvic floor therapy, guided by a physical therapist, can help individuals improve control over their bowel muscles. These exercises focus on strengthening or relaxing the pelvic floor, assisting with both constipation and fecal incontinence. Biofeedback uses sensors to provide real-time information about muscle activity, allowing individuals to learn how to better coordinate their bowel muscles for more effective emptying or control. It is important to consult a healthcare provider if new bowel symptoms appear, existing issues worsen, or if severe pain or blood in the stool is observed.