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    You are here : Home » About MS » Symptoms » Bowel Problems

    Bowel Problems

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    ConstipationProblems with the bowel are common amongst people with MS but are often not spoken about as some people find it too embarrassing. Around half of people diagnosed with MS will experience bowel problems at some point.
    Main problems tend to be with both constipation and emptying of the bowel, or with the opposite, a lack of control over the bowel opening.  It is also not uncommon for people to experience both of these at the same time.
    People with mobility issues may find they are more likely to have problems with their bowel. This is due to coordination issues between many different nerves and muscles.
    This is something that you should not have to deal with on your own. There are a number of healthcare professionals who are at hand to speak to about such problems and help to find the best solutions.
    Although bowel problems are common amongst people with MS, it is also important to remember that a number of medications can cause these problems too. An assessment with a Continence Advisor or an MS Nurse will help determine the best course of action.
    It is also important to remember that people with MS can be affected by other diseases of the bowel too.
    Why do some people with MS have bowel problems?
    For someone with MS the messages from the rectum to the brain may get interrupted and it is not always known when you may have the need to evacuate. Messages from the brain to other parts of the digestive system can also be interrupted.
    It takes the coordination of many different nerves and muscles to control the bowel correctly. Problems can be managed by a team of dedicated professionals who provide information and support and know the best ways to manage problems satisfactorily. Most areas have access to a Continence Advisor or MS Nurse who can provide specific advice and find the best ways of dealing with the individual’s situation.
    The bowel is a long tube carrying food from the stomach to the back passage (anus). Normal function is where food travels with ease to the first part which is known as the small intestine. This is where all the useful nutrients from food are absorbed. The large intestine (or colon) then absorbs the fluid. What is left is turned into stools (or faeces) which travels in to the rectum and leaves the body through the back passage.
    This is a complex procedure that the body completes; when nerve damage occurs this is easily disrupted.
    Everyone has different bowel habits. Most people with normal bowel behaviour pass stools more than 3 times a week.
    Changes to your normal habit can not only be a symptom of MS but could be due to dietary changes, fluid intake, changes to your emotional state or a side effect of a new drug. These are things that shouldn’t be overlooked when finding out what is causing the problem.
    Most people become aware of the need to evacuate their bowels. Messages are sent from the rectum to the brain, where the brain can tell the difference between solid or liquid stools or the need to pass wind. The rectum has many highly sensitive nerve endings; MS can affect these messages causing changes to bowel movements. This is just one way that MS can cause bowel problems. Messages between the brain and various parts of the digestive system can be a cause too.
    Bowel problems
    Those who have bowel movements less than 3 times per week are described as having constipation. Stools can become hard when inside the bowel leading to difficulties and straining when trying to evacuate. The longer the stools are in the colon, the more water will be absorbed, therefore the harder the stools will be and the more uncomfortable to pass. It can cause discomfort, embarrassment and sometimes pain. It is often not spoken about and people suffer in silence.
    Constipation can be caused by many reasons: a sluggish bowel, not enough fluid intake, medication side effects, reduced mobility and also reduced sensation in the rectal area.
    Reduced sensation can lead to reduced awareness of the need to empty the bowel. The longer this is ignored, constipation can result. A Continence Advisor can help organise a management strategy of how to deal with this.
    There are many strategies used, these include abdominal massage, specific posture positions, assessment of diet and also trying to encourage a regular bowel habit. Reflexes that empty the bowel are most active around half an hour after breakfast.
    Do not rush! It is important to allow yourself time when trying to open your bowel. If nothing has happened after 20 minutes stop and try again after the next meal or the next day.
    Evacuation difficulties can be caused by lack of coordination of the muscles that control the bowel emptying. Sometimes stools can travel normally through the colon but can be problematic passing them out of the rectum. It can feel like constipation even though the stool if softly formed. Specific exercises can be taught to help with this. As mentioned above, these can include posture changes and abdominal massage.
    Reduced fluid intake can cause problems for those with MS. As it is also common to have bladder problems, some people often try managing it by not drinking as much. The knock on effect this can have causes the body to extract as much fluid as it can from food waste, causing stools to become hard therefore increasing constipation. It really is important to drink enough - 1.5-2 litres per day is recommended (this is around 8 glasses). This will vary according to a person’s weight and height. If extra fluid intake aggravates bladder problems this should be discussed with a Continence Advisor or MS Nurse.
    Medication can have a huge impact on constipation. Commonly prescribed drugs such as detrusitol, oxybutinin, tegretol and amitriptyline all list constipation as a side effect. Dietary supplements such as iron tablets can also cause bowel problems. It is important to rule drug side effects out as it may be that another drug may be more suitable for you.
    Reduced mobility can lead to lack of exercise and often, weaker muscles. Both of these factors are thought to be important as muscle strength is required for the muscle contractions that happen in the gut.
    A reduction in mobility can also make it difficult to get to a toilet in time, which causes people to hold on to their stools. This can also lead to constipation.
    If a person has a severe reduction in mobility this can cause further problems as they may need assistance in toileting. Carers arriving at certain times of the day can make it harder to manage toileting issues.
    Management of constipation
    One of the main things to look at to help manage this symptom is your diet; assess daily on what you are eating and drinking. As previously stated, fluid is so important. Look closely at your fibre and fluid intake, fibre is required to help soften stools but it needs to be the right sort of fibre. Too much bran can slow down the gut and make a sluggish bowel worse. Fibre from fruit and vegetables should help but introduce them gradually so you do not get bloated.
    There are medications and supplements that are commonly used when additional help is required these range from stool softeners, enemas to different types of laxatives.
    Stool softeners are usually a short term solution to help relieve constipation, they are to help make it easier to pass stools.
    Enemas are used to help clear out the bowel by introducing liquids into the rectum and colon via the anus. This stimulates the wall of the rectum to help push the stool out. Similarly a suppository is used which is a capsule that is inserted into the back passage. Glycerine suppositories are medication free, whereas others contain a stimulant medication. It is often suggested to start with the glycerine ones and progress onto other medication based ones, such as bisacodyl. 
    There are different types of laxative; osmotic and stimulant. An example of an osmotic is Movicol. They work by increasing the amount of water that stays in your faeces as they pass through your large bowel. This makes them softer and easier to pass. Examples of stimulant laxatives are senna and bisacodyl. They work by speeding up the movements of your intestines. It is important to get the right dose on both of these; advice can be given by your GP, MS Nurse, Continence Nurse or you can ask a Pharmacist.
    Other methods to help relieve constipation are through anal irrigation. The Peristeen Anal Irrigation is effectively used when other methods have not been beneficial. It can be used for both constipation and bowel incontinence and comes as a complete system that can be transported. It works by inserting lukewarm water into the rectum using a catheter. When sitting on the toilet whilst the rectum is filled, the water is then emptied from the bowel along with the stools into the toilet. Many people have found this to be a very effective way of managing their bowel and often only have to perform the procedure every other day. An assessment is required by a healthcare professional that will then teach the procedure to the person or care giver.
    Bowel Incontinence
    Involuntary leakage can cause huge distress and embarrassment but once assessed it is normally treatable.
    It is often commonly linked to constipation; if stools become ‘impacted’ there can be leakage around it. The stool can become very hard which in effect acts like a plug inside the bowel. This can irritate the bowel wall causing more fluid and mucus to be produced which can leak out through the anus. It is important to help clear the impaction first using some of the options listed above. If this is not successful a consultation with a healthcare professional is needed to seek an alternative treatment.
    Other causes can be due to over use of laxatives; too much osmotic laxative can have the opposite effect.
    It is also important to remember that gastrointestinal viruses can still occur for people with MS, as can infections, a stomach upset from bad foods, antibiotics and other medications.
    Generally speaking the bowel is not normally active throughout the night. However in those with longer standing severe MS, the bowel can have movement whilst the person is sleeping, depending on the person this can happen occasionally or regularly.
    Management of bowel incontinence
    Assessing the problem first and foremost will work out whether it is due to MS or whether it is down to other factors. A Continence Nurse will be the best person for this. They may ask you to keep a diary of all bowel movements.
    Exercises may be given to help strengthen the muscles to allow greater control. This is of course dependant on a person’s ability and what control they currently have over their sphincter muscles. Exercises are usually taught by a Continence Nurse/Advisor. It is important the exercises are done correctly and to be mindful that it takes time for muscles to become stronger.
    In some cases Loperamide is given, otherwise known as Imodium. This helps to slow down the movement of the intestine. It is best to speak with a continence specialist about taking this for incontinence issues rather than purchasing and self-administering. This will not be effective in treating impaction.
    Other options…
    In more severe cases where there is a lot of muscle and/or nerve damage, or where the bowel problem cannot be managed in any other way stoma surgery may be the only option. This may be a colostomy or an ileostomy. This is usually a last resort and requires a lot of thought and discussion with the bowel surgeon, Continence Nurse, MS Nurse and the family involved.
    This operation brings part of the bowel out onto the wall of your abdomen where a bag is worn to collect the stools. A colostomy is where an opening is made from the large bowel and the bag is usually worn on the left side of the abdomen. An ileostomy is from the small bowel and the bag is usually worn on the right side of the abdomen.
    For those who have reached this decision it is often a positive one and one that can provide a better quality of life for the individual. It is important that people know this is an option. A stoma nurse will be heavily involved and will be there to answer any questions.
    Complementary therapies
    Anecdotal evidence suggests that some people find relief from their bowel problem through a complementary therapy. These mainly help with constipation more so than incontinence. The most common are abdominal massage (as previously mentioned) and Reflexology. Nutritional therapy or herbal medicines are also worth exploring, especially if sensitive to medications. It is important to tell your GP and/or MS Nurse if you are looking into alternative options.
    Daily management
    Skin care is a factor to bear in mind when a person has bladder or bowel problems. Bladder and/or bowel leakage can lead to skin soreness. Gentle care is needed to stop the soreness turning into open wounds. This is even more important for those with a limited ability to provide personal care for themselves. Carers should be made aware that the skin can become sensitive. A Continence Advisor can help advise on this.
    For skin around the anus perfumed soaps should be avoided, as should perfumed lotions and creams. Allowing sore skin to breathe is important, so wearing loose cotton underwear is helpful. Barrier creams such as Cavillon are useful to help prevent soreness. If sore areas continue it is advisable to make your GP/Nurse aware.
    Useful products
    There are a number of useful continence pads and pants that can be purchased to help contain bladder/bowel problems. They come in a variety of sizes and styles, disposable and washable. Finding what is right for you is often a case of trial and error. The Bladder and Bowel Foundation are just one organisation that can help give advice on these, as can a Continence Nurse. Some are available free on the NHS. 
    Useful organisations
    Disability Rights UK (formerly known as RADAR)
    Formed through a merger of Disability Alliance, Radar and National Centre for Independent Living. The ‘National Key Scheme’ gives disabled people access to disabled toilets around the country.
    Telephone: 020 7250 3222
    Email: [email protected]
    The Bladder and Bowel Foundation 
    A UK wide charity that provides information and advice on a range of symptoms and conditions related to the bladder and bowel.
    Helpline: 0845 345 0165
    General enquiries: 01536 533255
    Email: [email protected]
    All About Incontinence – Allanda
    Provide a wide range of incontinence products to meet your needs.
    Email: [email protected]
    Telephone: 0845 0942 742
    The manufacturer of Peristeen and other products.
    Telephone: 01733 392000
    Colostomy Association
    Provide information, advice and support to people who have undergone, or considering colostomy surgery.
    Telephone: 0118 939 1537
    24hr helpline - 0800 328 4257
    Ileostomy Association
    Provide information, advice and support groups to those who have undergone or who are considering ileostomy surgery.
    Telephone: 028 9334 4043
    Freephone: 0800 0184 724
    E-mail: [email protected]   
    As part of Disabled Living Manchester, PromoCon help to improve the life for all people with bladder or bowel problems by offering product information, advice and practical solutions to both professionals and the general public. They offer a confidential helpline for individuals and healthcare professionals.
    Helpline: 0161 607 8219

    © Multiple Sclerosis Resource Centre (MSRC)

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