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Bowel Problems: The Basic Facts

Diarrhea and MS
In general, diarrhea is less of a problem for people with MS than is constipation. Yet when it occurs, for whatever reasons, it is often compounded by loss of control. Reduced sensation in the rectal area can allow the rectum to stretch beyond its normal range, triggering an unexpected, involuntary relaxation of the external anal sphincter, releasing the loose stool.

MS sometimes causes overactive bowel functioning leading to diarrhea or sphincter abnormalities that can cause incontinence. The condition can be treated with prescription medications such as Pro-Banthine or Ditropan.

For the person with MS, as with anyone else, diarrhea might indicate a secondary problem, such as gastroenteritis, a parasite infection, or inflammatory bowel disease. It is never wise to treat persistent diarrhea without a doctor’s advice.

Your doctor may suggest a bulk-former such as Metamucil, Benefiber, or Perdiem. When bulk-formers are used to treat diarrhea instead of constipation, they are taken without any additional fluid. The objective is to take just enough to firm up the stool, but not enough to cause constipation.

If bulk-formers do not relieve diarrhea, your doctor may suggest medications that slow the bowel muscles, such as Lomotil. These remedies are for short-term use only.

See your doctor
Minor bowel symptoms may be treated with the suggestions offered on this fact sheet, but only your doctor can rule out the more dangerous conditions that a persistent symptom may be signaling.

After age 40, all people should have periodic examinations of the lower digestive system. The methods include a rectal exam or a sigmoidoscopy or colonoscopy. These last two tests, in which the bowel is viewed directly with a flexible, lighted tube, are increasingly routine as early diagnostic exams. They do not require a hospital stay. The colonoscopy, which examines the entire large intestine, is widely considered the better choice.

Good bowel habits
It is much easier to prevent bowel problems by establishing good habits than to deal with impaction, incontinence, or dependency on laxatives later on. If your bowel movements are becoming less frequent, take action. You may be able to prevent worsening problems by establishing good habits now.

  • Drink enough fluids.

Each day, drink two to three quarts of fluid (8–12 cups) whether you are thirsty or not. Water, juices, and other beverages all count.

It is hard to drink adequate fluid if one is waking up at night because of the need to urinate or contending with urinary urgency, frequency, leaking, or loss of bladder control. These are “red-flag” problems for people with MS. But such symptoms can be controlled. See your physician—and treat bladder symptoms first.

  • Put fiber into your diet.

Fiber is plant material that holds water and is resistant to digestion. It is found in whole-grain breads and cereals as well as in raw fruits and vegetables. Fiber helps keep the stool moving by adding bulk and by softening the stool with water. Incorporate high-fiber foods into your diet gradually to lessen the chances of gas, bloating, or diarrhea.

Getting enough fiber in your daily diet may require more than eating fruits and vegetables. It may be helpful to eat a daily bowlful of bran cereal plus up to four slices of a bran-containing bread each day. If you have limited mobility, you may need as much as 30 grams of fiber a day to prevent constipation. If you find you cannot tolerate a high-fiber diet, your doctor may prescribe high-fiber compounds such as psyllium hydrophilic muciloid or calcium polycarbophil.

  • Regular physical activity.

Walking, swimming, and even chair exercises help. Some regular exercise is important at any age or any stage of disability. Ask your doctor, nurse, or physical therapist.

  • Establish a regular time of day.

The best time of day is about a half hour after eating, when the emptying reflex is strongest. It is strongest of all after breakfast. Set aside 20 or 30 minutes for this routine. Because MS can decrease sensation in the rectal area, you may not always feel the urge to eliminate. Stick to the routine of a regular time for a bowel movement, whether or not you have the urge.

It also may help to decrease the angle between the rectum and the anus, which can be done by reducing the distance from the toilet seat to the floor to between 12 and 15 inches. But many people with mobility problems raise the toilet seat for ease of use. A footstool can create the same desired body angle, by raising your feet once you are seated on a higher toilet seat.

  • Avoid unnecessary stress.

Your emotions affect your physical state, including the functioning of your bowel. Take your time. Use relaxation techniques. And remember that a successful bowel schedule often takes time to become established.

Depression has been known to cause constipation. The constipation can upset you further, starting an unnecessary cycle of worsening conditions. If emotions are troubling you, talk to your doctor or nurse.

If you need more help
If these steps fail to address your constipation problem adequately, your doctor will probably suggest the following remedies.

  • Stool softeners.

Examples are Colace and Surfak. Mineral oil should not be taken while taking a stool softener, because it can reduce the absorption of fat-soluble vitamins.

  • Bulk-forming supplements.

Natural fiber supplements include Metamucil, Benefiber, Perdiem Fiber (brown container), FiberCon, Citrucel, or Fiberall. Taken daily with one or two glasses of water, they help fill and moisturize the gastrointestinal tract. They are generally safe to take for long periods.

  • Saline laxatives.

Milk of Magnesia, Epsom salts, and sorbitol are all osmotic agents. They promote secretion of water into the colon. They are reasonably safe, but should not be taken on a long-term basis.

  • Stimulant laxatives.

Other laxatives include Doxidan, and Perdiem (yellow container). These provide a chemical irritant to the bowel, which stimulates the passage of stool. Peri-Colace includes a stool softener. The gentler laxatives usually induce bowel movements within 8 to 12 hours.

Many over-the-counter laxatives have harsh ingredients. Even though no prescription is required, ask your doctor for recommendations.

  • Suppositories.

If oral laxatives fail, you may be told to try a glycerin suppository half an hour before attempting a bowel movement. This practice may be necessary for several weeks in order to establish a regular bowel routine. For some people, suppositories are needed on a permanent basis.

Dulcolax suppositories stimulate a strong, wave-like movement of rectal muscles, but they are much more habit-forming than glycerin suppositories. These agents must be carefully placed against the rectal wall to be effective. If inserted into the stool, no action will occur.

  • Enemas.

Enemas should be used sparingly, but they may be recommended as part of a therapy that includes stool softeners, bulk supplements, and mild oral laxatives.

Enemeez mini-enemas are not traditional enemas but rather lubricating stimulants.

  • Manual stimulation.

You can sometimes promote elimination by gently massaging the abdomen in a clockwise direction, or by inserting a finger in the rectum and rotating it gently. It is advisable to wear a plastic finger covering or plastic glove.

Note: These techniques may need several weeks before it is clear how well they are working. The digestive rhythm is modified only gradually.


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Copyright National Multiple Sclerosis Society, 2004