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How are bowel problems from multiple sclerosis (MS) treated?

A common symptom that affects approximately 68 percent of people with multiple sclerosis (MS) is bowel dysfunction. People can experience bowel dysfunction when demyelination in the central nervous system (CNS) interferes with nerve transmission needed for normal bowel function. Other factors like slowed transit time of the intestines, muscle weakness, fatigue and lack of exercise can also contribute to the problem. The usual bowel problems reported by people with multiple sclerosis (MS) are constipation, diarrhea and fecal incontinence.

The treatment for bowel dysfunction includes an assessment, interventions, medications and attention to bowel reflexes. Following these four steps can aid in helping the person with multiple sclerosis (MS) experience a more normal bowel function.

Step 1
Assessment of the person's history includes: frequency and type of bowel movements, usual time of day pattern, reliance on laxatives or enemas, current medications and comorbid medical conditions that may affect medications.

Step 2
Interventions should be designed to develop and maintain consistent emptying of the bowel. Use the following guide for dietary and fluid changes: keep a consistent habit and time of emptying (usually one to three days), maintain a balance of stool that is easy to pass, provide for sufficient hydration with 1.5 to 2 liters per day of non-caffeinated, non-alcoholic fluids, and include 25 to 30 grams per day of dietary fiber.

An exercise program shortens transit time through the gastrointestinal (GI) tract. Walking and active exercise are best, but when that is not possible, encourage as much activity as the person can do.

A dietary supplement that can aid in bowel emptying is a combination of several food products high in dietary fiber blended together.

Step 3
Medications may be necessary if dietary and fluid changes are not adequate. But they must be used with caution and under medical supervision. Laxatives are oral stimulants that provide a chemical irritant to the bowel. Laxatives can become habit forming so should be used cautiously. Routine use of large-volume enemas can result in over-distended bowel. Some of these medications include suppositories, stool softeners, bulking formers and enemas.

Step 4
Routine reflexes can aid in managing bowel function. There are several methods to stimulate a routine reflex to empty the bowel. Stimulation techniques include mini-enemas and/or digital stimulation. It is important that these stimulation techniques be used at the same time of day to help the body develop routine reflexes. The natural timing of reflexes needs to be considered when developing a bowel toileting routine.

Changes in the bowel program may be needed, but changes should be made one at a time. Allow a five- to seven-day trial period for each bowel program intervention.

If the above steps are ineffective, a colostomy is an option. A colostomy is a surgical operation that creates an opening from the colon to the surface of the body to create an exit for fecal matter. This is not an uncommon medical procedure for some people with severe disease and/or slowed transit time. A colostomy can actually provide the much needed relief for the person with the problem, and can simplify care by caregivers.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.