Bowels
About half of all people with MS experience bowel problems at some point in their lives. Bowel problems in MS occur because of the interruption of messages between the brain and various parts of the digestive system. This causes problems with sensation in the back passage and control of the muscles at the bottom of the anus, which may cause:
- constipation – difficulties in emptying the bowel
- incontinence – lack of control over bowel opening leading to bowel accidents
Many people find it difficult to talk about bowel symptoms because it can be embarrassing. With the right information and support, most bowel problems can be managed successfully so don't affect your daily life.
Constipation
Constipation is the passing of hard faeces (poo) with lots of effort usually less than three times a week. People who are constipated may also have:
- bloating and discomfort in the tummy
- tiredness and fatigue
- a loss of appetite
Managing constipation involves producing regular, soft faeces (poo) and allowing your bowels to empty more easily and effectively.
What you eat and drink, the amount you exercise, and having regular bowel habits can make a real difference.
Fibre
By having enough fibre in your diet, you can reduce your risk of constipation and reduce your need for medicines such as laxatives. The recommended daily amount of fibre for an adult is 30g. For more information, please see:
Fibre patient information leaflet
Drinking enough
Drinking enough fluids (water) is important. Some people with MS may not drink enough to manage bladder problems. By doing this their bodies will try to take as much water as possible from food waste, meaning harder stools (poo). It is recommended to drink at least 1.5 litres of fluid (water) a day, which is about six to eight glasses of water. Water is recommended as tea, coffee and some other drinks can dehydrate you and cause problems with your bladder.
Exercise
Exercising regularly improves your ability to empty your bowels by working the muscles in your gut more.
Sitting Properly on the Toilet
Squatting is the body's natural posture for opening the bowels. The best technique is the 'Brace and Bulge' technique.
- knees higher than hips
- lean forward
- put elbows on knees
- bulge abdomen
- straighten spine
For more information, please see the link below.
Opening your bowels patient information leaflet
Loose Bowel Movements
Some people with MS may have loose bowel movements. Loose faeces (poo) are more difficult to feel in the rectum.
Eating of wholegrains, such as wholegrain bread, pasta, and rice can help to bulk up the stool and reduce how often the bowels are open.
Medicines – Loperamide (Imodium) is a medicine that slows down the movement of faeces (poo) through the intestine. Stools (poo) become more solid, easier to control, and pass less frequently as a result. Loperamide should only be used after speaking with a health professional, such as a GP or pharmacist.
Bowel Accidents
Incontinence (accidents) can occur when someone is unable to control when their bowels open.
There are different reasons for this:
- it can be caused by reduced feeling in the back passage, so they don't know when to use the toilet. It is more difficult for them to feel or control loose stools
- constipation is the most common cause of bowel accidents. Overflow incontinence occurs when a hard plug of impacted stool (poo) builds up in the back passage or bowel, allowing a loose, watery, diarrhoea-like fluid to pass around it
Having a regular bowel management routine may help. This involves setting a set time to empty your bowels.
Getting to Know Your Bowels
You can track how your bowel problems affect you over time by keeping a diary. It can be shared with your MS team to show your bowel patterns.
Make a note of what you drink and eat, any medicines you take, and when you go to the toilet, including any leaks or incontinence episodes.
Please see the below link for an example of a diary.
Bowel habit diary patient information leaflet
Other Ways of Managing Bowels
As well as the suggestions above, there are other things that can be tried to help manage your bowels. You could try
- adding flax seed (linseed) to your diet
- using laxatives
- suppositories
- trans-anal irrigation
Before trying these, it is best to discuss bowel management with your MS Nurse/Practitioner, continence professional, District/Community Nurse or GP.
Locating a Toilet When Going Out
It is common to feel anxious about going out if you have bowel issues. If finding a toilet is something you are worried about, there are several tips which can help.
- Radar key – these can be ordered online for a small charge from Disability Rights UK. This means a person with a disability can have access to many locked public toilets around the UK
- a 'just can't wait' toilet card – can be ordered from the 'Bladder & Bowel Community'.
- map your journey – 'The great British toilet map' is an online map which can show you where all the toilets are.
Other Resources
Supporting Your Bladder & Bowel Health | Bladder & Bowel Community (bladderandbowel.org)
