What bowel problems can occur with MS?

There are two main bowel problems that can occur with MS. Constipation is the more common one, but some people also experience bowel incontinence. The two can be linked, but people who have constipation will not necessarily go on to develop a problem with incontinence, or vice versa.

Finding a way to manage bowel problems is not always straightforward, and you will need help from a health care professional. For just about everyone, it is likely that something more can be done to help.
 

MS and the bowel

People with MS do seem to be more prone to problems with constipation than the rest of the population. Around half of people with MS experience constipation (compared to approximately five per cent in the general Western population). Perhaps 30 to 50 per cent of people with MS experience bowel incontinence at some stage (compared to approximately two per cent of the general Western population). If you have MS and are experiencing bowel problems, you are not on your own.

MS bowel problems are more likely for people with severe disability, but people with MS who have mild disability can be affected too. Some people who have constipation will also experience bowel incontinence – the two problems are often linked in MS. For example, it is thought that a common cause of bowel incontinence in MS is linked to constipation, when stool becomes impacted in the bowel and there is ‘leakage’ around it. However, people who have constipation will not necessarily go on to develop a problem with incontinence, or vice versa.  

Researchers know quite a bit about how MS affects the bladder, but much less is known about how MS affects the bowel. It may be that in MS, the colon muscles can become weak and sluggish and the gut slows down, so that the processing of waste takes longer and stools become harder and more difficult to pass, causing constipation.

Nerve damage in MS could mean that the body is unable to interpret sensations in the rectum and upper anal canal. MS might affect reflexes and voluntary control of muscles, where anal sphincter muscles may not relax properly or squeeze tightly enough when you need them to.

Things that are ‘secondary’ to MS can also make for bowel problems. Medications can cause constipation. Medication taken to ease constipation may cause loose stools which, in turn, could lead to bowel incontinence. Bladder problems might lead people to have a low fluid intake, or problems with fatigue and mobility can limit exercise and activity levels. Straining to open the bowels can lead to muscle problems too.

There may be emotional and psychological factors. If going to the loo seems like too much of a struggle, people might ignore ‘the call to stool’. If people lose motivation or become depressed, that in itself can be constipating. If you have had an episode of incontinence, your anxiety about it happening again could contribute to another episode. People who develop severe cognitive problems may become unconcerned or less aware about looking after themselves in this regard.

If you depend on others for your care or if your toilet is not properly accessible, this can affect your bowel habits too. Because bowel problems in MS are probably caused by a number of factors, it follows that you might need to take action on several fronts to help you manage. The strategies that you use may also need to change over time, as your condition changes.

Each professional in contact with a person with MS should consider whether the person has any problems controlling bowel function. Potential problems include urgency, difficulty, pain, constipation or incontinence.
 

Sometimes, everything gets blamed on MS. But people with MS can be affected by diseases that affect the general population too. For example, bowel cancer is common in the UK, and while most symptoms do not turn out to be bowel cancer, do talk to your GP if you have any of the following:

Compliments of:

MS Society, UK