Bowel incontinence

Some people with multiple sclerosis find they have less control over when their bowels open. This can result in bowel accidents (incontinence). Your health professional may refer to this as faecal incontinence.

There are many successful approaches to treating and managing bowel accidents. Treatment options may include establishing a bowel management routine, strengthening your pelvic floor, retraining your bowel muscles, irrigation of the bowel and surgical options. It may take a bit of trial and error to find what works best for you.

What is bowel incontinence?

Bowel incontinence is a lack of control over when your bowels open. This can result in leakage and accidents.

What causes it?

Bowel accidents can happen in multiple sclerosis for a variety of reasons. 

  • Constipation is the most common cause of bowel accidents. When a hard plug of impacted poo builds up in the back passage, a diarrhoea-like fluid can pass around it and leak out. This is known as overflow incontinence.
  • Reduced sensation in the back passage can lead to bowel accidents. This is where you don't recognise the urge to go to the toilet.
  • Reduced control of the muscles at the bottom of your anus can make bowel incontinence more likely.
  • You're more at risk of bowel accidents if you're experiencing loose stools. This is because they're more difficult to feel and control. Loose poos can be caused by overuse of laxatives, too much dietary fibre and gastrointestinal infections.

How many people have bowel accidents?

Studies suggest that as many as five out of ten people with MS experience a bowel accident at some time. They're more common in people who have mobility problems as reaching a toilet quickly may be difficult.

What can I do about them?

Speak to a health professional

Reaching out to a health professional – such as your MS nurse, GP or a bladder and bowel (continence) service – is an important first step in getting the right treatment for bowel accidents. You may feel embarrassed or uncomfortable talking about bowel problems, but your health professionals will have lots of experience talking about these kinds of symptoms. You can usually contact your local bladder and bowel service directly without a referral from your GP.

If only I had discussed this with someone sooner it would have saved years of uncertainty, worry, loss of dignity and freedom.

Get to know your bowels

Keeping a diary can give you an overview of how your bowel problems affect you over time. You can share it with your health professionals to show what your bowel patterns are. 

You could keep notes in a notebook or diary. Write down what you eat and drink, and any medication you take. You can also make a note of when you go to the loo, any problems emptying your bowels, and any leakage or accidents.

The Bladder and Bowel Community has a bowel diary template you can download. There are also smartphone apps available to help you monitor your bowel function, such as the Bristol Stool Chart app.

Strengthen your pelvic floor

Your pelvic floor is a sheet, or hammock, of muscles that extends from your tailbone (coccyx) at the bottom of your spine, to your pubic bone at the front. They form the floor to your pelvis and support your bladder and bowel. Pelvic floor exercises may strengthen the muscles around the anus, giving you greater control of your bowel movements. These exercises are usually taught by a continence advisor or specialist physiotherapist.

Pelvic floor exercises can support healthy bowel movements in women and men. Find your pelvic floor muscles by trying to stop the flow of urine when you go to the toilet. Once you've felt these muscles, you can strengthen them by squeezing the muscles 10–15 times in a row. You can try holding the squeeze for longer as your muscles get stronger. It helps to do them multiple times a day.

There are apps you can use to build an exercise plan and remind you to do your pelvic floor exercises, such as NHS Squeezy.

More about your pelvic floor exercises from the NHS

Think of it as bowel physio, you change the muscles you use and strengthen them to come to the rescue!

How is bowel incontinence treated?

The aim of treatment is to regain control over when you open your bowels. There are several approaches. It may take some time, and a combination of strategies, to find out what works for you.

Establish a bowel management routine

This involves emptying your bowels at a regular time that suits you. It can involve the use of laxatives, suppositories or transanal irrigation. Emptying your bowels regularly reduces the chances of constipation and bowel accidents.

Biofeedback retraining

This technique is available in some specialist centres to help people who have difficulty controlling their bowel movements. The aim of biofeedback retraining is to help you understand how to use your bowel muscles more effectively. You’re usually given a range of exercises to retrain your bowel muscles to strengthen and relax. This can involve having a small probe inserted into your back passage while you do the exercises. The device provides feedback on how well you’re doing them.

Biofeedback therapy can also involve sessions on:

  • how the digestive tract works
  • positioning techniques
  • dietary and lifestyle changes
  • behavioural therapy
  • psychological support.

A health professional, such as your GP, MS nurse or continence advisor, can refer you for this therapy.

Transanal irrigation

Transanal irrigation – also known as rectal irrigation – involves introducing warm tap water into your bowel. The water is inserted via the anus, using a catheter or cone, whilst you sit on the toilet. The water helps to wash faeces out of the bowel and encourages the bowel muscles to contract.

Transanal irrigation can be useful if you’ve been unable to successfully manage your bowels with lifestyle changes and medication. There are several systems available on prescription, including Aquaflush, Navina, Peristeen and Qufora. Some irrigation devices are small enough to be discreetly carried in your bag.

Assessment and training with a suitable healthcare professional is essential before using transanal irrigation.

I don't have to worry about accidents or about not being able to go out for fear of being too far away from a toilet.


Surgery may be an option if bowel accidents are affecting your quality of life, and they can’t be improved any other way. The surgery offered would usually be a colostomy. This involves bringing the end of the bowel out through the wall of your abdomen. Waste is then collected in a special bag.

This can be a very positive choice for some people. But it needs to be carefully discussed with your continence specialists and MS team.

I now have a bag stuck to my abdomen – a small price to pay to be totally continent.

Antegrade continence enema (ACE)

Some gastroenterologists may consider an antegrade continence enema for faecal incontinence. This is a surgical procedure. The surgeon will create a small tube that links your bowel to an opening on your abdomen. A narrow tube, called a catheter, can then be inserted into the opening to perform washouts. This involves using a syringe or washout bag to gently push warm water through the catheter into your bowel. This is done while sitting on the toilet and flushes out the contents of your bowel. Your continence specialist will advise on how often you need to perform washouts.

Products that can help

Pads and pants

Pads and pants can help to deal with bowel accidents. They can be useful when you’re first exploring treatment options with a continence team and haven’t yet been successful in finding a solution that works for you.

There’s a wide variety of discreet products available. There are also organisations, such as Continence Product Advisor, that can help you choose what’s most appropriate for you.

Some incontinence products, such as pads, are available on the NHS. Your local continence service will be able to advise on whether you qualify. This will usually involve an assessment.

Anal inserts

An anal insert is a soft silicone plug that you insert into your rectum. It creates a seal and stops the leakage of faeces. They’re inserted using an applicator and removed by gently pulling on the external part of the plug.

It’s important that you’re assessed by your continence nurse or an appropriate healthcare professional before trying an anal insert. They’re not suitable for, or tolerated by, everyone.

The plug has given me so much more confidence to go out more often. I know I am not going to leak, it has been brilliant for me.

Skin care

Caring for the skin around the anus is important when you have incontinence.

Try to remove faeces from soiled areas straightaway, as it can quickly damage the skin. Barrier creams can be useful in preventing discomfort, soreness and damage. Examples include Sudocrem and Cavilon. Be careful not to apply thick layers of barrier cream. This can block pores, clump in orifices, and reduce the absorbency of pads.

It can also help to:

  • gently wash and pat dry the area if it’s been soiled after a bowel movement
  • wear loose cotton underwear that allows skin to breathe
  • avoid perfumed soaps, creams, lotions, and talcum powder.

Find out more

  • Bladder and Bowel Community – a charity providing information and support for people with all types of bladder and bowel related problems
  • Colostomy UK – a charity offering support and care for people who are contemplating or have undergone a colostomy
  • Bowel incontinence – NHS
  • Bladder and Bowel UK – a charity offering advice, support and practical help for people with bladder and bowel problems, including information resources and a confidential helpline
  • Continence Product Advisor – a website providing evidence based information on a wide range of continence products
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