Bowel problems

Bowel problems in multiple sclerosis can include constipation, bowel accidents and loose bowel movements.

There's a range of effective treatments for these bowel issues. Straightforward lifestyle changes to your diet and activity levels can make a real difference too. Depending on your symptoms, treatment options may include medication, irrigation of the bowel, establishing a bowel management routine, abdominal massage, pelvic floor exercises and, in some cases, surgical options such as a colostomy. 

What are bowel problems?

The most common bowel symptoms in MS are:

  • constipation and problems emptying the bowel
  • incontinence or lack of control over bowel opening, leading to bowel accidents.

It's not uncommon for people with MS to experience both constipation and incontinence at the same time. Less often, MS might cause diarrhoea or loose bowel movements.

If any of the bowel problems listed below are affecting your life, it might be time to contact a health professional for help and support.

  • You’ve noticed changes in your bowel habits, such as going to the toilet more or less often.
  • You spend a long time trying to empty your bowels, but without success.
  • If your stools have changed – they might be harder, softer or have changed colour.
  • You’re having to rush to the toilet.
  • You have no control over when your bowels open.
  • You leak faeces or pass wind without being aware of it.

If you have blood in your poo, prolonged diarrhoea, constipation, or unexplained weight loss, speak to your GP straightaway for an assessment. It’s important not to ignore these symptoms as they can be a sign of bowel cancer.

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.

With the right information and support, the majority of bowel problems can be managed successfully so they no longer have as much impact on your daily life.

How common are they in MS?

Bowel problems are common symptoms in multiple sclerosis, and are probably under-reported. Although estimates vary about the number of people with MS who are affected by bowel symptoms, it's believed that around half of all people with MS will be affected at some stage.

How are bowel symptoms diagnosed?

When you see your health professional, they’ll take a full history of your symptoms. They may ask you some of the following questions.

  • How often do you usually empty your bowels?
  • Do you ever have problems with constipation or loose bowel movements?
  • How much fluid do you drink each day?
  • What type of fluids do you drink? (eg, water, squash, coffee)
  • What are your stools like? (eg, hard, soft, liquid)

In addition to taking a history of your symptoms, they may ask you to complete a bowel diary for a week. This will give them an insight into your diet, any medications you take, how often you use the toilet, and the consistency of your poo.

Your health professional may also ask to carry out an examination of your back passage (rectum) and bowel opening (anus). This is known as a rectal examination. This is to assess your muscle tone and sensation, and to see if there are any other problems that might affect your bowels, such as haemorrhoids (piles). It should only take a few minutes and isn’t usually painful.

What causes bowel problems?

Bowel control is an extremely complex process that involves the coordination of many different nerves and muscles. Bowel problems in MS occur when messages are disrupted between the brain and the digestive system. This can cause problems with sensation in the back passage (rectum) and control of the muscles at the bottom of the anus (anal sphincters). As a result, people with MS may experience constipation and incontinence.

Bowel problems can be made worse by other MS symptoms, such as fatigue and spasticity. For example, fatigue might lead you to become less active, slowing the movement of waste through your colon. Similarly, spasticity may affect muscle control and tone which may make going to the toilet more difficult.

Not all bowel symptoms are caused by MS. Other causes can include:

  • what you eat and drink
  • being away from home, with different foods and toilet environments
  • lack of exercise and reduced mobility
  • medications – particularly antidepressants and those used to treat pain and bladder problems
  • hormonal changes related to the menstrual cycle
  • pregnancy and childbirth – the gut often slows down due to the hormones present in pregnancy, and childbirth can weaken pelvic floor muscles
  • fear of pain when going to the toilet – for example, because of haemorrhoids
  • other health conditions, such as irritable bowel syndrome
  • abdominal or pelvic surgery
  • bowel cancer.

What can I do if I have bowel problems?

Speaking to a health professional – such as your MS nurse, GP or a bladder and bowel team – is an important first step in getting the right treatment for bowel problems. Alongside this, lifestyle changes can make a real difference.


There are a number of changes you can make, or techniques you can try, that may help with constipation. The aim of managing constipation is to make your poo softer and easier to pass.

Some of the changes you can make include:

  • eating regularly
  • increasing fibre in your diet
  • drinking more fluids
  • exercising regularly
  • getting your posture right on the toilet
  • practising abdominal massage
  • reviewing your medications with a health professional.

Read more about these lifestyle changes on our constipation page.


There are steps you can take to reduce the risk of bowel accidents and regain control of when you open your bowels.

This can include:

  • pelvic floor exercises – to strengthen the muscles around your anus, giving you greater control
  • establishing a routine for opening your bowels.

Read more about these management strategies on our bowel incontinence page.

How are bowel problems treated?

Continence advisors or continence services (also known as bladder and bowel services) deal specifically with bladder and bowel symptoms. They can talk you through the treatment options mentioned below. Some continence services can be contacted directly without a referral from your GP. Your MS specialist nurse and GP can also help with managing bowel problems.


Treatments for constipation include medicines such as laxatives and rectal suppositories and enemas. Transanal irrigation – which involves introducing warm water into your bowel to flush out your poo – is also an effective treatment for constipation.

 Read more about these treatments on our constipation page.


Treatments for bowel accidents include:

  • biofeedback retraining – helping you understand how to use your bowel muscles more effectively
  • transanal irrigation – introducing warm water into your bowel to flush out your poo
  • surgery – such as a colostomy or an antegrade continence enema (ACE).

Read more about these treatments on our bowel incontinence page.

We hear from Amelia, a person with MS who has experienced bowel problems. Here, she explains how transanal irrigation has improved her symptoms. It also includes a discussion with a panel of health professionals who have expertise in bowel problems.

Find out more

Coggrave M, et al.
Management of faecal incontinence and constipation in adults with central neurological diseases.
Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD002115.
Full article (link is external)
Cotterill N, et al.
Neurogenic bowel dysfunction: clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013.
Neurourology and Urodynamics 2018;37:46–53.
Full article (link is external)
Gulick E.
Neurogenic Bowel Dysfunction Over the Course of Multiple Sclerosis: A Review
International Journal of MS Care 2022;24(5):209–217.
Full article (link is external)
McClurg D, et al.
What is the best way to manage neurogenic bowel dysfunction?
BMJ 2016;354:i3931.
Summary (link is external)
Multidisciplinary Association of Spinal Cord Injury Professionals.
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Full article (PDF, 3.5MB) (link is external)
National Institute for Clinical Excellence.
Faecal incontinence: the management of faecal incontinence in adults.
London: NICE; 2007 (reviewed June 2018).
Full guideline (link is external)
National Institute for Clinical Excellence.
Multiple sclerosis: management of multiple sclerosis in primary and secondary care.
London: NICE; 2014.
Full guideline (link is external)
Preziosi G, et al.
Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies
Degenerative Neurological and Neuromuscular Disease 2018;8:79–90.
Full article (link is external)
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