Bowel problems are common symptoms in multiple sclerosis, and are probably under-reported. Although estimates vary about the number of people with multiple sclerosis who are affected by bowel symptoms, it is believed that around half of all people with MS will be affected at some stage.
Many people 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 impact, or have as much impact, on your daily life.
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 is 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 your bowel problems are affecting your life, if things have changed or you're worried, don't hesitate to contact your health professional. It might be time to contact them if:
- you've noticed any changes in bowel habits, for instance if you're 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 – it might be harder or softer or have changed colour
- if there is blood in your faeces, prolonged diarrhoea or constipation, or unexplained weight loss
- if you have to rush to the toilet
- if you have no control over when your bowels open
- if you leak faeces without being aware of it.
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 as a result of the disruption 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, resulting in problems such as constipation and incontinence.
Bowel problems can also be made worse by other MS symptoms such as fatigue and spasticity. For example, fatigue might lead you to become less active which may slow 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, they can also be caused by other factors such as side effects of medication you're taking, your diet, how much you exercise, and other health conditions such as irritable bowel syndrome.
What can I do if I have bowel problems?
Speak to a health professional – It's best to get in touch with a health professional if you're experiencing bowel symptoms that are affecting your daily life. Your health professional will take a full history of your symptoms and they may also ask you to complete a bowel diary to get a good understanding of your diet, medications and when you go to the toilet. They may also ask to carry out an examination of your back passage and anus to find out more about the muscle tone, sensation and any other problems that might affect your bowels. A rectal examination only takes a few minutes and is not usually painful.
Keep a bowel diary – Keeping a diary can give you an overview of how your bowel problems affect you over time. You could keep notes in a notebook or there are smart phone apps available to help you monitor your bowel function, such as the Bristol Stool Chart app. It's useful to share it with your health professionals to give them a better understanding of your bowel patterns. Write down what you have to drink, eat, any medication you take and when you go to the loo, including any problems with emptying your bowels or episodes of leakage or incontinence. It's also useful to see if any dietary changes, such as increasing your fibre intake, have made any difference to your bowel movements.
There are a number of changes you can make or techniques you can try that may help with constipation. This includes eating regularly, increasing your fibre intake, drinking enough fluids, exercising regularly, getting your posture right when sitting on the toilet and abdominal massage. We have more information about these practical tips and suggestions on our constipation A-Z page.
Pelvic floor exercises are something you can try which may help to strengthen your pelvic floor muscles and reduce the chances of bowel accidents. We have more information about these exercises on our bowel incontinence A-Z page.
How can I manage my MS bowel problems?
In this video we hear from Amelia, a person with MS who has experienced bowel problems. Here she explains how her symptoms were successfully managed. It also includes a discussion with a panel of health professionals who have expertise in bladder and bowel problems in MS.
How are bowel problems treated?
Continence advisors or continence services deal specifically with bladder and bowel symptoms and can talk you through the treatment options mentioned below. Some continence services can be contacted directly without a referral from your GP. You can search for your local continence service on the Bladder and Bowel Community website.
Treatments for constipation include laxatives, rectal stimulants and transanal irrigation. We have more information about these treatments on our constipation A-Z page.
Treatments for bowel accidents include biofeedback retraining, transanal irrigation and, in some cases, a colostomy. We have more information about these treatments on our bowel incontinence A-Z page.
Bladder and bowels podcast
In this podcast we explain a little bit about the science behind why bladder and bowel symptoms occur in MS. We also share advice on how best to deal with these kinds of problems in the workplace.
Finding a toilet when out and about
Some people who experience bowel symptoms may feel anxious about leaving the house in case they need to use a toilet. If you worry about finding a toilet when you're out and about, there are sources of help and support available.
- The National Key Scheme gives people with a disability access to many locked public toilets around the country. You can buy a key for a small charge from Disability Rights UK.
- A toilet card, sometimes called a 'just can't wait card', can discreetly let people know that you have a medical condition and need to use the toilet urgently. These can be ordered from the Bladder and Bowel Community.
- Changing Places toilets provide more space and equipment for people who cannot use standard accessible toilets. They have a large changing area, adjustable changing bench and a hoist system. There are hundreds of Changing Places toilets in the UK in major shopping centres, airports, train stations and town centres. You can search for toilets on the Changing Places website.
- The Great British Toilet Map is the UK's largest database of publicly-accessible toilets. You can search for public toilets near you using the online map.
- Some councils run Community Toilet Schemes which allow members of the public to use toilets in local businesses for free without having to make a purchase or use their services. Participating businesses usually display a sticker in the window that shows they're part of the scheme. Contact your local council to see whether a scheme is running in your area.
- There are a range of mobile phone apps that can help you locate your nearest toilet.
- London: MASCIP; 2012. Full article Guidelines for management of neurogenic bowel dysfunction in individuals with central neurological conditions.
- Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD002115. Full article Management of faecal incontinence and constipation in adults with central neurological diseases.
- London: NICE; 2007 (reviewed June 2018). Full guideline Faecal incontinence: the management of faecal incontinence in adults.
- London: NICE; 2014. Full guideline Multiple sclerosis: management of multiple sclerosis in primary and secondary care.
- BMJ 2016;354:i3931. Summary What is the best way to manage neurogenic bowel dysfunction?
- Neurourology and Urodynamics 2018;37:46–53. Full article Neurogenic bowel dysfunction: clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013.