Ask the expert: Bowel and bladder problems in MS

3 May 2018

Talking about your toilet troubles can sometimes be embarrassing – there's no getting away from it! But bowel and bladder symptoms in MS are common and often easily managed, so it's important to be open about what you're going through so you can get the support you need. We put some of your questions about these issues to MS specialist nurse Noreen Barker.

What are the pros and cons of using catheters?

Noreen says: Catheters can be a worrying issue. Nowadays we have lots of people who manage their bladder if they have any urgency, frequency or incomplete emptying by using an intermittent catheter. When this is first discussed, some people may have a few concerns. It's not natural to want to put a tube into yourself, but there's a great range of catheters in different materials and sizes.  With intermittent catheters you put them into the bladder, and the idea is you drain out the residual urine that's there, take the catheter out, and then you get on with your day. People might worry about how they manipulate catheters, but I would say if you have the dexterity to do your buttons up, put your earrings in or hold a pen, there is probably a catheter that will suit you.

The other worry ladies have is that anatomically it can be quite challenging to put the catheter in, but if you have someone who teaches you in the right way, it can make a big difference. If you're getting up to go to the toilet four or five times at night, having an accident at night, or rushing to the toilet, they can make a big difference. Out of all things over the years I've encouraged people to do, it's usually one of the things that changes people's lives for the better.

Are there any exercises I can do to help strengthen my bladder?

Noreen says: There are exercises called pelvic floor exercises, or if you're looking on an American site they may be called Kegal exercises. These are exercises to engage your pelvic floor, which is a sling of muscles in your pelvis, which supports all of your pelvic organs. If you have any weakness of your pelvic floor, for example if you've had babies or problems with constipation, then you can do exercises to strengthen these muscles. Usually they are talked about in terms of stress incontinence, which is when you leak if you cough, sneeze or laugh, but they are also very good at helping to calm down the ‘urge'  if you have some urge incontinence as well. Bladder and Bowel UK have useful information on pelvic floor exercises.

Always seek advice, as sometimes a fresh pair of eyes on something can make a big difference.

What is the best way to deal with constipation?

Noreen says: I think the best way is looking at what is happening. Is this a new problem? Or is this something that's been going on for a long time? Sometimes it's good to look at what your bowel habits were like before and think about what has changed in life. It could be very simple – eating the right foods and drinking the right things. Or sometimes it could be making sure you allow yourself enough time to go to the toilet. We all live such busy lives now, so if you've got problems with faecal urgency or frequency, you may have to allow yourself time to do the right things in the morning. Many of us now will eat our breakfast and rush out the door, and not actually give ourselves the time to go to the toilet. Naturally, our bodies have something called the gastrocolic reflex, which is when we eat or drink something and that stimulates our gut peristalsis, and most of us will get a call to go to the toilet maybe 20 minutes or so after we've had something to eat or drink. For some people that will be first thing in the morning, for others in the evening, depending on the hours you work or shift patterns, but it's trying to find that right time to go.

Sometimes it's good to look at what your bowel habits were like before and think about what has changed in life.

Other things people could try  include: abdominal massage, keeping mobile and exercising. There are lots of medications out there too; it could be a once-everyso-often stimulant to get your bowel moving, softeners to keep the stool easy to go or very strong medications, such as suppositories or enemas if people really can't go. But sometimes it's just as simple as having the right position on the toilet. So always make sure you have your feet on the floor or a little stool if you can't reach the floor, your knees slightly higher than your hips and sit forward a little bit. That will put you in a nice anatomical position to go. Some people tell me they use other things to help stimulate their bowels, for example adding linseed or flaxseed into their diet, taking aloe vera, or I have lots of people who swear by their cup of coffee in the morning. It's just about finding the right thing for you and finding that right pattern which keeps things going. If you can't manage it by yourself, always seek advice, as sometimes a fresh pair of eyes on something can make a big difference.

What incontinence supplies are available on the NHS and how can I access them?

Noreen says: This is a very common question. Incontinence supplies - from little shaped pads to quite big products - are available on the NHS but they are not a prescription item. In order to access them you are going to need to see your local bladder and bowel service. They often have a policy that they won't supply to people who want to wear pads ‘just in case', and they might have a certain criteria, so say you have an accident three to four times a day. Usually a pad will be given if you've gone through a thorough assessment.

Sometimes I have bowel problems where, without warning, I just lose it, even when I'm out. Is there anything I can do to help with this?

Noreen says: This can be a really tricky problem. A lot of the time it depends on what your normal bowel habits are like. For all of us, if you're motions are very loose, you can't always distinguish what is wind and what is your bowel. But having a regular routine and trying to empty your bowels before you leave the house might help. Sometimes it's quite a long process to get that right pattern. But often these symptoms can be improved, so I would say the most important thing is to see someone about it and get an individualised care plan.

What is your top tip for dealing with MS bowel and bladder symptoms?

Noreen says:  My top tip has got to be don't keep it a secret! They are the most common symptoms in MS, and out of all of the symptoms they are quite easily improved, if not sorted completely. I think it's not being afraid to talk to people about it, because we can all have problems with our bowel and bladder, whether we have MS or not.

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