MS Bowel Symptoms

Multiple sclerosis is a progressive degenerative disease of the brain and spinal cord in which myelin sheath and axons of neurons (nerve cells) are damaged so that the nerves carry impulses slowly or not at all. You may develop weakness, paralysis, vision and hearing impairment, difficulty speaking, difficulty urinating, vertigo and chronic pain. When the neurons that control your bowels become impaired, you may have problems with elimination.

Constipation

• Normal bowel movements should occur at least twice weekly, but you may have fewer, resulting in constipation, which is the most common bowel problem associated with multiple sclerosis. Constipation can occur for any of several reasons: because food moves slowly through your bowels because of your damaged nerves; because you have an inadequate diet; and because of lack of exercise related to weakness or paralysis.

Impaction

• When constipation is chronic, the stool remains in the bowel for longer periods, and the bowel continues to absorb fluid from the stool until the stool forms a hard dry mass (impaction) that blocks the bowel and may be too large for you to expel, especially if your muscles are weak. You may feel the urge to defecate and may have pain and pressure in the abdomen and/or rectal area. The increased rectal pressure can cause painful hemorrhoids.

Diarrhea

• Diarrhea is much less common but can occur, especially if you are sensitive to particular foods. More commonly, diarrhea (especially watery) is a sign that you have an impaction. The liquid stool in the bowel above the impaction builds in pressure and leaks around the impaction.

Incontinence

• Fecal incontinence (leakage of stool) may occur if you lose sensation or control of the muscles that control defecation because of nerve damage, but fecal incontinence often occurs because of repeated impactions. The pressure caused by the impaction interferes with your muscle control. Additionally, if you use laxatives to control your constipation and prevent impactions, you may vacillate between diarrhea and constipation, making it difficult to control your bowels.

Strategies

• You may need to use a laxative or even have an enema if you are severely constipated or impacted, but chronic use of laxatives increases constipation over time, so you should try to avoid using them. A better strategy is to routinely use stool softeners and/or fiber supplements, add fiber (from sources such as bran, fruits and vegetables) to your diet, try to exercise and drink plenty of fluids.