Multiple Sclerosis Centers of Excellence
Bowel Management in Multiple Sclerosis
Bowel problems are not something most people want to talk about, and the topic can feel uncomfortable or embarrassing. But having a conversation about bowel function with your multiple sclerosis (MS) team is one of the most important things you can do to manage your symptoms and improve your daily life.
Why MS Affects Bowel Function
Your central nervous system - your brain and spinal cord - controls the speed of your digestive process. It tells your bowels when to speed up and when to slow down. When MS disrupts the communication between your brain, spinal cord, and bowels, things tend to slow down, and constipation often results.
Managing Constipation
Constipation is the most common bowel problem in people with MS. For some, the first step is simply making time to have a bowel movement at the same time every day, ideally after a meal, when your gut is naturally more active.
When timing alone is not enough, a structured approach called a bowel program can help. A bowel program is a combination of routines and medications designed to help you have regular bowel movements and reduce the chance of accidents.
Diet is the foundation. Eating consistent amounts of fruits, vegetables, and fiber can make a big difference in how well your bowels move. A registered dietitian can give you suggestions tailored to your specific needs.
Oral medications are the most commonly used next step. These may come as pills or powders mixed with liquid. They work either by speeding up your bowels (stimulants) or by keeping stools from getting too hard (softeners). Some people need only one type, while others use a combination.
Rectal medications may be needed if oral medications are not enough. Suppositories (solid medications placed into the rectum) and enemas (liquids placed into the rectum) work by stimulating a bowel movement shortly after use. Timing matters - most people use these after breakfast or dinner, when the bowels are naturally more active. Consistency with timing is key. Think of it as training your bowels to move at a predictable time each day.
Managing Loose Stools and Diarrhea
While constipation is more common, some people with MS experience the opposite - loose stools, diarrhea, or bowel incontinence. Common triggers include spicy foods, fatty or fried foods, certain high-fructose fruits, caffeine, chocolate, coffee, and alcohol. Simply avoiding these foods can sometimes help. Adding fiber can also help firm up stools.
Loose stools can also be a sign that you are taking too much bowel medication. Talk to your medical team about adjusting your medications to find the right balance. Do not start over-the-counter medications to slow your bowels without talking to your provider first, as these can cause constipation if not used correctly.
When to Talk to Your Provider
Pay attention to changes in your usual bowel pattern. If you normally deal with constipation but suddenly start having loose stools, or vice versa, this could mean something else is going on or that your bowel program needs adjusting. Your health care team can help figure out the cause and make changes. There is no one-size-fits-all solution to bowel management in MS, but working closely with your providers can help you find an approach that fits your life.
Based on an article by Megan K. Raverty, MD.
