Managing bowel incontinence

Fewer people with MS experience bowel incontinence than constipation, but it can be one of the most distressing MS symptoms.

Continence advisers are there to help.

You can self-refer to many NHS Continence Advisory Services, though in some cases you may need a referral from your GP.

For details of your nearest service, contact the Bladder and Bowel Foundation.

This page looks at:

• assessments for bowel incontinence
• tips for managing problems
• treatments and products that can help

For more in-depth information, see our MS Essentials publication on Managing the Bowel in MS.

Assessment

An assessment is generally the first step to managing bowel incontinence.

A thorough assessment will help work out if the problem is likely to be MS or other factors, can assess the extent of any nerve or muscle damage and recommend the best treatment for you.

• They have to ask you a lot of questions to best assess how they can help you. It may seem embarrassing or intrusive but it is best to answer fully. You will also be asked general questions about past operations, childbirth (if relevant), and your diet and fluid intake.
• You might be asked to keep a diary showing when your bowels open in the toilet, when you have a bowel accident, or (if you wear a pad) when you need to change it.
• Medical staff will examine the anal sphincter muscles but an accurate evaluation of ?squeeze pressures? is only really obtained from using an anorectal manometry test, where a small tube or balloon measures pressures in the anus. There are other tests to find structural problems, like tears in sphincter muscles. Endosonography uses ultrasound to scan the sphincter muscles. Defaecography uses x-rays to help medical staff assess the workings of the rectum and sphincter.

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Tips for managing bowel incontinence

Check your diet

Advice will vary from person to person. High-fibre foods, caffeine, milk products, chocolate, alcohol, spicy food and artificial sweeteners can have the effect of producing loose stool in some people.

Arrowroot biscuits, marshmallow sweets and ripe bananas can help make stools firmer. It is worth experimenting to see if you can identify anything that upsets your control or makes stools firmer.

A regular and comfortable bowel routine

Try to establish a regular routine for going to the toilet. You can plan to be in place at a time when your bowels are most likely to open, for example, 20 to 30 minutes after a meal or a hot drink.

If you have a set routine and can feel comfortable and relaxed, this can help encourage the bowel to develop a regular pattern.

Check your medications

See if any are likely to be causing constipation or loose stool. There can be a fine line between helping constipation with laxatives and causing bowel incontinence.

People with MS who have bowel incontinence should be assessed for constipation with overflow, possibly exacerbated by laxative use.

Planning

Knowing where to find accessible toilets is a great help when planning a day out. The charity RADAR has a 'National Key Scheme' (NKS) that gives access to disabled people to around 9,000 public toilets around the country.

If you are going further afield, the Bladder and Bowel Foundation has a free booklet called 'Travelling with Confidence', with advice on coping with a bladder or bowel problem when going on holiday, or business trip.

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Treatments and products

Steps to control leakage and diarrhoea

An anti-diarrhoea drug like loperamide (e.g. Imodium) may be effective in treating loose stool. Sometimes codeine phosphate is used.

When you are constipated, bowel leakage may stop if you clear the bowel with, for example, a suppository or enema. If not, you may need to combine, with caution and advice, a treatment that empties the bowel and treatment with loperamide.

Some people may be taught to wash out the lower bowel. You can also be taught to stimulate local reflexes using a finger (digital stimulation). There are sphincter exercises for strength and control that you can learn to do.

There are descriptions of sphincter exercises and more information on managing the bowel on the Bladder and Bowel Foundation website.

Surgery

Surgery may be an option for some people. Find out more in the MS Essential on Bowel problems.

Skin care

A continence adviser or GP can guide you on preventing soreness and caring for sore skin around the anus. This might include:

• Gentle wiping or wiping with damp cotton wool
• washing in plain water
• using plain soaps
• avoiding creams and lotions (unless advised to use them, for example a barrier cream)
• wearing cotton underwear that allows skin to breathe 

Odour control

A chemist may stock some deodorants and air neutralisers specially designed to control smells from urine and stools. Some are available with a doctor?s prescription.

Products to help

You can get full details of the range of pants and pads that are available from PromoCon, a national resource centre for information on continence products.

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