It can mean any of the following:
- infrequent bowel actions
- hard pellet stool
- abdominal pain
- sense of incomplete emptying
- excessive wind
While most people will not have all of these, a combination is possible.
Constipation is more common in MS than bowel incontinence. The two can be linked, but people who have constipation will not necessarily go on to develop a problem with incontinence, or vice versa.
It's not always easy to approach the subject of bowel problems or constipation with your doctor or nurse. But professional help can make a real difference when trying to manage these issues. A GP, MS nurse, neurologist or a continence adviser can help.
Tips for treating constipation
Good fluid intake
The generally recommended fluid intake is approximately 10 cups (1.5 to 2 litres) per day. A good fluid intake can help treat and prevent constipation.
If you have MS-related bladder problems, you may have limited your fluid intake. In this case, you will need to treat these as well.
For some people, coffee may stimulate bowel movements. However, as caffeinated drinks can irritate the bladder and increase the flow of urine, it’s not a good idea to rely on them as your main source of fluids.
A balanced diet
Eating a balanced diet, which includes at least five portions of fruit and vegetables every day and plenty of fibre, can help you to achieve regular bowel movements. These foods may help relieve mild constipation:, which includes at least five portions of fruit and vegetables every day and plenty of fibre, can help you to achieve regular bowel movements. These foods may help relieve mild constipation:
- fruit (especially prunes or prune juice, figs, dried fruits)
- nuts (including linseeds)
For severe constipation, however, fibre in some cereals, like unprocessed bran, may not help waste move through the colon any faster and could lead to bloating. Fruit, vegetables and nuts might be more helpful.
Activity and exercise
If MS symptoms such as fatigue or reduced mobility mean you’re less active than you used to be, this can add to problems with constipation.
Being active doesn’t have to mean going out and playing a sport – it’s about finding the right activity to suit you and your abilities.
Regular and comfortable routine
Try to schedule a regular time to go to the toilet, and make use of the gastro-colic reflex: this is an automatic response, triggered by food or drink entering the stomach, which stimulates a wave of contractions in the bowel.
Around 20 to 30 minutes after breakfast is often the best time. Or you might schedule a regular time after coffee or a hot meal.
A toilet also needs to be fitted out so you can feel comfortable and stable. As it’s most natural for humans to squat to pass a stool, you may find it helps to have something to rest your feet on, so your knees are above hip level.
When going to the loo, try to relax and breathe normally. If you hold your breath and strain, you’ll tense up your anus – whereas you should be aiming to relax your anus to allow the stools to pass. Take your time (and have privacy), but try not to spend endless time in the toilet straining. If your bowels do not open, try again at the same time next day.
Some types of drugs commonly taken in MS are can cause constipation, including:
- drugs used to treat over-active bladder in MS such as oxybutynin (brand name Ditropan) or tolterodine (Detrusitol, Detrol)
- anti-spasticity drugs, like baclofen, used to treat muscle stiffness and spasms
other commonly used drugs, including over-the-counter supplements, such as: some multivitamins; painkillers containing codeine; or medicines to treat heartburn, high blood pressure or heart problems
Still having difficulty?
The general measures for treating constipation can help many people, but if they don’t, speak to your GP or continence adviser who will be able to prescribe further treatments.