However, according to some researchers, bowel incontinence is not independent of other bowel symptoms such as constipation and urinary urgency. Article published in magazine in December 2018 Degenerative neurological and neuromuscular diseases. In fact, many people with MS experience all three of these problems on a regular basis.
Here’s an overview of how MS changes bowel function and causes incontinence, and the steps you can take to regain some control over your bowel habits.
How bowel incontinence occurs in MS
Normal intestinal function depends on a signaling network throughout the central nervous system Dr. Tamara Bokow Kaplana neurologist at Brigham and Women’s Hospital in Boston.
“The brain and gut are constantly communicating. Normally, the gut sends information through the spinal cord, and the spinal cord has to get to the brain and then go back to the gut,” Dr. Kaplan says. The brain considers information from the gut, as well as convenience and social signals, to decide whether it’s time to poop.
If this signaling is disrupted at any point, Kaplan says, the body may no longer receive permission to empty its bowels at a convenient and socially appropriate time. This can lead to a variety of destructive problems, especially if you also have MS-related problems in that area, such as decreased sensation in your rectum and decreased control of your external anal sphincter, a ring-shaped muscle at the end of your anal canal. May cause symptoms.
Related: 8 things to try when MS affects your sense of taste and smell
It may seem counterintuitive, but one of the most common causes of bowel incontinence is actually constipation.
“Severe constipation can cause retention of stool in the colon,” Kaplan says. This makes it very difficult to control bowel movements when the inner anal sphincter eventually opens, allowing the pelvic floor to relax and the rectal muscles to push out stool.
However, some people with MS may experience bowel incontinence without or without constipation, especially if the lateral anal sphincter is not working well.
Bowel problems are often closely related to bladder problems, and not just because they’re both caused by disruptions in nerve signaling that affect the same area of the body.
“People with overactive bladder often try to self-medicate by restricting their fluid intake,” Kaplan says. “That can make constipation worse and, in some cases, lead to incontinence.”
Related: 11 Awkward But Interesting Facts About Poop
Get help with MS bowel incontinence
One of the big barriers to people with MS getting effective treatment for their gut problems is that most doctors don’t ask about them, Kaplan says. She saw this in a research project that involved examining the records of MS patients.
“Doctors don’t bring this up, and often patients don’t know how to bring it up,” she says. Patients are also “potentially unaware that this might be related to their MS, or what their neurologist would do about it if it were.”
Therefore, the first step in getting treatment for your gut problems is to tell your neurologist or primary care doctor what’s going on. “It’s really important to know exactly what your symptoms are,” Kaplan says. “We often manage based on patient self-report.”
Your doctor may ask you to record your bowel symptoms, eating and drinking, and other potentially related activities. You may develop patterns related to what you eat and drink, and your doctor will also take stock of your overall diet.
How diet and medications contribute to intestinal problems
“I don’t think people realize that the food we eat and drink can make a real difference to our gut symptoms,” he says. Rachel Stacomba nurse practitioner and senior vice president of population health at Independence Care System in New York City.
Not consuming enough fiber and fluids can lead to constipation, and consuming spicy foods, dairy products, caffeine, and artificial sweeteners can all cause problems with bowel urgency.
In more difficult cases, it may be helpful to follow a very restricted diet to see what foods are problematic, Stacom says. Then, “have people slowly introduce food to see if it makes their stomachs worse.”
Another potential cause of constipation and urgency is the type of medication you’re taking. Some have stimulant effects, put stress on the stomach, and cause intestinal contractions. It can also slow digestion, cause constipation, and possibly increase the risk of incontinence.
Adjusting the dosage of a drug can be difficult, especially when the drug is working as intended. But “there are some simple things you can do, such as adjusting your eating and bathroom schedule,” to counter the effects of the drug, Kaplan says.
Related: Is your diet causing diarrhea?
Medical interventions for bowel incontinence in MS
Certain medications, often in combination with a bowel training routine, can help manage constipation and bowel incontinence. “Sometimes it’s important to have regular bowel movements,” Kaplan says.
One technique is to take a powdered laxative called polyethylene glycol at the same time each day. “If someone can get into the habit of having a bowel movement after breakfast, they are freed from the fear of having an accident for the rest of the day,” Kaplan says.
Kaplan says if polyethylene glycol doesn’t work, there are a number of other medications to consider, including stool softeners and stimulants such as bisacodyl and senna. However, many of them can have side effects and should be used very carefully as they can become less effective as tolerance develops.
Kaplan says glycerin suppositories are another helpful option for many people with bowel incontinence. Glycerin suppositories are inserted into the rectum and usually induce a bowel movement within 10 minutes. “They essentially help soften the stool in the rectal area and are not chemically absorbed,” she explains. “Overdose is prohibited.”
If you know you’re going somewhere, from a long car ride to a social event, you can use suppositories beforehand if you want to avoid the risk of an intestinal accident. “Many patients tell me that it’s a huge relief to be able to time their bowel movements and have them when it’s convenient for them,” Kaplan says.
Pelvic floor PT and other solutions for bowel incontinence
Dr. Kaplan has observed that some patients benefit from pelvic floor physical therapy, such as pelvic floor muscle training, which helps strengthen both the pelvic floor muscles and anal sphincter, and It may be possible to treat both bladder and bladder problems. Review protocol published in the Cochrane Database of Systematic Reviews in 2018.
For some people, she says, all it takes is one or two sessions with a therapist and then they can do the exercises at home.
Related: Pelvic floor physical therapy for MS: supporting bladder, bowel and sexual function
according to Reviews published in 2018 Degenerative neurological and neuromuscular diseasesif intestinal symptoms such as constipation and incontinence cannot be effectively treated by lifestyle modification or establishing a bowel movement plan, other measures such as intestinal biofeedback or transanal irrigation (TAI) should be considered.
The use of TAI, a device that flushes the rectum with water, has been shown to help relieve symptoms in MS patients, a researcher has announced. The study was published in the journal April 2016 Neurogastroenterology and motility.
And if you still need protection from bowel accidents, wearing adult briefs can be helpful for many people with MS. When it comes to absorption, remember that “not all are created equal,” Stacomb says. You may also consider applying a skin protectant cream or ointment to areas that may come into contact with soiled briefs, he says. National Incontinence Association — especially if you spend most of the day sitting in a wheelchair or have reduced sensation in the area.
All of these treatments begin with a consultation with your doctor. “These are very common problems that a lot of people struggle with,” Kaplan says. But “if doctors don’t report these symptoms, patients have to find the courage to say, ‘I have a problem.'”