Bowel Health in MS

It is important to talk with your family doctor about changes in bowel activity that aren’t caused by MS. Constipation or loose bowel movements, bleeding, and pain may be a signal that needs a closer look. 

Many people living with MS experience bowel problems. These problems can happen because MS affects the nerves that help control the bowels. They can also be caused by reduced physical activity, side-effects from certain medications, not drinking enough water, or not eating enough fibre. 

The most common issue is constipation, which means having fewer than three bowel movements a week. It can also involve hard stools, stomach pain, or feeling bloated. Other bowel problems include:

• Urgency: Feeling like you need to go right away and might not make it in time.
• Impaction: When stool gets stuck in the rectum and can’t come out easily.
• Involuntary bowel movements: Accidents or leakage when you’re not trying to go.

If bowel problems aren’t managed, it can worsen other MS symptoms like spasticity (tight or stiff muscles), fatigue, and overall quality of life.

It’s important to talk openly with your healthcare provider about bowel problems. They can help figure out what’s going on by asking about your bathroom habits, what you eat, what medicines you take, and how active you are. If bowel problems happen often, cause discomfort, or get in the way of daily life, it’s a good idea to reach out. 

Getting support early when symptoms first appear can make it easier to manage them. Don’t wait until things get worse; even small changes are worth talking about.

Change your diet: 

Eat more fibre (whole grains, fruits, vegetables) and drink plenty of water. Most adults need about 25–30 grams of fiber per day. For example, the following foods are high in fibre:

• 1 medium apple with skin
• 1 slice whole wheat bread
• ½ cup cooked broccoli
• 1 small handful of almonds (about ¼ cup)
• High fibre cereals like oatmeal and shredded wheat

Start slowly and drink plenty of water to avoid bloating. Mixing and matching these foods throughout the day can help you meet your fibre needs while supporting bowel health. See Nutrition and MS for more information about a balanced diet. 

Keep hydrated: 

Drinking enough fluids helps keep your bowels moving. If you’re cutting back on your fluids to avoid bladder problems, talk to your healthcare provider as they may treat bladder issues first, then help with bowel symptoms.

Not drinking enough can lead to constipation, which might cause stool to back up and leak. It can also make bladder urgency worse, since a full bowel presses on the bladder. To help both bladder and bowel work better:

• Try to stop drinking fluids about 2 hours before any activity where you want to avoid bathroom breaks.
• Drink 6 to 8 glasses of water each day.
• Avoid drinks that can bother the bladder like caffeine, alcohol, or pop. 

Get physically active: 

Regular physical activity helps your bowels work better. Any kind of movement like walking, stretching, or workouts will help support digestion and overall health. See Physical activity and MS for more information. 

Get into a routine:

Try to use the bathroom at the same time every day, especially after meals. Your body’s natural reflex to empty the bowel is strongest about 20–30 minutes after eating, especially breakfast. Sitting on the toilet at the same time daily, even without the urge, can help build a regular habit.

Medications

There are different types of medications that can help with bowel symptoms. Some are available over the counter, and others may be prescribed by your healthcare provider depending on your situation.

• Fibre supplements – products with psyllium can help bulk up stool and make it easier to pass.
• Stool softeners – like docusate sodium, help soften stool so it’s easier to go.
• Stimulant laxatives – like senna or bisacodyl, help trigger the bowel to move. These should only be used occasionally because they can be habit-forming. Over time they can make constipation worse.
• Prescription medications – may be needed if symptoms don’t improve with other treatments.

Always check with your doctor or pharmacist before starting something new, especially if you take other medications or have ongoing symptoms.

Other ways to help manage bowel problems

There are a few other ways that can help make bowel movements easier and more comfortable. 

• Gently massaging your stomach in a clockwise direction can help encourage movement in your colon.
• Strengthening your pelvic floor muscles, the group of muscles at the bottom of your pelvis that help control your bladder and bowel, may reduce constipation or leakage. These exercises can be done at home or with a physiotherapist.
• Using a small footstool under your feet while sitting on the toilet also helps; it puts your body in a better position, like a squat, which can make it easier to pass stool without straining yourself.

Ask your healthcare provider or physiotherapist for help if you are not sure how to get started.

Fecal incontinence means having trouble controlling bowel movements, which can lead to accidental leakage. This can happen for a few reasons:

• Weak pelvic floor muscles, which normally help keep the bowel closed until you're ready to go.
• Reduced sensation in the rectum, making it harder to feel when stool is ready to pass.
• Overflow from severe constipation, where backed-up stool pushes past the blockage and leaks out.

Accidents can be upsetting and embarrassing, but they can be managed with the right support. If you’re experiencing bowel accidents, talk to your healthcare provider about treatment options that can help improve control. Depending on your situation, they may suggest:

• Pelvic floor therapy – exercises to strengthen the muscles that help you hold and release stool.
• Biofeedback – a technique that helps retrain your body to better sense and respond to bowel signals.
• Rectal irrigation – gently flushing the bowel with water to help prevent accidents.

Fecal impaction happens when a large, hard mass of stool gets stuck in the rectum and can’t come out on its own. Sometimes, this leads to overflow diarrhea, where loose stool leaks around the blockage. It can happen when constipation goes untreated for a long time or when the muscles that control bowel movements aren’t working properly.

Treatment may include:

• Manual removal – a healthcare provider gently removes the stool by hand.
• Enemas or suppositories – an enema flushes the rectum with liquid to help soften and move stool; a suppository is a small, medicated insert placed in the rectum to trigger a bowel movement.
• Rectal irrigation – flushing the bowel with water regularly to prevent buildup.
• Follow-up care – includes changes to your diet, staying active, and setting a regular time to use the toilet.

When your bowels are working well, you probably don’t give them much thought. But when they’re not, things can get uncomfortable quickly. The good news is there’s a lot you can do to improve your bowel health. Start by having an honest talk with your healthcare provider, it can make a big difference in how you feel day to day.