Many people with multiple sclerosis (MS) face challenges from other chronic conditions (comorbidities). The most common comorbidities that occur alongside MS include depression, anxiety disorders, high blood pressure, high cholesterol, and lung disease — however, some people living with MS may also experience inflammatory bowel disease (IBD).

IBD is an umbrella term for a group of chronic conditions including ulcerative colitis and Crohn’s disease. These conditions cause inflammation in different areas of the gastrointestinal (GI) tract. Common symptoms of IBD include:

• Weight loss
• Bloating
• Abdominal pain or cramping
• Decrease in appetite
• Diarrhea
• Rectal bleeding or bloody stools
• Fatigue

One MyMSteam member shared their experience with IBD: “Early in my MS diagnosis, I used to have bowel problems,” they said. “At first, it was constipation, then I started to have diarrhea. I saw a gastroenterologist, and they discovered I had Crohn’s disease caused by my MS.”

How Is MS Related to IBD?

Bowel symptoms affect roughly 70 percent of people diagnosed with MS, some of which may be due to IBD. In fact, one study found that the prevalence of MS may be 1.5 to 5 times higher in people diagnosed with IBD compared to the general population. The connection between MS and IBD has been studied since the early 1980s, and researchers are just beginning to understand what may be responsible for the association between the two conditions.

Both MS and IBD are autoimmune diseases, meaning the body’s immune system attacks its own tissues. One study found that MS can cause changes to the intestinal tissues. This change in the gut — sometimes called “leaky gut” — allows for various materials to enter, change the microbiota (intestinal bacteria), and trigger an autoimmune response. Leaky gut may also be a contributing factor to IBD or its symptoms.

Stress is also suspected to play a major role in the development of IBD. A person living with MS will encounter various physical, social, and emotional stressors as they cope with their condition. This stress may interact with other IBD risk factors to lead to IBD.

Risk Factors for IBD and MS

Both MS and IBD are more commonly found in young adults and people living in developing countries. MS and IBD also share common risk factors, including:

• Low levels of vitamin D in the blood
• Poor diet
• Use of oral contraceptives (birth control)
• Psychological stress
• Cigarette smoking

Other Causes of IBD Symptoms in MS

IBD can cause constipation and diarrhea, symptoms that may also occur with MS. However, IBD may not always be the cause of bowel problems in MS.

Causes of Constipation

Constipation is the most frequently reported bowel complaint among people diagnosed with MS. Bladder dysfunction is also common, and some people will try to reduce their fluid intake to combat their bladder problems. However, reducing fluid intake can often cause and worsen constipation. In the other direction, the buildup of stool can also create pressure on the urinary system and prolong some bladder issues.

Other factors may contribute to constipation in MS:

• Damage or loss of myelin (demyelination) can disrupt the signaling between the GI tract and the brain and spinal cord, otherwise referred to as the central nervous system.
• Fatigue, difficulty walking, and weakened abdominal muscles may cause slower movement of waste material through the colon and make it more difficult to have a bowel movement.
• Spasticity, or muscle spasms or stiffness, may also cause abnormal bowel functioning.
• Decreased mobility and physical activity can affect bowel functioning.

Causes of Diarrhea

Diarrhea is a less commonly reported bowel problem among people living with MS. Depending on the type of MS, some people experience reduced sensation in the rectal area. A loss of sensation may cause the release of loose stools.

Although many MS treatment options can help manage MS symptoms, some MS medications may cause negative side effects such as diarrhea and abdominal pain.

“I started having major stomach issues like cramps and diarrhea while I was taking Aubagio,” shared one MyMSTeam member. Another member wrote, “I try not to take steroids on an empty stomach because it will give me stomach pain. I sometimes take an antacid with each dose to prevent irritation.”

It is important to observe how your body reacts to certain MS medications and to speak to your doctor right away if you begin to experience any negative side effects.

Managing IBD and Bowel Issues in MS

Depending on the severity of your IBD symptoms, they can sometimes be treated by having a healthy lifestyle and adopting good bowel habits. More severe IBD symptoms may need to be treated by medication or surgery. People older than 50 years should also undergo a yearly colon exam or colonoscopy. This preventive screening is not only important to detect colon cancer but is also useful to observe any signs or symptoms of IBD.

IBD Treatment

If bowel problems are due to inflammatory bowel disease, your doctor may prescribe medication that is specifically designed to treat Crohn’s disease or ulcerative colitis, including biologics, aminosalicylates, corticosteroids, or antibiotics.

In severe cases, surgery for Crohn’s disease or ulcerative colitis may be needed. If you have IBD and MS, talk to your doctor about the best options for managing both conditions.

Some MyMSTeam members have shared their tips on treating IBD symptoms:

• “I drink peppermint tea with honey.”
• “I stopped drinking caffeine and alcohol and stopped eating very spicy or acidic foods.”
• “I take magnesium daily, drink a lot of water, and only eat small amounts of food throughout the day.”
• “I cut out gluten and dairy from my diet and it has helped a lot.”

Healthy Lifestyle Changes

Lifestyle approaches may also be helpful. Lifestyle changes for managing bowel problems or IBD include:

• Getting plenty of rest
• Getting daily exercise (for people with mild to moderate MS)
• Having a well-balanced diet
• Keeping a food diary to identify what triggers symptoms
• Quitting smoking
• Reducing stress by using relaxation techniques such as meditation, yoga, tai chi, massage, or deep breathing exercises

Good Bowel Habits

It is important to have good bowel habits to prevent bowel problems. Some habits to incorporate into your daily routine include:

• Drinking eight to 12 cups of fluids daily
• Eating fiber-rich foods such as whole-grain bread, bran cereals, fruits, and vegetables
• Incorporating fiber supplements such as Metamucil, Benefiber, Perdiem Fiber, FiberCon, Citrucel, or Fiberall
• Setting aside time after eating breakfast (or whenever is most convenient for you) for using the bathroom
• Using a footstool to encourage bowel movement

Stool Softeners and Laxatives

If bowel problems persist or worsen, over-the-counter and prescription medications are available to help manage the symptoms. It is important to discuss options with your doctor or to be seen by a gastroenterologist (an IBD specialist). Common medications to treat bowel problems include:

• Stool softeners such as Colace and Surfak
• Oral laxatives such as Miralax or Milk of Magnesia
• Rectal stimulants such as Glycerin Suppositories or Dulcolax

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 175,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you living with multiple sclerosis and IBD? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.