The symptoms of multiple sclerosis (MS) can vary from person to person and may change over time. But for nearly 70 percent of individuals with MS, symptoms include bowel problems like constipation, diarrhea, incontinence (loss of bowel control), and diverticulitis (inflammation of small pouches that form in the digestive tract). Bowel problems can result from MS’ impact on the body or from unrelated issues, including food sensitivities, lack of fiber, or dehydration.

Many MyMSTeam members report experiencing bowel problems. One member said it feels like their days “revolve around the bathroom,” while another noted that bowel issues are “limiting quality of life.”

If you have bowel problems, it’s a good idea to understand what causes them, what the symptoms are, and how you can deal with them.

What Causes Bowel Problems in MS?

MS is a chronic autoimmune disease of the central nervous system, which includes the brain and spinal cord. In people with MS, the body’s defenders (white blood cells) attack the central nervous system, causing inflammation and stripping nerves of their protective coating (myelin).

This process can disrupt signals to and from the brain and spinal cord that control bowel function, leading to what’s known as neurogenic bowel dysfunction. This type of dysfunction is common among people with MS: Researchers have found it may affect anywhere from 39 percent to 73 percent of people with the condition.

MS can also prevent the muscles of the pelvic floor from relaxing. These muscles help to eliminate waste from the body. Additionally, multiple sclerosis may block the gastrocolic reflex. This reflex, which occurs naturally after eating, helps food move through the lower digestive tract.

Constipation

Constipation is the most commonly reported bowel problem in MS. It occurs when too much water is absorbed by the body, causing stools to be hard, dry, and difficult to pass.

There are several possible causes of constipation in MS. Aside from problems with the nerve signals between the bowel and brain, constipation may result from poor dietary habits, lack of physical activity, and depression, all of which can disrupt the digestive tract. Certain MS medications may also cause or worsen constipation in some people.

Many people with multiple sclerosis have difficulties with walking (gait) and fatigue. These symptoms can slow down the movement of waste through the large intestine, leading to constipation. Having weakened abdominal muscles may also make it more difficult for a person to have a bowel movement.

Spasticity, which refers to muscle spasms and stiffness, is another common symptom of multiple sclerosis. Pelvic floor muscles that are in spasm may be difficult to relax, impacting a person’s ability to move their bowels. Some people also experience bladder problems, such as incontinence or a spastic (overactive) bladder. People may try to manage these problems by limiting the fluids they drink, which can lead to constipation.

Diarrhea

Generally speaking, diarrhea is much less common than constipation in people with MS. Diarrhea refers to soft, liquid, or watery stools, which can occur when the contents of the bowel move too quickly through the digestive tract or not enough water is removed during digestion. In some cases, MS may cause the bowel to be overactive, leading to diarrhea.

If you’ve been diagnosed with MS and experience diarrhea, it may not be related to your condition, however. Diarrhea may happen as the result of a food sensitivity, food allergy, stomach virus, or change in activity levels.

Bowel Incontinence

Bowel incontinence refers to a loss of voluntary control of the bowels. This symptom frequently accompanies diarrhea in people with MS, although it may also be caused by long-term constipation.

It is possible for people with MS to experience both constipation and incontinence or bowel leakage. Some people may alternate between the two symptoms. One MyMSTeam member said that they are usually constipated as a result of their pain medication, but when they have an attack, they “don’t have full control.”

Diverticulosis and Diverticulitis

Diverticulosis refers to the presence of small pouches or bulges on the wall of the colon (large intestine). Diverticulitis occurs when one or more of these pouches (known as diverticula) become infected or inflamed.

Diverticula can form in weak spots of the colon when constipation exerts pressure on the intestinal walls. People with MS may develop diverticulosis as a result of chronic constipation or lack of exercise. Other risk factors for diverticulosis include:

• Aging
• Smoking
• Obesity
• Taking certain medications (including steroids, opioids, or nonsteroidal anti-inflammatory drugs)
• Eating a diet low in fiber and high in animal fat

MyMSTeam Members on Bowel Problems in MS

Most people experience occasional bowel problems. They may have a day or two of constipation, or might experience diarrhea, for example, after eating contaminated food. But for people with MS, these symptoms can be much more frequent. They can be frustrating and embarrassing, and can even impact a person’s quality of life.

Many MyMSTeam members have shared their difficulties with bowel issues. One member described their bowel issues as “constant,” writing that battling bowel problems for eight weeks was causing them to feel extra fatigued.

Another shared that they were “dealing with diverticulosis ... Still trying to figure out what and how to eat. It’s a challenge.”

One member with diverticulitis urged another facing bowel issues to see their doctor: “I [had] polyps and several diverticula. I had a round of diverticulitis a few years ago that put me in the hospital for four days, not fun! Please get checked soon, just in case!”

Another member found that especially tough days even triggered their incontinence: “I am finding that on my bad days, when I have really bad exhaustion, my bowels ‘leak.’ Sometimes, it is so bad that I bleed.”

It’s normal to be frustrated by these symptoms. Some members even write about how unfair it feels: “I shouldn’t be incontinent at 32,” wrote one member experiencing increasingly frequent bowel problems, while another responded that at 52, they are “still too young.”

Fortunately, there are ways to manage bowel problems — whether caused by MS or not. Talk to your doctor if you notice any new or worsening bowel symptoms. They will be able to find the treatment that’s right for you. Your neurologist may also offer a referral to a specialist, such as a gastroenterologist, for treatment.

Managing Bowel Problems in MS

There are many methods of managing bowel problems, including lifestyle changes, over-the-counter (OTC) drugs, and prescription medications. Which one is right for you will depend on your symptoms and your health care provider's recommendations.

Managing Constipation

In some cases, the side effects of medications for MS symptoms can include constipation. Opioid pain medications can cause a condition known as opioid-induced constipation. “I had this problem, and it turned out to be the meds that caused it,” wrote a MyMSTeam member. “Talk to your doctor. They can give you another medication for it.”

In addition to adding fiber into your diet and drinking plenty of fluids, using certain OTC medications and treatments may help alleviate constipation. Always talk to your doctor before starting a new medication, even if it doesn’t require a prescription.

• Stool softeners — Docusate, found in medications such as Colace and Surfak, helps to soften the stool, making it easier to pass. Mineral oil can also help alleviate constipation by lubricating the digestive tract, but it should not be taken at the same time as a stool softener.
• Saline laxatives — Milk of magnesia, Epsom salts, and sorbitol are types of osmotic agents that promote the secretion of water into the large intestine (colon). While reasonably safe, these laxatives should not be used in the long term.
• Stimulant laxatives — Medications like senna act as chemical irritants that stimulate the movement of stool through the bowel.
• Glycerin suppositories — Suppositories are inserted via the rectum and may be recommended if oral laxatives don’t provide relief. These suppositories are taken 30 minutes before attempting a bowel movement.
• Bisacodyl suppositories — These suppositories stimulate strong movements in the rectal muscles. Notably, bisacodyl suppositories are more habit-forming than glycerin suppositories.
• Enemas — Enemas work by injecting liquid directly into the rectum. Enemas may be recommended alongside stool softeners, mild oral laxatives, and bulk supplements (which can help ease diarrhea), and they should not be used on a regular basis.

Some MyMSTeam members have discussed using enemas for constipation. One wrote that a saline enema brought “success when things got really bad.”

Some, however, find that enemas don’t always provide as much relief as they’d hoped: “I take laxative sachets daily to help with the transition of my food, but, alas, I still require assistance to void by way of enemas, which are not as effective these days, most likely contributing to the pain.”

Managing Diarrhea

The two most common methods for managing diarrhea are bulk-forming supplements and antidiarrheal medications.

Bulk Formers

Bulk formers, such as wheat dextrin and psyllium, help moisturize and fill the digestive system. Bulk-forming supplements should be taken without any additional fluid if being used only for diarrhea. People experiencing both diarrhea and constipation may take bulk formers with one or two glasses of water.

Antidiarrheals

If bulk formers are not successful in remedying diarrhea, your doctor may recommend antidiarrheal medications, such as diphenoxylate and atropine. These medications slow the bowel muscles and are intended for short-term use.

Managing Diverticulosis and Diverticulitis

Although diverticulosis is often asymptomatic and doesn’t require treatment, eating a high-fiber diet — including plenty of fruits and vegetables, legumes (beans), nuts, seeds, and grains — can help reduce the risk of developing diverticulitis.

If you do develop diverticulitis, the treatment your doctor recommends will depend on its severity. Mild cases of diverticulitis are often treated with oral antibiotics. Your doctor may also recommend that you take OTC pain relievers to manage discomfort and eat a liquid or low-fiber diet.

Severe or recurrent cases of diverticulitis may require hospitalization. Doctors may provide IV fluids to keep you hydrated and IV antibiotics to treat the infection itself.

Surgery may be necessary if you experience:

• Persistent rectal bleeding
• Colon blockages or strictures (narrowing of the colon) due to scarring
• Abscesses (swollen, fluid-filled pockets of infection)
• Fistulas (tracts or tunnels between the colon and other organs)
• Intestinal perforation (tearing), which may lead to peritonitis (potentially life-threatening infection of the intestinal walls)
• Severe diverticulitis that returns or does not improve with other treatments

Staying Regular

Certain lifestyle habits may help you prevent or manage bowel problems and maintain regular bowel movements.

Drink Plenty of Fluids

According to the National Multiple Sclerosis Society, you should aim to drink at least 48 ounces (six to eight glasses) of water each day. As one MyMSTeam member recommended, “drink at least a liter of water a day … . The water helps keep things moving.”

Talk to your doctor if you are concerned that upping your fluid intake will contribute to bladder dysfunction, such as incontinence.

Eat Enough Fiber

Fiber, which helps add bulk and soften the stool, can be found in fresh fruits and vegetables, as well as in whole-grain breads and cereals.

One MyMSTeam member shared that they get additional fiber by adding two to three spoonfuls of flaxseed and chia seeds to their yogurt.

Another wrote that adding fiber to their diet helped ease their bowel symptoms more than medication: “I had gotten a prescription from my doctor, which didn’t help. What has helped is eating more fruits and vegetables and once a day, drinking a glass of juice with Miralax in it.”

You should talk to your doctor before making any major changes to your diet. Generally, it’s a good idea to incorporate high-fiber foods into your diet only gradually to help prevent gas, diarrhea, or bloating from occurring.

Get Physical Activity

Doctors used to advise against exercise for people with multiple sclerosis. Today, experts understand that exercise can have tremendous wellness benefits for people with MS. Aside from its positive impacts on physical and mental health, exercise helps keep stool moving regularly through the digestive tract.

Meet Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. Here, more than 185,000 members come together to ask and answer questions, offer support, and share their experiences with MS.

Have you had bowel problems with MS? How are you managing them? Share your story in the comments below or by posting on MyMSTeam.