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 bowel problems. One member said it feels like their days “revolve around the bathroom,” while another noted that bowel issues are limiting their 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 manage 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 myelin (protective coating).

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, MS may block the gastrocolic reflex. This reflex, which occurs naturally after eating, helps food move through the lower digestive tract.

MS can disrupt the signals to and from the brain and spinal cord that control bowel function. This type of dysfunction is common among people with MS

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 a lack of fiber in your diet, lack of physical activity, and not drinking enough fluids. Certain MS medications may also cause or worsen constipation in some people. Opioid pain medications can cause a condition known as opioid-induced constipation.

Many people with MS have difficulties with gait (walking) 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 MS. Pelvic floor muscle spasms can make it hard to relax these muscles, which may cause trouble with bowel movements. 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 happen 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.

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

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

People with MS can 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 is when there are 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 Experience Bowel Problems

Most people experience occasional bowel problems. They may have a day or two of constipation or diarrhea based on what they ate. But for people with MS, these symptoms can be more frequent. They can be frustrating, embarrassing, and can even affect quality of life.

There are many methods your doctor may recommend for managing bowel problems. This may include lifestyle changes, over-the-counter drugs, and prescription medications.

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.

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 frequent bowel problems. Another responded that at 52, they are “still too young.”

How To Manage Bowel Problems With MS

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 can find bowel management techniques and treatments that are right for you. Your neurologist may refer you to a specialist, such as a gastroenterologist.

There are many methods your doctor may recommend for managing bowel problems. This may include lifestyle changes, over-the-counter (OTC) drugs, and prescription medications. The treatment that’s right for you depends on your symptoms and your health care provider's recommendations.

Lifestyle Changes

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’re 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.

Get Physical Activity

Doctors used to advise against exercise for people with MS. 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.

Managing Constipation

In addition to adding fiber to your diet and drinking plenty of fluids, using certain OTC medications and treatments may help ease constipation. Taking these medications around the same time each day can help with retraining your bowel movements so you can go at a more regular time. 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 ease constipation by lubricating the digestive tract, but it shouldn’t be taken at the same time as a stool softener.
• Saline laxatives — Sorbitol solution, magnesium hydroxide (Dulcolax, Phillips Milk of Magnesia, Ex-Lax), and polyethylene glycol (Miralax) are types of osmotic laxatives. An osmotic laxative is a type of medication that helps relieve constipation by drawing water into the intestines, softening stools, and making them easier to pass. While reasonably safe, these laxatives are not for long-term use.
• Stimulant laxatives — Also known as chemical irritants, these medications stimulate the movement of stool through the bowel. Senna is an example of a stimulant laxative.
• Glycerin suppositories — Suppositories are inserted via the rectum and may be recommended if oral laxatives don’t provide relief. These suppositories are taken 15 to 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 should not be used on a regular basis.

If your medications are causing constipation, talk to your doctor so they can adjust your treatment plan. “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.”

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. To help with diarrhea, bulk-forming supplements should be taken with lots of water. Drinking enough liquid after taking bulk formers can help the supplement work properly and limit side effects. People experiencing both diarrhea and constipation may take bulk formers with one or two glasses of water.

Antidiarrheals

If bulk formers don’t help stop diarrhea, your doctor may prescribe antidiarrheal medications, such as diphenoxylate and atropine. These medications slow the bowel muscles and are intended for short-term use. Loperamide (Imodium A-D) is a common alternative that’s available over-the-counter and typically has fewer side effects than diphenoxylate and atropine.

Managing Diverticulosis and Diverticulitis

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

If you do develop diverticulitis, the treatment your doctor recommends will depend on how severe it is. Mild cases of diverticulitis are sometimes treated with oral antibiotics but sometimes only OTC pain relievers to manage discomfort and a liquid or low-fiber diet.

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

Talk With Your Doctor

If you’re having bowel problems with MS, don’t hesitate to talk to your doctor. They can help you figure out what’s causing your symptoms and recommend treatments or lifestyle changes to improve your bowel health. You don’t have to manage these issues alone — your doctors are there to support you.

Find Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 217,000 members come together to ask questions, give advice, and share their stories with others who understand life 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 the Activities page.