Bowel Incontinence in MS: Why It Happens, What to Do About It

Here’s an overview of how MS can change your bowel function, leading to incontinence, and steps you can take to regain some control over your bowel habits.

Normal bowel function depends on a signaling network throughout your central nervous system, says Tamara Bockow Kaplan, MD, a neurologist at Brigham and Women’s Hospital in Boston.

“The brain and bowel are in constant communication. Normally, the bowel sends information through the spinal cord, which has to get to the brain and then back to the bowel,” Dr. Kaplan says. Your brain considers not just information from your bowel, but also convenience and social signals, to determine whether it’s time to have a bowel movement.

If this signaling is disrupted at any point, Kaplan says, your bowel may not get the go-ahead to empty at a convenient and socially appropriate time. This can cause a range of disruptive symptoms, especially if you have other MS-related problems in the area, too, such as reduced sensation in your rectum or less control of your outer anal sphincter (the circular muscle at the end of your anal canal).

Even though it may seem counterintuitive, one of the most common causes of bowel incontinence is actually constipation.

“Extreme constipation can lead to stool backup” in the colon, Kaplan says. This makes it much harder to control bowel movements when the inner anal sphincter finally opens and the pelvic floor relaxes to allow the muscles in the rectum to push the stool out.

But some people with MS experience bowel incontinence without constipation — or without knowing they’re constipated — especially if the outer anal sphincter isn’t functioning well.

Bowel problems often go hand in hand with bladder problems, and not just because they’re both caused by a disruption in nerve signaling that affects the same region of the body.

“Oftentimes when someone has an overactive bladder, they try to self-treat by limiting their fluid intake,” says Kaplan. “That can, in turn, worsen constipation and, in some cases, lead to incontinence.”

For people with MS, one huge barrier to getting effective help for bowel problems is that most doctors don’t ask about these issues, says Kaplan. She’s seen this in a research project that involves going through the records of people with MS.

“Doctors aren’t bringing this up, and a lot of times patients aren’t sure how to bring it up,” she says. Patients are also “potentially not aware that this could be related to their MS — or what their neurologist would do about it” if it were related.

So the first step to getting help for bowel problems is telling your neurologist or primary care doctor what’s been happening. “Getting an accurate picture of symptoms is really important,” says Kaplan. “We often base a lot of our management on what patients self-report.”

Your doctor may ask you to keep a journal of your bowel symptoms, along with what you’re eating and drinking and other potentially relevant behaviors. Patterns related to what you eat and drink may emerge, and your doctor will get a clear picture of your overall diet.

“I don’t think people realize that the food we eat and what we drink can really make a difference” in bowel symptoms, says Rachael Stacom, a nurse practitioner and senior vice president of population health at Independence Care System in Brooklyn, New York.

Not consuming enough fiber or fluids can contribute to constipation, while consuming spicy foods, dairy products, caffeine, and artificial sweeteners can all lead to problems with bowel urgency.

In more difficult cases, it may help to follow a very restricted diet to see what foods might be problematic, Stacom says. “We’ll then have people slowly introduce foods to see if that aggravates their stomach.”

Adjusting medication doses may be difficult, especially if they’re working for their intended purpose, but, “Sometimes there are some easy things we can do, such as adjusting diet and a bathroom schedule” to respond to the effects of the medication, says Kaplan.

Certain drugs can be helpful for managing constipation and bowel incontinence, often in combination with a bowel training routine. “Sometimes the key is to get your bowels on a regular schedule,” says Kaplan.

One technique involves taking a laxative powder called polyethylene glycol at the same time each day. “If someone can establish having a bowel movement routinely after breakfast, then that means for the rest of the day, they might be free of the fear that they might have an accident,” she offers.

There are many other drugs to consider if polyethylene glycol doesn’t do the trick, says Kaplan, including other stool softeners and stimulants like bisacodyl and senna. But many of them should be used very judiciously, since they can have side effects and their effectiveness may wane as you develop a tolerance to them.

Another useful option for many people with bowel incontinence, she says, are glycerin suppositories, which you insert into your rectum to induce a bowel movement — usually within 10 minutes. “They essentially help soften the stool that’s in the rectal area, and they’re not chemically absorbed,” Kaplan explains. “You can’t overdose on them.”

If you know you’ll be going someplace — a long car ride or a social function — where you don’t want to risk a bowel accident, you can use a suppository beforehand. “I’ve had so many patients tell me that this was so liberating to them, because they could time their own bowel movement and do it at their convenience,” she says.

Some people need only one or two sessions with a therapist and can then do the exercises at home, she says.

The place to start for any of these treatments is to have a conversation with your doctor. “These are very common issues that many people are struggling with,” says Kaplan, but “If doctors don’t bring these symptoms up, patients have to be courageous enough to say, ‘I’m having a problem.’”

• Bowel dysfunction, including bowel incontinence, is a common problem in people with multiple sclerosis (MS). It can often lead to feelings of frustration and embarrassment.
• There are effective solutions to help manage bowel incontinence associated with MS, including medications and pelvic floor physical therapy.
• If you are experiencing bowel incontinence, it’s important to talk to your neurologist or another member of your MS care team to find a solution that works for you.