Constipation, Incontinence, and Multiple Sclerosis
Constipation can be one of the more uncomfortable and unpleasant symptoms of Multiple Sclerosis (“MS”). Approximately 35% of people with MS experience constipation, and 25% of people with MS report at least one episode of incontinence per week. It is important to consult with a physician before commencing any medications or other forms of constipation relief.
Why Multiple Sclerosis Can Cause ConstipationCommon causes of constipation for people with MS include reduced and/or limited physical activity, poor dietary habits, decreased movement of food through the intestinal tract, weakened abdominal muscles (making the act of passing a bowel movement difficult), relaxing of pelvic floor muscles, malfunctioning signals from the bowel to the brain, and reduced fluid intake (in an attempt to control/avoid bladder problems). Certain medications (both prescribed and OTC) can also increase risk for constipation, such as antidepressants, anti-spasticity medications, overactive bladder medications, painkillers, and high blood pressure medications.
Symptoms of Constipation and Fecal IncontinenceSymptoms of constipation include bloating and pain in the lower abdomen, needing to strain to pass a bowel movement, less frequent bowel movements (typically fewer than three bowel movements per week), hard, dry, or small feces, and a incomplete evacuation of the bowel. People with MS are also more prone to fecal incontinence due to weakening of the pelvic floor muscles and/or reduced control over the muscles of the pelvic floor. Symptoms can range from small leakage of stool and/or gas to the total inability to control bowel movements.
Lifestyle Changes to Promote Regular Bowel MovementsConsider the following lifestyle changes to help promote regular bowel movements and reduce symptoms of constipation and/or incontinence. Bowel Routine: It is important to establish a regular bowel management program to improve quality of life and prevent further medical complications from constipation or incontinence. Establish a predictable time for bowel movements to train the bowel, prevent accidents, soften stool, decrease spasticity, and interruption of bladder function (from stool buildup in the rectum). First thing in the morning or half an hour after a small meal are ideal. Proper Fluid Intake: Ideally 8-12 cups of non-caffeinated fluid daily to moisten stool and make them easier to pass. Reduce or eliminate diuretics such as alcohol and caffeine. Physical Activity: Be sure to maintain an appropriate level of physical activity (based on a consultation with a physician) to promote peristalsis. Fiber Intake: Consuming a proper amount of daily dietary fiber from whole grains, fruits, nuts, seeds, and legumes can help prevent and/or alleviate constipation. Avoid foods that can exacerbate constipation such as dairy and red meat. Positioning: ensure proper positioning during defection (squatting is the most desirable position).
Types of Laxatives and How They WorkThere are many different types of laxatives, and it can be confusing to understand the difference! Laxatives relieve constipation by loosening stools and/or inducing a bowel movement. Laxatives come as pills, capsules, liquids, suppositories, and enemas. Over-the-counter laxatives are designed for short-term or occasional use. Use only as directed. Ongoing constipation should be evaluated by a healthcare provider. Always consult with a physician before taking any medication for constipation relief. Laxatives may be taken orally, as tablets or liquids, or rectally as suppositories or enemas. Most oral laxatives take days to produce results, while most rectal dose forms are relatively quick acting. Because different things can cause constipation, different laxatives work in different ways to resolve your constipation. Here we break down what you need to know about the different types of laxatives.
- Emollient Stool Softeners: Emollient laxatives contain the active ingredients docusate sodium and docusate calcium. Stool softeners work by hydrating and softening stool, making it easier to pass, and are considered to be gentle and well-tolerated.
- Lubricant: Lubricant laxatives contain mineral oil, which coats stool to help it move more easily through the intestine, and also coats the intestines to help prevent water loss from the stool. Mineral oil is not for use on a regular basis. It can interfere with your body’s absorption of fat-soluble vitamins, such as vitamins A, D, E, and K. Lubricant laxatives are typically used for more immediate relief of short-term constipation. Mineral oil can have serious side effects with certain medications and can negatively impact absorption of Vitamin K.
- Bulking Forming: Bulk forming laxatives contain the active ingredients psyllium, methylcellulose, and calcium polycarbophil, and work by forming a gel in your stool that helps it hold more water. Stool increases in volume as a result, triggering the intestine to pass stool more quickly. Bulk forming laxatives may be helpful for conditions such as irritable bowel syndrome diverticulosis, and colostomies. When using bulk forming laxatives it is essential to drink plenty of fluid for maximum results.
- Hyperosmotic Laxatives: hyperosmotic laxatives contain the active ingredients polyethylene glycol and glycerin, which draw more water into your intestines. This helps soften the stool to help it move more easily through the intestinal tract.
- Saline Laxatives: Saline Laxatives contain the active ingredients magnesium citrate and magnesium hydroxide, which draws more water into the intestine, softening stool and stimulating movement in the intestines. Saline laxatives should not be used on a regular basis. When used regularly, they can cause dehydration and electrolyte imbalance.
- Stimulant Laxative: Stimulant laxatives contain the active ingredients such as bisacodyl or sennosides, and work by stimulating the bowel and increasing movement in the intestines. Despite the quicker results, stimulant laxatives come with many unpleasant side effects and should not be used on a regular basis as they can cause dehydration, electrolyte imbalances, bloating, gas, and abdominal pain.