Bowel Incontinence Considerations

How is incontinence evaluated?

As with constipation, the first step to managing bowel incontinence is through a thorough assessment of the problem. It is important to determine whether the problem is related to MS or to other factors, and to assess the extent of nerve or muscle damage, in order to recommend the best treatment.

Any assessment will include an extensive list of questions for the person with MS and/or family members to identify when and under what circumstances the incontinence developed, how it is impacting daily activities, current medications and diet, relevant medical history, and current bowel routine.

Ultrasound or x-rays can be used to determine if there are structural problems, such as tears or polyps.

What can I do if incontinence is a problem?

• Check & change diet as recommended: Your loved one should have an individualised diet plan. High-fibre foods, caffeine, milk products, chocolate, alcohol, spicy food and artificial sweeteners can have the effect of producing loose stool in some people. It is worth experimenting to see if anything upsets bowel control or makes stools firmer. Seek advice from a qualified Dietician to get further advice around managing diet.

• Schedule a bowel routine: Try to establish a regular routine for bowel movements. A set routine can help encourage the bowel to develop a regular pattern.
• Give bowel medications as needed: Use suppositories and laxatives to regulate a timed bowel movement every day or every other day. Some individuals with MS can schedule a routine every third day and be comfortable.
• Check medications: Many medications can cause loose stool.
• Take steps to control leakage and diarrhoea : When symptoms are mild, an anti-diarrhoea drug like loperamide (Imodium®) may be effective in treating loose stool. Bowel leakage may stop if the bowel is cleared with a suppository, enema, or digital stimulation. Remember that diarrhoea may occur because of other reasons, i.e. viral or bacterial infection or food poisoning.
• Utilise exercises for strength and control: Squeezing the muscles that control voluntary exit of stool may help strengthen them and thereby improve control. It takes time for exercise to make muscles stronger.
• Consider a rehabilitation program: A physical therapy or occupational therapy program is sometimes recommended for strengthening exercises and to assist with the bowel routine and the use of proper equipment.