Bowel Care

What measures can I take to prevent bowel problems as much as possible?

• Monitor bowel habits—Keep a diary of bowel movements (time, consistency, shape, number of movements, presence of blood, etc.), but remember that not all bowel problems are related to MS.
• Maintain a regular bowel program if possible—Establish a regular time for emptying the bowels. Unfortunately the disease might block the natural increase in activity of the colon following meals, but 20-30 minutes after breakfast is a good time to try to benefit from the gastro-colic reflex (a reflex that stimulates a wave of contractions in the bowel). Try to wait no more than 2-3 days between bowel movements.
• Provide privacy when possible—Having to rely on others to be ‘toileted’ at a specific time is a huge barrier to people being able to perform. It can be difficult to have a family member stay around during that time. Provide privacy when you can.
• Access the right equipment—If your loved one is able, consider using a commode chair or elevated toilet for comfort during the bowel routine. Elevating the knees by placing the feet on a small stool may be helpful. If getting out of bed is not possible, positioning on the left side might help. An occupational therapist or physical therapist can prescribe the right equipment to help the process.
• Maintain fluid intake—Try to have your loved one drink several glasses of water daily. Cutting back on fluid intake makes constipation worse. Lack of water may harden the stool, making it more difficult to pass. In addition, increased pressure from the stool on the urinary system may increase bladder problems.
• Encourage drinking something hot as the first beverage in the morning, such as tea or prune juice, to help stimulate a bowel movement. People with MS with swallowing problems should use thickeners as needed. Those with gastric or j-tube should receive water via the tube as recommended by their clinicians.
• Maintain fibre intake—Eating plenty of fresh fruits and vegetables and whole grain breads and cereals is the best way to maintain the amount of fibre in the diet. Your health care provider may recommend a fibre supplement such as Metamucil®. People with MS with swallowing problems and a feeding tube might need to consult with a nutritionist.
• Encourage Exercise—If physical activity is not possible, active or passive range of motion may increase bowel motility. Any activity level can promote bowel motion.
• Be sure your loved one receives a routine colonoscopy (earlier than age 50 if there is a family history of colon cancer).
• Discuss issues such as persistent rectal bleeding, unexplained severe pain or discomfort, a lump or mass in the abdomen, or extreme fatigue with your GP or gastroenterologist.
• Perform a medication review—Review medications with the nurse or doctor. Some types of drugs commonly taken in MS are known to cause constipation, and it may be possible to switch to a similar drug that won’t affect the bowels, or perhaps just a change to a different dose of the medication.