Bowel Problems and MS

Here is My Question:
With my MS I have frequent bouts of irritable bowel syndrome and it causes interference with daily abilities, sometimes by making frequent trips to bathroom. What I am wondering is how do I decide if it is the irritable bowel syndrome or MS related?! I know there are bowel problems with MS but not fully educated on the symptoms and what not. I do avoid eating red meat and other foods that can trigger it.... but it seems to be more occasional lately.

Answer:
This is a great question and one that I think many patients with MS have on their mind when they see their neurologist, but may be too embarrassed to bring up at the clinic visit.  

Bowel symptoms are fairly common in MS and can lead to social isolation and to other health problems.  There are many potential causes of bowel dysfunction and it is important to make the doctor aware of the issue so it can be properly evaluated and addressed.  This is an expansive topic, and one that is impossible to fully answer in a blog post; however, I'll outline general principles about the symptoms of these conditions as well as initial steps a patient with MS can take to try and alleviate the problem.

Irritable bowel syndrome (IBS) is a functional bowel problem which means that extensive medical evaluation cannot identify another cause for abdominal discomfort, pain, and variable symptoms of diarrhea/constipation.  IBS is a prevalent condition in the general population and tends to affect younger patients and preferentially affects women more than men (similar demographic as MS), which makes the co-occurrence of these diseases common.  

Bowel dysfunction due to MS tends to manifest mainly as constipation, but some can also experience fecal incontinence (accidents).  When a scar of MS involves the part of the nervous system that helps coordinate signaling to the bowels to evacuate (located primarily in the spinal cord--especially the lowest segment), these bowel symptoms emerge.  Other contributors to bowel problems that are related to MS include:  immobility or sedentary lifestyle, dehydration (ie, avoiding liquids because of bladder problems), poor dietary intake of fiber, and the acknowledgement that many different medications prescribed to treat other MS symptoms can cause bowel dysfunction as a side effect.  All the more reason to review your symptoms with the MS specialist.

For patients primarily experiencing constipation who are mobile and able to walk, general strategies include increasing fiber in the diet (men= 30 to 40 grams/day and women=21 to 25 grams/day), keep well hydrated (while avoiding caffeine and sugary alcohol), and establish a consistent exercise routine (check with your doctor first about exercise).  Implementing this strategy is generally effective but should be done with patience because it can take a few weeks for the bowels to respond.  If this does not improve bowel function, or you are not mobile, then the next step would be to set up an appointment with your MS specialist to specifically discuss the problem.  Depending on how problematic your symptoms are, you may want to alert the doctor early on in the visit that this is your main problem (and other problems may need to take a back seat or be addressed at a future clinic visit).  

Occasionally, these symptoms are more difficult to manage with conservative strategies alone or your symptoms may suggest another problem other than MS that requires the help of a gastroenterologist (digestive system expert).  The gastroenterologist can evaluate for inflammatory bowel diseases (which are seen in patients with MS more often than the general population), food allergies, and infections of the digestive tract which cause bowel symptoms as well.

If you go see your doctor about bowel problems, you may want to print up this article published in the International Journal of MS Care (CLICK HERE TO DOWNLOAD) and take it with you to the appointment or provide it to your physician in advance so they can review it ahead of time.  This article is a good reference for the doctor to help facilitate a productive clinic visit.

I hope this helps.

ASN