People who are diagnosed with multiple sclerosis (MS) often anticipate that they may have problems with their vision or with their walking but are blindsided by the possibility that MS can cause problems seemingly outside the brain and spinal cord.
Everyone experiences different symptoms with their own journey and their symptoms may vary over time. But what you may be surprised to learn is that about 70% of MS patients have varying problems with their bowels. Some have constipation, some diarrhea, some incontinence, and some even diverticulitis (inflammation of small out-pockets that arise in the bowel).
This seems inconsistent at first look when we look at the cause of MS, a chronic autoimmune disorder of the brain and spinal cord in which the body’s own cells attack the lining of the nerves. When we dive deeper into the widespread control of the brain and spinal cord over practically every organ system, we learn that the brain and spinal cord send nerve signals to the bowel to help it work properly. When those signals are disrupted, a condition called “neurogenic bowel dysfunction” occurs, which alters the motility of the gut. Further, when the MS plaques occur, they cause stiffness and rigidity in various parts of the body. One place this rigidity occurs is in the pelvic floor. The muscles in the pelvic floor affect how bowel movements pass from the body. Another place that can be affected is the lower digestive tract. MS can block the gastrocolic reflex which is the urge to defecate after eating.
Of course, patients with MS can develop constipation from the same reasons people without MS do- dehydration, lack of fiber in the diet and lack of exercise. Different medications used to treat MS patients and other medical conditions, like opioid pain killers, certain blood pressure medications and some anti-depressants, can slow the gut.
While less common than constipation, MS patients can also experience diarrhea. This occurs when MS causes the bowel to contract too quickly. Again, patients with MS can develop diarrhea from non-MS causes, such as viruses and food sensitivities.
Diverticulosis (inflamed pouches of the colon) can occur more frequently in MS because of chronic constipation and lack of exercise. But like anyone else, they can occur from other non-MS factors such as aging, smoking, obesity, meds, and low-fiber diets.
The most important step if you suffer from bowel problems is to talk with your doctor and make sure it is not from a non-MS cause that needs to be addressed. Bowel symptoms can often be controlled by lifestyle changes, over-the counter medicines, or prescription medicines. You need to stay in tuned with your body and your symptoms. If you notice new symptoms, you may have disease progression and a discussion with your doctor about the need for a therapy change may be in order. BeCare MS app can help you track your neurologic function and your symptoms so you can be a driver in your own healthcare.