5 Tips for Managing Constipation in MS

Introduction

Changes in bowel function are common in MS – with the most common being constipation. When the nerve signals that provide communication between the brain and the bowel are damaged, the passage of stool can be slowed. The longer that stool remains in the bowel, the more moisture it loses and the drier and harder it becomes.

Constipation is generally described as having fewer than three bowel movements a week, with stool that is hard, dry, and difficult or painful to pass. The following chart shows examples of stool that range from hard and dry to watery. Type 4 stool is the type that you want to be aiming for because it is soft, smooth, and easy to pass.  

Tip #1: Diet Matters

Your food and drink choices have a significant impact on your bowel function. 

• Drink plenty of fluids (with limited caffeine to avoid irritating your bladder).
• Eat foods rich in fiber, such as fruits, beans, vegetables, whole grains, nuts, and bran. 
• Eat fewer processed foods, including white bread, breakfast cereals, cheese, deli meats. 

Tip #2 Physical Activity Matters

When you move, your bowels move.  

• Staying as active as you can helps to stimulate the movement of stool through the bowel. 
• Stretching, walking, sit-to-stands, squats, swimming, yoga, tai chi, or whatever else you enjoy doing alone or with others, will benefit your bowel. 

Tip #3 Having a Consistent Routine Matters

Your body gets used to certain rhythms. 

• Try to allow for a consistent, relaxed time each day for a bowel movement, preferably right after a meal when the gastrocolic reflex is strongest. 
• Don’t ignore the urge to pass stool – if it feels ready to pass, stop what you’re doing and take advantage of the urge.  

Tip #4 Working with Your MS Care Provider Matters

If you notice changes in your bowel function that last more than a couple of weeks, discuss it with your MS provider. 

• MS care providers are familiar with this common symptom and are more than happy to help you with it. 
• A registered dietician or nutrition consultant can work with you to modify your diet in ways that support your bowels. 
• A physical therapist can recommend exercises and physical activities that will help you keep your body and bowel moving, regardless of your ability level.  
• A pelvic floor physical therapist can help you strengthen your pelvic floor – which helps with bladder, bowel, and sexual function. 
• An occupational therapist can introduce you to tools – like the Squatty Potty – that promote healthy bowel function.

Tip #5 How You Use Over-the-Counter Remedies Matters

It may occasionally be necessary for you to use a laxative to help with bowel movements. 

• Discuss this with your primary care or MS care provider so that they can recommend the best type for you to use. 
  • Fiber supplement (Citrucel, FiberCon, Metamucil)
  • Osmotic agents (Miralax, Milk of Magnesia)
  • Stool softeners (Colace, Docusate)
  • Lubricant (mineral oil)
  • Stimulant (Correctol, Dulcolax) 

• The goal is to use the mildest form of laxative that will help you regain regular bowel function. 
• Laxatives should never be used on an ongoing basis because they are habit-forming – which means that over time they teach your bowel to depend on them rather than acting smoothly and independently on its own. 

The key to managing constipation is to proactively avoid it when you can with fiber, fluids, and physical activity, and to consult with your healthcare provider promptly if you need more help.