"This study highlights the problem of bowel dysfunction that is common in MS in particular in progressive disease. The aim is to have a regular bowel action, either daily or at least every 2 days. The main problem in MS is bowel hypomotility (slow or sluggish movements); MS-related constipation therefore needs to be treated with prokinetic agents, i.e. drugs that increase the muscular action of the bowel. The most common prokinetic agent I prescribe is senna. Prokinetic agents often need to be taken with bulking (fibre) and loosening (liquid) agents. Loosening agents keep liquid in the bowel, for example lactulose or polyethyelene glycol (Movicol). It is important to realise that dehydrating yourself to control your bladder problems can make constipation worse; therefore you need to drink adequate quantities of water throughout the day. Similarly drugs to help your bladder dysfunction, pain and spasticity may make constipation worse. Therefore if you are constipated your medications need to be reviewed . Some MSers become so constipated that they get faecal impacted and go onto develop intermittent overflow diarrhoea; i.e. the bacteria in the bowel liquefies the stool above the impaction and the liquid overflows past the impaction. A typical history is periods of constipation, punctuated by episodes of diarrhoea. Faecal impaction is a serious problem and sometimes warrants admission to hospital to treat."
"Faecal urgency, and urgency incontinence, is also a big problem; if you have to go you have to go. This is best treated by developing a bowel routine and trying to evacuate your bowels at a regular time of day, typically in the morning. This can be aided by using something to stimulate the bowels. I typically use start with glycrine suppositories or mini-enemas. If the latter fails I may elect to use transanal irrigation. Transanal irrigation sounds terrible, but in MSers who need it often makes a massive difference to the quality of their lives and gives them some control back to tackle a problem that often leaves them stranded at home. I have therefore lowered my threshold for trying it, particularly as I have seen the benefits some MSers derive from it."
"Bowel dysfunction is one of the many symptomatic problems that may be avoided by preventing or delaying the development of disability. This is another reason to actively manage your MS with DMTs. Preventing disability, i.e bowel dysfunction, is better that treating it."