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Bowel problems and MS

It’s well-known in the multiple sclerosis (MS) community that bowel issues are common for those living with the disease. According to the National MS Society, constipation is the most common bowel complaint among people with MS, affecting an estimated 29 to 43 percent of individuals.

Many MS’ers aren’t able to rid themselves of potential toxins — at least not in a timely or comfortable fashion. I’m one of those and the search for answers led me to co-author a book on the subject, candidly titled, “Bowel and Bladder Issues with Multiple Sclerosis by Two Pee Brains With Potty Mouths Talking Shit About MS.”

So, why is this something so many people with MS deal with and how can you cope with it? Here are some insights that may help.

There are several factors at play here: neurological damage, medication, insufficient water intake, and limited physical activity. Let’s take a look at each of those factors.

Neurological damage

Due to lesion placement, those of us with MS may not receive the signal from our brains to our bowels that say: “You gotta go!” Alternately, you may not have the capacity to relax and release or push — hello, spasticity.

Our bodies, when working correctly, have an automatic mechanism called peristalsis, where muscles alternately constrict and relax to move contents of the intestines forward and out. When a lesion lands in the wrong place, this mechanism can be impacted.


Many medications can cause constipation — especially those used for pain. It’s a cruel irony that medication given to relieve pain may cause more pain due to the constipation it causes. Check with your doctor or pharmacist to see if any of your medications might be to blame.

Water and fiber intake

You’ve probably heard that you should drink six to eight glasses of water per day. Drink even more than that. Not only will that keep you hydrated, it’ll keep your stool softer and help transport it through your intestines.

Additionally, eating more fiber is always a first-line recommendation when experiencing constipation. You’ll need to drink more water when you up your fiber in order to keep everything moving properly. Many American diets are severely lacking in fiber. The recommended daily fiber intake is 25 to 30 grams per day. Pay attention to food labels and count your typical fiber intake. Increase it if you fall short of that level.

Physical activity

Exercise facilitates colonic movement by making the poop move through the intestines more rapidly. Try taking a walk, standing, marching, yoga, using a stationary bike, or a peddling exercise machine if you have physical limitations.

1. How many times should I poop in a week?

The answer to this question varies from person to person. Some people will feel better with daily bowel movements, while others can skip a day or two and be fine. A good gold standard would be at least three per week. Pelvic floor dysfunction physical therapist Erin Glace says, “I try to aim for daily bowel movements for my patients.”

Whatever is contributing to the constipation, the initial treatment is the same for anyone. Be aware of your body and the individual quirks of your gut along with behavioral changes. This will help prevent problems and keep everything moving.

2. What should the consistency of my poop be?

Ideally, it will be like a banana. This will vary with what you eat.

3. What should I be eating to help with my constipation?

Increase your fiber to the recommended 25 to 30 grams per day. Think: nuts, seeds, beans, lentils, peas, some fruits such as berries and bananas, vegetables, wheat bran and whole grains.

That’s what to add to your diet. Equally important is what to remove from your diet. This gets back to knowing your own gut and what bothers it.

A lot of people find that dairy is a culprit in causing bloating, gas, and constipation. Cut out dairy — milk, cheese, yogurt, ice cream, and butter — for two to four weeks and see if your symptoms improve. There’s a growing body of evidence that some people are sensitive to gluten. You may want to try the same elimination diet for gluten as well.

4. Add fiber, eat better, drink more water, exercise more. I’ve tried all of that and I’m still constipated. Any suggestions I haven’t heard before?

If you haven’t heard of pelvic floor exercises for constipation, they can make a world of difference. Here’s why: Your pelvic floor helps to hold poop in and let the poop out.

The posterior, or back, part of the pelvic floor works for bowel control. There’s a part of the pelvic floor called the anal sphincter. It’s a small but strong circular muscle that wraps around the end of the rectum, helping to create closure. Think of it as the end of a balloon that you blow into.

The anal sphincter doesn’t get all the glory for bowel control, though. There’s another key player called the puborectalis, a U-shaped muscle that loops around the rectum to pull it forward towards the pubic bone, creating a kink. This kink helps keep poop in when you want and relaxes to allow it out when you want.

Learning how to do Kegel exercises correctly can help strengthen these muscles and teach you how to relax them. It’s the relaxation that’s most beneficial for constipation. If you haven’t been trained in how to correctly execute a Kegel, find a pelvic floor dysfunction physical therapist in your area by checking through the location tool on the website for the American Physical Therapy Association.

So, how do you poop correctly?

That may sound like a no-brainer but, did you know there’s a right way and a wrong way to poop? A big mistake that people with constipation make is straining. Pushing and pushing — sometimes so much that their face turns bright red. By doing this, you may cause your pelvic floor muscles to contract, which will close the outlet and create more problems.

  • Use a step stool. Mimic the squat position of our ancestors. Get your knees up higher than your hips. This gets the kink out of the puborectalis. You can just use a bucket or garbage can for this or you could purchase a Squatty Potty. Many people are amazed at the difference this positioning can make.
  • Don’t strain. Instead, gently balloon out your stomach and allow your pelvic floor muscle to drop and open. It may feel like a gentle push of your pelvic floor. You can check this push sensation by placing your finger over your anus and you should feel a pushing out of the anus.
  • Be consistent. Try to have your bowel movements at the same time every day. In the morning, after a high fiber breakfast is the ideal time. It doesn’t have to be morning if this doesn’t work for you though. Don’t sit for longer than 5 to 10 minutes if you can’t go.
  • Perform self-abdominal massage. This helps to get everything moving. You can add a little heat with a hot pack or a heating pad. Use heat for 10 minutes or so, then gently massage your belly. Move up on the right side, across the top under your rib cage, and down on the left. Massage three to four times, going nice and slow, moving your fingers in small circles. This shouldn’t be painful. Do this at night before bed, in the morning, or even while you’re soaking in a warm bath.

If you try all of these suggestions and you’re still experiencing constipation, it’s time to call your doctor. You may want to start with your neurologist who may refer you to a gastroenterologist. There are a number of tests they can run to identify the cause of the constipation and address it, potentially with a medication protocol that could be just what the doctor ordered!

Kathy Reagan Young is the founder of the off-center, slightly off-color website and podcast at FUMSnow.com. She and her husband, T.J., daughters, Maggie Mae and Reagan, and dogs Snickers and Rascal, live in southern Virginia and all say “FUMS” everyday!