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MS constipation blues? See 12+ treatment options

Feeling “irregular” on the regular? Constipation is a common issue for people living with multiple sclerosis (MS), affecting as many as 40% of patients. Over 15,000 MS members on PatientsLikeMe report experiencing bowel problems and of those, about 47% have reported it as “moderate” or “severe” – take a look here. With help from our team of in-house health professionals, we took a closer look at this taboo topic, as well as available treatments.

What’s going on with constipation?

Typically, constipation is defined as having fewer than three bowel movements a week. But only you know what’s “regular” for you — constipation isn’t just about bowel movement frequency and averages. It can also mean going #2 less often than what’s normal for you – or having stools that are hard, dry or difficult to pass.

Other symptoms that can come with constipation include incomplete evacuation of stool, abdominal bloating, cramping and straining. When constipation becomes chronic or interferes with your daily life, it may be time to seek treatment.

What’s the constipation/MS connection?

MS and some medications used to treat it may cause constipation. MS damages the nerve cells of the intestines and can slow down and impair the muscles that usually push food along. Constipation can also lead to bowel incontinence.

Constipation, the most common bowel complaint in MS, can be caused by poor diet or physical inactivity which can disrupt the digestive system. Symptoms like difficulty in walking, fatigue, spasticity and dehydration can also contribute to constipation. Medications used to treat MS – like antidepressants or bladder-control medications – can also cause constipation. These drugs block the chemicals in the brain that are responsible for involuntary muscle movement or contractions.

Decreased physical activity, poor diet, dehydration, genetics and other health conditions can also cause constipation.

What lifestyle changes can help?

Talk with your healthcare provider to decide whether and how to treat your constipation, keeping in mind all your medications and other condition(s). Also, ask about nutrition counseling and exercise ideas.

Here are some lifestyle tweaks to consider:

  • Establish a regular time of the day for bowel movements. Having a consistent time to go each day trains the body to regulate bowel movements.
  • Eat regular meals that include fruits and vegetables, whole grains and other high-fiber foods.
  • Avoid low-fiber, starchy foods like white bread. These can “plug up” your system.
  • Try drinking six to eight 8-ounce glasses of hydrating fluids (ideally water) per day.
  • Steer clear of alcohol or coffee – they can worsen constipation. Maintain an exercise routine, if possible. Regular physical activity can also help move things along.
  • Try keeping a diary to track symptoms, diet, medications and bowel movement (or lack thereof). See if there are any patterns that may give clues about the cause of your constipation.

How about OTC options?

If you think you need more than just lifestyle modifications to alleviate your constipation, talk to your health care provider about which (if any) over-the-counter (OTC) or prescription treatment options might be best for you – and how often to use them. You’ll find several treatments at the drug store, but they work differently, and some should be used sparingly. Your provider can help you decide which treatment would be best considering your symptoms, medical history and other medications you’re taking. Here are some OTC examples:

  • Emollient laxatives (also known as “stool-softeners”): These allow more water to mix with stool making it softer and easier to pass. Example: Colace (docusate)
  • Bulk-forming laxatives: These are mixed with an 8-ounce glass of water or juice. They contain fiber that will “bulk-up” the stool, which helps it move along. They also soften the stool by allowing more water to remain in it. This means softer, larger stool that is easier to pass. Examples: Benefiber (guar gum), Citrucel (methycellulose), Fibercon (polycarbophil), and Metamucil (psyllium)
  • Lubricant laxatives: These lubricate the intestines to help soften the stool and make it easier to pass. They should only be used for a short time because they can absorb vitamins, preventing absorption into the body. Example: mineral oil
  • Osmotic laxatives: These help draw water into the intestines to soften the stool. They may cause gas when first used. Example: Miralax (polyethylene glycol 3350)
  • Saline laxatives: These often have magnesium sulfate, magnesium phosphate or magnesium citrate in them. By retaining water in the colon, these drugs soften the stool, similar to osmotic laxatives. Examples: Milk of magnesia (magnesium hydroxide), magnesium citrate
  • Stimulant laxatives: These should be used sparingly because they can cause diarrhea/cramping and – if used long term – colon damage. They help stimulate the muscles of the intestines to move things along. Examples: Doculax (bisacodyl), senna, senna tea
  • Enema products: These stimulate the colon using a stream of fluid introduced via the rectum. The fluid also softens the stool, making it easier to pass. Some enemas include laxative ingredients, such as docusate sodium and mineral oil. Example: Fleet enema (saline enema)
  • Suppositories: These medications are inserted into the rectum. There are two types: Glycerin suppositories lubricate the rectum; bisacodyl suppositories stimulate movement. (Doculax suppositories)

Several combination products and prescription products are also available.

Some people with MS have noted that the Squatty Potty – an ergonomic footstool that helps position your body better for using the toilet – can help relieve constipation.

What treatments/lifestyle changes have you tried for constipation? Join PatientsLikeMe to chime in and help others in the community.

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