Bowel issues are very common in people with MS. In fact, after fatigue, constipation is the most common MS symptom I get questions about. With MS, constipation may be caused by an interruption of impulses to the brain that signal the need for a bowel movement. But it can also be caused (and remedied) by factors that we have more control over. Because constipation is such a problem for people with MS it is especially important to make sure we establish habits that promote good bowel health and regularity.
Constipation is characterized by infrequent bowel movements (usually fewer than two BMs per week), or by frequent straining to have a BM. Some tips to manage constipation include:
Eat Plenty of Fiber
Consuming fiber rich foods like colorful fruits, vegetables, whole grains, beans, nuts and seeds can help to keep you regular. Fiber is what my grandmother used to call “roughage”… Introduce more fiber into your diet gradually and build on your intake over time.
Prebiotics are non-digestible carbohydrates (fiber!) that provide fuel for probiotics and promote gut health. But not all fiber is a prebiotic. Examples of prebiotics include: fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS) and sugar alcohols such as sorbitol. Foods that are naturally high in sorbitol can contribute to softer stools that pass more quickly through the intestinal tract so you could add them to your diet to see if they offer any relief.
Foods High In Sorbitol:
Pears, Pear Juice, Dried Pears
Peaches, Peach Juice, Dried Peaches
Apricots, Apricot Juice, Dried Apricots
Plums, Dried Plums (aka prunes), Prune Juice
Dried Fruit Mixes
*Note: Don’t overdo it with these sorbitol rich foods! Large quantities of these foods can swing the bowel problem pendulum the other way for you so track the results.
Drink More Water
It is important to stay well hydrated. Chronic dehydration can contribute to constipation, frequent joint pain, headaches, low energy and confusion.
Often if you wait until you sense thirst you may already be dehydrated. The best way to prevent dehydration is to make a conscious effort to stay hydrated throughout the day — make sure your urine is light yellow.
Fiber and water go hand in hand. If you are increasing your fiber intake you should increase your water intake at the same time. A high fiber diet without enough fluid can make matters worse by contributing to constipation.
Move Your Body, Move Your Bowels
One of the key risk factors for constipation is inactivity. Aerobic exercise can help keep you regular by stimulating more efficient intestinal contractions, which will help to keep things moving. It also helps to speed up the amount of time it takes for food to move through your digestive system, thus decreasing the amount of water absorbed from the stool into the body.
MS symptoms like fatigue and reduced mobility can mean less physical activity. Regular exercise can help to normalize bowel function. Aim for 60 minutes of physical activity per day. You can break it down into smaller chunks of time to make it easier. Walking is a great exercise but it is not the only game in town. Check out this MS Exercise Challenge designed by physical therapists. If you have physical limitations work with your doctor or a physical therapist to come up with a personal exercise program that meets your needs. Some physical activity is always better than none!
Get Regular With Your Routine
Establish a regular time to empty your bowels—the body likes routine. 20-30 minutes after a meal is often a good time to head to the loo but It can be challenging to keep to a schedule if the sensation of needing to “go” is decreased. There is an app for that! Or several actually…
These apps have different functions that can be helpful in establishing and keeping to a bowel schedule. They can provide annoying reminders that you can respond to when you might not be getting the reminder from your body. They encourage you to track your fluid intake. And they can track a number of other things that may be helpful. (No affiliation here, just find them to be useful).
Bowel Mover Lite Free This is my favorite of the free apps. Gluten monitoring has been added as as a new function which will be very useful for anyone with celiac disease or gluten sensitivity but I just want to reiterate that there is no evidence to support a connection between MS and Gluten so there is no need to track gluten intake because you have MS. The more useful functions, in my opinion, are the ability to track frequency of BMs, water intake and stress as well as the ability to see patterns.
Bowel Mover Pro $2.99 Offers all of the functions in the free version but you can also create you own items to track, like, say exercise or servings of fruits, vegetables, whole grains or other fiber foods. Being able to combine these items with BM tracking may well be worth the $2.99 price.
Bowelle Free. This is geared toward people with IBS but may be helpful. It tracks food intake, stress and emotions, Water intake and BMs. It provides space for notes and offers up to 5 custom fields.
Bathroom Map Free Provides comprehensive list of toilet locations available wherever you are. Bathrooms are rated, shown on an interactive map, and sorted by distance. This will be a very handy little app…
Alternate Hot & Cold Beverages
Try drinking a hot beverage followed by a glass of ice water to stimulate bowels.
Over the Counter Constipation Products
These can be helpful but should be used in moderation; long-term use is not recommended. If you have not had a BM in 3 days, consult your MD.
Check Your Medicines and Supplements
Medicines (prescription and nonprescription), herbs, and dietary supplements can impact bowel function. This information may be available on the medicine bottle or paperwork that comes with most prescriptions. To determine if a medicine or supplement could be the cause of your bowel symptoms, review your list of medicines with your health care provider.