Constipation as a Symptom of Multiple Sclerosis

Constipated
Constipation as a symptom of MS. Christian Martinez Kempin / Getty Images

As a symptom of multiple sclerosis (MS), constipation is really a bummer. It can be chronic, rather than coming and going. You can spend days existing with a feeling of “not rightness.” It can get painful. It is also not really something that many people feel comfortable talking about, so they silently suffer from the problem, rather than getting the sympathy and help that they need.

However, it is important that you seek help for your constipation.

Waiting it out is a bad idea, as this could lead to damage to your rectum or stool impaction. In addition, it is possible that the treatment will be easy, such as changing medications or increasing water intake.

What Does Constipation Feel Like?

Most people have been constipated at some point in their life and know what it feels like. However, there is a more precise definition than just “I can’t go.” According to the American College of Gastroenterology, Constipation is defined as infrequent stools, difficulty passing stool, or both. Typically infrequent stools mean having two or fewer bowel movements per week and difficulty passing stools may include straining, feeling like you have not eliminated the entire bowel movement, or having hard stool.

How Common Is Constipation?

It is difficult to say how many people with MS experience constipation, as it tends to be under-reported. This is probably due to many factors, such as:

  • patients not connecting this symptom to MS, so not reporting it to their neurologists
  • patients being focused on more dramatic symptoms during their neurologist visits
  • patient being too embarrassed to report constipation to their doctors

This all being said, it is estimated that between 50 to 75 percent of people with MS experience constipation at some point.

In fact, it is the most common bowel problem experienced by people with MS.

What Causes Constipation?

Two ingredients comprise a healthy, regular bowel movement:

  • The stool must keep moving through the intestines
  • There must be enough water in the stool

These are really interrelated things. When the stool slows down on its journey through the bowels (especially the colon, the last part of the large intestine), water is absorbed to make the stool solid. When it slows down too much, too much water is absorbed by the colon and the stool becomes hard and difficult to pass.

That being said, constipation in MS can be caused by any of the following factors (or a combination):

Neurological Damage: As mentioned, stool must keep moving. In people with MS, lesions may prevent the brain from accurately receiving or transmitting signals that control conscious attempts to have a bowel movement. In other words, you may not be receiving the signal that you “have to go,” or you are unable to effectively relax and push as needed to have a bowel movement. The involuntary movements that keep the stool moving through the lower parts of the digestive tract may also be impaired. Again, these problems are compounded by the stool being too hard to pass easily, due to prolonged time in the colon.

Limited Physical Activity: An important component of intestinal motility (the movement of digested food through the intestines) is physical activity, such as walking. Many people with MS are unable to move around and walk much, due to weakness, spasticity, sensory ataxia or fatigue.

Side Effect of Medications: Constipation is a side effect of many of the medications that people with MS take to control symptoms. These include:

  • Antidepressants, especially tricyclic antidepressants including Amitriptyline (Elavil, Endep), Desipramine (Norpramin), Doxepin (Sinequan), Imipramine (Tofranil-PM), nortriptyline (Pamelor)
  • Painkillers, especially those containing morphine or codeine, as well as other pain-alleviating drugs like Ultram (tramadol).
  • Medications for bladder dysfunction called anticholinergics like Detrol tablets and Detrol LA extended-release capsules (tolterodine)
  • Medications for spasticity, including Baclofen and Zanaflex (tizanidine)

Not Drinking Enough Water: It's common for people with MS to cut back on water, especially if they experience problems with urinary urgency or nocturia. Some people with MS also reduce fluid intake when they are going out or traveling, as getting to a restroom may be difficult. That being said, it is still important that you drink plenty of water throughout the day if you have MS. Remember too, water is best. Caffeine and alcohol act as diuretics and can dehydrate you more. If water is not that appealing to you, try putting a lemon or lime in it to give it some flavor.

How Severe Can Constipation Get?

Constipation that is not managed can result in fecal impaction, which happens when constipation is so severe that the entire rectum becomes filled with a large, hard ball of stool. In these cases, manual disimpaction is needed, in which a doctor or a nurse removes the blockage manually (using a gloved finger).

A Word From Verywell

Constipation is common in MS, but the good news is that there are things you can do to prevent it or at least reduce it. Strategies include:

  • Drink 6 to 8 glasses of water daily
  • Incorporate fiber into your diet (for example, whole grains and a rainbow of fruits and vegetables)
  • Stay active, as much as possible
  • Establish a time each day that you use the bathroom—this is called bowel training
  • Consider occasional laxatives when your constipation kicks in, but discuss options with your doctor first, as some may cause dependency

Finally, it's important to note that you should contact your doctor for any persistent change in bowel habits. Constipation by itself can be a sign of something more serious, like colon cancer, so get it checked out.

Sources:

American College of Gastroenterology. (2016). Constipation and Defecation Problems.

Gallien P et al. Constipation prevalence in multiple sclerosis about a cohort of 81 patients. Ann Phys Rehabil Med. 2016 Sep;59S:e39-e40.

National MS Society. (2014). Bowel Problems: The Basic Facts.

Randall T. Shapiro. Managing the Symptoms of Multiple Sclerosis (5th ed.). New York: Demos Medical Publishing, 2007.

Continue Reading