What causes constipation in people with multiple sclerosis?

As a symptom of multiple sclerosis (MS), constipation is indeed common. It can be chronic constipation, or it can be a temporary condition – it comes and goes. You can spend months proving yourself “wrong” in identifying the symptoms of constipation. This can become a painful experience. But it is better to understand exactly whether you have constipation in MS than to suffer silently from this problem instead of receiving sympathy and medical help.

Don't suffer in silence - go to the doctor

Among the amazingly varied set of symptoms associated with multiple sclerosis, constipation must be one of the greatest inconveniences of this disease.

The most important thing is that you seek help for this problem. Waiting and silently enduring pain in the anus and the inability to go to the toilet for a long time is a bad idea, as it can lead to damage to the rectum or its blockage. It is quite possible that the treatment of constipation in multiple sclerosis will be easy and simple, but you should first consult a doctor to diagnose this disease.

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How do you feel?

Everyone has constipation, and in theory, everyone seems to know what it feels like. However, there is a more precise definition of sensation than simply “I can’t go to the toilet.” It includes sensations and facts such as:

• Two or less bowel movements per week
• Feeling as if you have not eliminated all the stool from your bowels and it takes at least 25 minutes to go to the toilet
• You strain to have a bowel movement for more than 15 minutes, and then again and again
• You have lumpy or hard stools and bowel movements are painful

How common is constipation in multiple sclerosis?

It is difficult to say how many people with multiple sclerosis experience constipation, statistics are usually greatly underestimated. This is due to many factors, such as false shame of patients who are afraid or embarrassed to report constipation to their neurologists, and do not want to go to a proctologist or gastroenterologist.

However, it is estimated that between 50% and 75% of people with MS will experience constipation at least once in their lives. It is the most common bowel condition experienced by people with MS.

How to avoid constipation?

Two conditions in multiple sclerosis include healthy, regular bowel movements

1. The stool must move through the intestines.
2. There should be enough water in the stool.

According to medical experts, these are very interconnected things. When stool slows down as it travels through the intestines (especially the colon, particularly the last, lower part of the colon), water is no longer absorbed into it, and the stool becomes hard. When the passage of feces slows down too often, too much water is absorbed by the intestines, and the stool becomes heavy and difficult to pass.

Constipation in multiple sclerosis may be caused by one of the following factors (or a combination of them):

Neurological disorders

As mentioned, stool must be moved forward and not allowed to sit in the rectum. In people with MS (multiple sclerosis), lesions in the nervous system can block the areas of the brain that receive or transmit signals for bowel movements.

In other words, you can't get the signal from your brain that you "have to go to the bathroom" - or you can't relax effectively and have a bowel movement when you need to. The involuntary movements that push stool out of the rectum, especially the lower part of the digestive tract, can also be difficult.

Again, these problems are aggravated by the fact that when certain functions of the nervous system are disrupted, it is too difficult for feces to exit due to prolonged stagnation in the rectum.

Limited physical activity

An important component of intestinal motility (movement of digested food through the intestines) is physical activity, such as walking. Many of us are unable to move and walk a lot for many reasons: laziness, weakness, spasticity, sensory ataxia or simple fatigue. This problem can especially bother people with multiple sclerosis. And then such a person can be bothered by constipation.

Side effect of medication

Constipation is a side effect of many of the medications that people with MS must take to control their symptoms. These medications include

• Antidepressants, especially tricyclic antidepressants, including: amitriptyline (Lolita, Endep.), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil-PM), nortriptyline
• Painkillers, especially those containing morphine or codeine, and other narcotic drugs such as tramadol
• Drugs to treat bladder dysfunction or diarrhea, also called anticholinergics, include Norpanth, Pro-Ballet, tolterodine (tablets and capsules), dicyclomine (Bentyl).
• Drugs to relieve spasticity (increased muscle tone), including baclofen and tizanidine

Insufficient drinking water

Some people with MS significantly reduce their fluid intake, especially when they go on a short or long trip to the countryside where getting to the toilet may be difficult. But it is very important to drink plenty of water and other fluids throughout the day if a person suffers from constipation. In addition, people with MS also have a higher risk of getting urinary tract infections, so they need to be careful about the fluids they take in throughout the day.