SECTION 13: BOWEL

A significant percentage of people with MS develop bowel problems at some time in the course of their MS. Constipation is fairly common for individuals with MS, and this problem may be ongoing or periodic in nature. Incontinence or diarrhea is far less common with MS and is often temporary. Medications are sometimes a cause of bowel incontinence, and these can include antibiotics and even treatments used to relieve constipation.

A. CONSTIPATION

Constipation is the most common bowel problem in MS, and results from lesions in the nervous system that control the rate at which stool is passed through the bowel. This slowed movement results in more water being absorbed, causing hard, dry stools. It can also occur in people who limit their intake of fluids to minimize bladder problems, as the result of a lower activity level, and in some cases by medications taken to control other MS symptoms.

OVERALL MANAGEMENT

The management of constipation has three main components: diet - including at least 24 ounces a day of water and 20-30 grams of fiber; a consistent bowel program; and the use of stool softeners or other substances that stimulate more rapid passage of stool through the bowels and increase its bulk.

STOOL SOFTENERS

Stool softeners help to retain liquid in the stool to allow easier passage through the bowel.

Colace®(docusate)

This is an oral medication in softgel or tablet form. The usual dose is 1 to 2 softgels or tablets each day, taken morning and/or evening.

Surfak®

This is an oral medication in pill form. The usual dose is 1 pill a day, most commonly taken in the morning.

Chronulac®

This is an oral medication in syrup form. The usual dose is once or twice a day, in the morning and/or evening. It is usually taken after meals, as its taste may be unpleasant.

BULK FORMERS

Bulk formers absorb liquid and swell to form soft, bulky stools. They increase both the bulk and fluid content of stool, stimulating faster and easier passage. They should be taken with 1 to 2 glasses of water.

Metamucil®(psyllium hydrophilic mucilloid)

This is an oral medication in either gel capsule form taken with water or juice, or as a powder mixed with water or juice, usually at bedtime.

Fibercon®

This is an oral medication in tablet form. The usual dose is 2 tablets, taken 2 to 4 times per day with 8 ounces of liquid.

Citrucel®

This is an oral medication in powder form. The usual dose is 1 tablespoon, 2 to 3 times daily, mixed into 8 ounces of water.

Fiberall®

This is an oral medication in chewable tablets, wafers, or powder. The usual dose is 1 to 3 times daily with 8 ounces of water.

LAXATIVES; ORAL MEDICATIONS

This group includes over-the-counter laxatives taken orally. Only mild laxatives are recommended.

Miralax®

This is an oral medication in powder form. The usual dose is 1 capful dissolved in 4 to 8 ounces of water or juice, 1 to 2 times per day.

Pericolace®

This is an oral medication in capsule form. The usual dose is 1 to 2 capsules at bedtime, which may be increased to twice a day if needed.

Milk of Magnesia®(magnesium hydroxide)

Magnesium hydroxide acts by stimulating the movement of fluid into the bowel, causing a bowel movement within a short time. This fairly harsh laxative should not be used on an ongoing basis.

The dose is 30 cc at bedtime.

Mineral Oil

Mineral oil coats the bowel and stool, helping to retain moisture in the stool. It is normally taken at bedtime so that a normal bowel movement will occur the next morning.

Laxatives; Rectal Stimulants

Traditional enemas should be avoided, as they are too harsh for routine use. The following gentler stimulants should be used only as needed, as extended use may result in dependence.

Glycerin Suppositories

These mild suppositories contain no medication and are often used when establishing a regular bowel program. They draw water into the bowel, helping to soften stool.

Dulcolax®(bisacodyl) Suppositories

This suppository contains a medication that stimulates movement of the rectal muscles to facilitate a bowel movement.

Enemeez®Mini Enema (docusate)

This is an enema-type medication in an easy-to-use, single-dose squeeze container. A bowel movement usually occurs within several minutes.

Fleet®(sodium phosphate) Enema

This is a rectal enema that usually produces a bowel movement within 2 to 5 minutes.

B. DIARRHEA

Diarrhea and fecal incontinence are less common than constipation, but can be debilitating. Management primarily consists of making the stool firm and bulky, yet soft and easy to move through the bowel.

OVERALL MANAGEMENT

Metamucil®

This is an oral medication in powder or capsule form. Although used to treat constipation, when used to prevent diarrhea, the bulk former is taken no more than once a day and without any additional water.

Imodium®and Related Medications

These are oral medications in tablet form. These work by slowing the passage of stool through the bowel. These medications should not be taken on a regular basis, as dependence may result.