Inconvenient, Isolating...and Manageable: Bowel and Bladder Issues in MS

By: Ann Mullinix, OTR/L, NBC-HWC – Occupational Therapist & Marie Namey, APRN, MSCN – Advanced Practice Nurse
02 Feburary Bowel Library

As a result of irritation of the nerves that control storage and emptying, the majority of patients with MS will experience some form of bowel or bladder dysfunction at some stage of their disease.  In fact, it has been reported that about 60% of people with MS experience bowel symptoms and up to 80% experience bladder symptoms.  These are common issues for patients in all stages of MS, but particularly as the disease advances and mobility becomes impaired.

Bowel and bladder dysfunction can cause complications that may compromise your health and significantly impair your quality of life.  However, instead of just enduring or passively compromising to these changes, you can take control through lifestyle modifications and medical management.

Our bodies respond positively to habits; they like to know what to expect. Many people can train their bodies to void and evacuate regularly by establishing a routine that is (a) predictable, (b) healthy, and (c) unique to you. Getting in the habit of going to the bathroom thirty minutes following a meal can help create an elimination pattern. Creating a daily schedule, such as emptying every three hours, will assist your bladder in knowing what to expect and help it feel more at ease.

Here are a few tips for lifestyle modifications that may help you better manage your bowel and bladder issues:

  • Daily movement has a positive impact on bowel function. Remember to move-walk, try seated arm aerobics, fold clothes, swim….any movement you can do will make a difference.
  • Take a minute to evaluate your environment. How accessible are your bathrooms? It is not uncommon to have barriers in a home to get to a bathroom such as clutter, throw rugs, stairs, lighting, or small doorways.  Organizing your environment to increase your safety and ease can be a game-changer. Rehabilitation professionals, including occupational and physical therapists, have specialized training in this area who can partner with you to make adaptations if you need assistance.
  • Changes in strength and coordination can add unwanted time in removing clothing. Wearing pants with adaptive fasteners (elastic waist, velcro, magnets) can make this task more efficient and decrease stress. If transferring to a toilet is difficult, using adaptive equipment such as grab bars or a raised toilet will help increase safety and independence.
  • Planning ahead is critical, especially with community restrooms. It is frustrating when restrooms are marked “accessible” only to find the handicap toilet is the farthest stall to reach or is in a confined space. Empower yourselves with what you can control.  If you are going out, ask ahead of time where the most accessible bathrooms are.  Also, be prepared by wearing protective pants and having a change of clothes. 
  • Even with all the planning in the world, it is important to also develop a “flexible” mindset to adapt to unforeseen circumstances.  A mental health professional can be helpful on so many fronts, including helping you balance planning with flexibility. 
  • Remember that your support system is there to help you and can be a great asset.  Effective communication is key.  A mental health professional can also help you and your support partners develop these important skills.
  • Bowel and bladder health is supported by habits of good nutrition.  Eat foods high in fiber such as fruits, vegetables, legumes, and whole grains. While we need 20-30 grams of fiber a day, the average American only eats about 12 grams a day.
  • Drink water: 48-64 ounces a day! Take into consideration that caffeine, aspartame, and alcohol irritate the bladder, so drink these ingredients in moderation and be familiar with how they uniquely affect you.
  • Never underestimate the power of sleep! A regular sleep pattern will aid in metabolism and elimination. Of course, sleep can be a challenge with MS due to a variety of symptoms. Reducing the need to eliminate during the night will make a big difference (like you didn’t know that!). Talk to your healthcare team about developing sleep hygiene habits and incorporating relaxation techniques before going to bed, such as meditation, deep breathing, and visual imagery.
  • Good sleep may also mean restricting fluid intake an hour before going to bed and avoiding screen time (television and computer use) one hour before bedtime. A healthy diet full of protein, vitamins, and minerals will also aid in falling asleep.
  • Managing daily stress will make a significant difference. There is evidence linking emotional and mental stressors to physiological changes. Find techniques meaningful to you so you can enhance relaxation in your daily life.

 

In addition to these lifestyle factors, an individually tailored medical management program can provide life-changing solutions and allow you to focus on what you really want to. Talk to your MS provider, no matter how “big” or “small” your concerns are.  Bowel and bladder symptoms should be addressed as a component of your comprehensive care.  If your healthcare provider is not asking you about this important area of your health, you need to take initiative. If they are not able to help, ask to be referred to someone who can.  Organizations like Can Do MS and the National MS Society have resources to help you discuss these tough topics so you can be informed and advocate for yourself. 

Your provider can point you to resources and healthcare professionals who can partner with you to make the changes you desire, so that you can live with purpose and enjoyment!

Finally, you may be wondering why MS causes so many issues with bowel and bladder function. It’s a complex question, but in summary, normal bowel habits and voiding are dependent on coordination between the brainstem and spinal cord.  Demyelination, a distinguishing feature of MS, can lead to disconnects along these pathways. The effects of these disconnects often extend to the digestive and urinary system, resulting in elimination dysfunction. Mobility issues can also contribute by slowing transit time through the intestine. 

Constipation, specifically, is a common result of impaired neurological function in the sacral area of the spinal cord, resulting in a slowing of transit time in the bowel (“slow bowel”), while weakened abdominal muscles (also common in MS) may create more difficulty in “bearing down” strongly enough to evacuate. Decreased activity caused by difficulty walking, fatigue, or a sedentary lifestyle can also contribute to the problem.

Remember, if you are unclear or need more guidance about any of these issues, ASK!