Life with MS

Bowel and bladder problems are, for many with MS, some of the more embarrassing and difficult to talk about. As a result, some do not receive the help that is available to manage them until they have significantly affected their quality of life. For some, incontinence is the issue but for others, it is an inability to empty. Let’s look at some of the causes of these conditions and then methods to manage them.

Nerves and cues
The nerves that help to cue individuals their bladders or bowels need to empty are in themiddle section of the spinal cord. Nerves that “feed” the responses to the pelvis and lower extremitiesare in close proximity to each other a little above the waist. Because of that, individuals with MS who have altered sensation in their legs may also not be getting normal messages coming from those nerves to their bladders or bowel. This can result in leakage or incontinence of either urine or stool because the individual does not feel the sensation to empty. For others, the nerve is hypersensitive and makes it feel like there is a need to be on the toilet every hour or more. An overactive bladder often sends a cue that it is full when, in fact, it contains only a small portion of the urine the average bladder holds before the urge to void is felt.

A healthy normal bladder generally cues us to empty it when it contains about a cup (8 ounces or 240 cc) of urine. With an overactive bladder, a person may feel the need to void with 80 cc – or about a third of that amount in the bladder. The other end of the spectrum is a neurogenic bladder where an individual does not feel the urge to go until the bladder has stretched to three or four times the capacity of a normal bladder and may void only a couple of times a day instead of the norm of every four to six hours while awake.

Food and beverages
Many foods and beverages have the potential to be bladder stimulants. These may affect different people in different ways so it is recommended if you have OAB to eliminate them and see if it makes a difference, then reinstitute if no difference is noted. The big ones are caffeine and alcohol, which do affect almost everyone. Carbonated beverages can also be a problem.

Foods that are acidic also are a problem for most people whose bladder is too active. Foods high in acid content include chocolate, citrus fruits, pineapple, tomatoes, and raw onions. Hot spices – such as chili powder, cayenne pepper, curry and more have the potential to interfere with normal bladder function in some people.

Bowel problems
Bowel problems often go hand in hand with bladder issues because the nerves are so closely located within the spinal cord. MS lesions in that region may set the stage for people to need to learn to manage both. Constipation is a problem that as many as 75-80 percent of people with MS live with. Diet and physical activity are key to managing constipation. The more active we are, the more the gut is stimulated to move food through the gastrointestinal tract and out. Foods high in fiber are needed to bulk stool and keep it moving. Persons with constipation issues should add extra fruits and vegetables to their diets. Dense fibrous foods such as raw vegetables, celery, cabbage, and broccoli are needed. Sufficient water throughout the day helps to keep stool moist and moving.

Some people benefit from products that pull water from your body into the gastrointestinal tract to keep stool softer and moister. Things such as MiraLAX are often recommended. There are products that add fiber and may be recommended to be taken with a full glass of water before meals. Laxatives are occasionally needed to empty the bowel but should not be used regularly without the oversight of your doctor; they have the potential to remove normal impulses that the bowel has to contract and move things along, instead training the bowel to rely on the irritating factor that laxatives induce.

Stool incontinence is seen less frequently in people with MS than constipation but can be a stigmatizing and debilitating problem for some. If the signals are severely altered in the nerve messages to the gut, it is possible for the rectum (lower portion of the colon) to fill and put pressure on the anal sphincter (the muscle that keeps the stool from leaking) and stool may leak. Generally, this is not in the amount of a normal bowel movement but can be something as simple as smearing of stool. If you have thoroughly cleaned yourself after a bowel movement and the next time you sit on the toilet you wipe and there is stool on the paper, you may be dealing with some stool incontinence. It is often that simple and small, but can leave an individual feeling unclean and less willing to engage in normal activities with others. A gastroenterologist may be helpful in managing bowel problems that have not responded to these tactics.

Bowel and bladder therapists are frequently very helpful in creating an individualized treatment plan for persons with issues related to bowel or bladder retention or overactivity that can result in incontinence. Many MS comprehensive treatment centers now have these specially trained individuals on staff. Spinal cord injury centers also employ them. Please ask for a referral if this discussion has sparked thinking towards changes that may be possible to improve your quality of life or that of someone whom you care for.