Bowel Management

Bowel Management

Bowel Management with MS

Bowel problems are another common but often less talked about symptom of multiple sclerosis (MS). Changes like constipation, difficulty emptying the bowel, or, less often, loss of control can affect many people living with MS. These issues can be distressing, uncomfortable, and may sometimes lead to worry or embarrassment—but you are not alone.

MS can impact the nerves that control the bowel, as well as the muscles involved in moving waste through the body. Symptoms vary, but there are many practical strategies and treatments that can help you stay comfortable and confident.

It’s important to remember that bowel issues are medical problems, and help is available. By talking openly with your doctor, MS nurse, or care team, you can find solutions that fit your needs and support your overall wellbeing. Most people with MS find that with the right support, bowel symptoms can be managed so you can keep living your life to the fullest.

Frequently Asked Questions (FAQs)

What is bowel dysfunction in MS?

Bowel dysfunction in MS usually means difficulty with regular, complete or controlled bowel movements. For some, this might be constipation—where stools are hard and difficult to pass. For others, it might be urgency, loose motions, or even bowel incontinence. Symptoms can range from minor to severe, but support and treatment are available to help you maintain bowel health and quality of life.

MS can disrupt the nerve signals between the brain and the bowel. This can slow bowel movement, weaken the abdominal and pelvic floor muscles, or make it difficult to relax the muscles needed for a bowel movement. Common contributing factors include:  

  • Decreased fluid intake
  • Not enough dietary fibre
  • Ignoring the urge to go
  • Reduced mobility or exercise
  • Incorrect toilet posture
  • Certain medications (e.g. painkillers, antidepressants)
  • Emotional factors such as anxiety or depression

Other contributors include pelvic floor weakness, difficulty getting to the toilet, constipation, medications, and general lifestyle factors.
Don’t feel embarrassed—these issues are common, and help is available. See your GP, MS nurse, or continence nurse specialist if you:

  • Pass stools less often or find them hard and difficult to pass
  • Experience bloating, pain, or discomfort around your stomach or rectum
  • Lose bowel control or have accidents
  • Notice consistent diarrhoea or loose stools

Specialists can help with tailored advice, assessment of underlying causes, and treatment plans that suit your needs.
Many strategies can help:

  • Drink 1.5–2L fluid per day (about 6–8 cups)
  • Eat plenty of fibre: At least 3 serves of vegetables and 2 of fruit daily
  • Exercise regularly: Even gentle activity like walking helps bowel movement
  • Toilet timing: Take time to sit and relax on the toilet, ideally every morning as part of a daily routine
  • Good posture: Use a small foot stool or ‘Squatty Potty’ to raise your feet, creating a natural squatting position for easier emptying
  • Don’t ignore the urge—delaying can worsen constipation)
  • Keep a bowel diary: This can help you and your healthcare team understand patterns and triggers

Many people find carrying a Can’t Wait Card from Continence NZ gives peace of mind when out.
Treatment depends on severity and cause, and may include:

  • Lifestyle adjustments: More fluids, dietary changes, regular exercise
  • Bowel management programmes: Individualised routines and schedules
  • Fibre supplements or laxatives: Use under healthcare advice
  • Suppositories, enemas, or washouts: Sometimes needed for severe cases or if full emptying is required
  • Mobility and bathroom aids: Occupational therapists can advise on access and equipment; physiotherapists on exercise and transfers
  • Pelvic floor exercises: Taught by specialised physiotherapists to improve muscle strength and control

If you experience persistent loose stools, see your doctor to rule out infections or underlying bowel conditions before starting medication.

General Information

You do not have to face bowel challenges with MS alone. There are excellent resources and support services to help you manage symptoms and improve your quality of life. Reporting changes in bowel habits to your doctor or nurse ensures you get the help and resources you need – for better health, dignity, and confidence with MS.

Contact your regional MS organisation to access MS nurses, continence specialists, peer support, and other useful resources:

Bladder, Bowel and Sexual Intimacy