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    Giving people knowledge, a positive attitude and a sense of empowerment is one of the most important aspects of our work. By working with each participant, individually and in-depth, we are able to help them learn how to take control of as many aspects of their life as possible.

    Can Do MS Staff Member
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    by Pat Kennedy RN, CNP, MSCN, Can Do MS Nurse Educator & Programs Consultant

    We often see TV ads about bowel issues and think that these problems are common and manageable.  They are common and they are manageable, even if your MS is the cause.  Unfortunately, bowel problems are not discussed often with others, including care providers.  We’ll try to offer some reasonable suggestions that may help you.

    In MS, we mostly hear about constipation and loss of control.  The potential reasons for these problems are many:
    - Alteration in neurologic status
    - Weakened abdominal muscles
    - Spasticity of pelvic muscles
    - Sensory loss
    - Poor diet
    - Reduced fluids
    - Prolonged movement of waste through the intestines
    - Decreased activity
    - Medications
    - Inattention to signals
    - Difficulty accessing the bathroom or removing clothing

    When waste stays in the intestines, it becomes harder, dryer and more difficult to pass causing constipation and discomfort.  When sensation is diminished, knowledge that the bowel is full is not recognized by the brain.  When this happens, the ability to control letting the stool out can also be diminished.  Diarrhea sometimes occurs when the bowel is blocked by hard, dry stool and looser stool leaks around it.  In any case, the following suggestions may be helpful to you.

    - Enrich your diet with higher fiber foods.  Be a label reader.
    - Drink more fluids.  If bladder problems are also an issue, deal with the bladder problems first. Be sure to discuss this with health care provider.
    - Move more, however you can do that best.
    - Discuss medications with your provider to see if any of them can contribute to constipation.
    - Wear easy to remove clothing and, if needed, work with a physical therapist or occupational therapist to learn how to negotiate your bathroom better.

    Begin to regulate your system:
    - Choose a time of day to empty your bowels.  Make it a time you can stick to week in and week out.  Some people go every day, several times a day or every 3 days.  What ever works for you is best for you.
    - Start by sitting on the toilet at that time.  To help train the body, try using a glycerin suppository to stimulate the rectum to empty.
    - If the stool is too hard, add a “bulk agent” to your daily routine such as psyllium, Citrucel, Benefiber and others.  If you add these, be sure to take in sufficient water (6 glasses a day) to keep the fiber from becoming hard also.  Take these products daily to establish a regular, consistent stool.  Stool softeners can be used as well.  They all cause the stool to be softer, moister and easier to pass.

    Establishing a pattern takes time, but once you do, you will go when you want to and not be surprised or uncomfortable.

    Avoid regular use of laxatives, including herbal types, but use them if you have nit moved your bowels in 3 days.  Enemas are not recommended on a regular basis but can be used as needed.  If bowel problems are long standing, the rules change and different recommendations might be needed.  As always, discuss this with your health care provider.  It may be recommended that you see a gastroenterologist for more thorough investigation.

    Hopefully some or all of these suggestions will be helpful for you.  Other suggestions can be found in Managing the Symptoms of Multiple Sclerosis by Randall T. Schapiro, MD and Multiple Sclerosis for Dummies by Rosalind Kalb, PhD, Nancy Holland, EdD, RN, MSCN and Barbara Giesser, MD.

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