Did you know constipation with intermittent diarrhoea may mean you have faecal impaction?
The majority of people with MS who have bowel problems suffer from constipation. This occurs because the MS bowel is sluggish due to reduced motility. This can be made worse by anticholinergic drugs that are used for treating urinary frequency and urgency. Over time pwMS may impact their bowels with faeces, which can form a faecolith (faecal stone). Above the hard and impacted faeces or faecolith, the gut bacteria overgrow and liquefy the stool, which is then able to bypass the impaction and cause diarrhoea.
So if you suffer from chronic constipation and intermittent diarrhoea you need to contact your HCP for help.
Please note another cause of this problem is cyclical use of laxatives, i.e. you get constipated and then you use laxatives to treat your constipation. The laxatives then cause diarrhoea so you stop taking them. You then become constipated again and the cycle repeats itself.
To manage MS-related constipation you really need to:
- Optimise your diet by eating lots of fibre.
- Don’t dehydrate yourself. Drink plenty of water and don’t equate caffeine and alcoholic beverages as hydrating. Both caffeine and alcohol cause the kidney to make more urine (diuresis) and are in fact dehydrating.
- Try and eliminate concomitant medication that exacerbates constipation (anticholinergics and opioids).
- Exercise regularly; the anticipation of exercise and exercise stimulates a defaecation reflex.
- If you need to use laxatives start with a prokinetic agent that stimulates the bowel to move, for example, senna, and then add-in bulking (e.g. psyllium husks or other fibre substitutes) followed by liquifying agents (lactulose or polyethylene glycol).
- Don’t suppress the need to go to the toilet; a lot of people with chronic constipation have learnt bad habits, for example, they don’t like using toilets that are unfamiliar to them.
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