Responses are provided as general educational resources and should not be interpreted as diagnoses, prognoses, or treatment suggestions.  Information and perspectives represent the views of the individual author(s); Can Do Multiple Sclerosis is not responsible for the accuracy or currency of the responses.  Readers should consult with their healthcare team.

filtered by: "bowel" (remove)

Nurse Practitioner Response:

Kathy Costello, ARNP
Associate Vice President of Programs, Can Do MS

PTNS, or percutaneous tibial nerve stimulation is a procedure used once weekly for 12 weeks to help control bladder urgency and loss of control. In this procedure, a small needle (like an acupuncture needle) is placed over the tibial nerve – just above the inner side of the ankle. A small amount of electrical current is delivered through the needle and the tibial nerve is stimulated, which causes stimulation of the nerves around the bladder leading to the brain. The nerve stimulation leads to decreased urgency and urination. The electrical pulses help block the nerve signals causing the bladder to be overactive.

InterStim Therapy is an FDA-approved treatment for overactive bladder and urinary retention. With InterStim Therapy, an implantable device sends mild electrical pulses to the sacral nerves to reduce symptoms of bladder control problems. InterStim requires a surgical procedure and has been used for a number of different symptoms, including:

  • Urinary incontinence
  • Overactive bladder (OAB)
  • Urinary retention: the inability to empty the bladder
  • Fecal incontinence: the inability to control bowel movements causing stool to leak unexpectedly from the rectum.

While both PTNS and the InterStim can be very effective for bladder and bowel issues, they are not for everyone. For either of these interventions, a careful and thorough assessment by a urologist familiar with MS is needed before any treatment plan is decided upon.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

Sling surgery is often used to treat stress incontinence, which can occur when someone (with or without MS) loses urine when laughing hard, stepping off a curb, or engaging in various kinds of physical activity. It may be used in a person with MS for this purpose, but it does not address the most common MS symptoms (difficulty emptying or difficulty storing urine).

I would suggest that you discuss your urinary symptoms with your MS provider and have a thorough evaluation by a urologist to determine exactly what types of urinary problems you are having – and which treatments would be most effective for you. 

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

So sorry that you are having bowel symptoms.  Fortunately, the bowels often respond to interventions.  First, if you have not already, talk to your MS provider about this, to ensure that the symptoms are MS related and not another bowel issue.  Treatments for bowel symptoms are individualized to the specific issue, and interventions may include: increasing fiber (sometimes with a soluble fiber supplement) to create more bulk, dietary modifications to reduce any irritation to the system, sufficient fluid intake to ensure this is not liquid leaking around hard stool, regular physical activity which helps overall bowel function, pelvic floor physical therapy that can help to strengthen the pelvic floor for better muscle control, and medications that can sometimes be used depending on the specific issue.  Here is a Can Do MS library article that you may find helpful: https://www.cando-ms.org/online-resources/can-do-library/bowel-and-bladder-symptoms-tips-for-success  And here is an archived webinar with helpful information about bowel function (also bladder) - the bowel information starts at minute 34:21: https://www.youtube.com/watch?v=Q2Zlwvh3VpM Please talk to your MS provider about the symptoms so that the best treatment plan is developed for the issues you are experiencing.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

For men, bladder issues may be caused by MS as well as by prostate issues. As men age, the prostate often becomes enlarged, making urination difficult. Since MS can also cause urinary urgency and urinary hesitation (or difficulty starting the urinary stream), it’s important for older men to be carefully evaluated to determine the cause(s) of any urinary problems they are having. The correct diagnosis will inform the best treatment strategy. In younger men with MS, prostate enlargement is unlikely to be playing a role in any urinary symptoms they experience. For them, the treatment strategies discussed in the program are the same as for women.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

Bladder and bowel symptoms are very common in MS. Damage caused by MS in the brain or spinal cord may interfere with nerve transmissions that control bowel and bladder function. These symptoms not only have a significant impact on your quality of life, but they can also impact other MS symptoms. For example, constipation, which is the most common bowel symptom in MS, can increase spasticity (stiffness) in your limbs and interfere with bladder function. Bladder symptoms can increase your risk of falls, disrupt your sleep, and make you more susceptible to bladder infections. And these infections, which can elevate your core body temperature, can make other MS symptoms like fatigue, weakness, pain feel worse. So, it’s very important that you report these symptoms to your MS provider and have a thorough evaluation.

As I mentioned, the most common bowel symptom is constipation. Adequate fluids, a diet high in fiber, a regular bowel schedule, and exercise are the best strategies for managing this symptom. Occasionally, loose stool may leak around a hardened, impacted stool. While this may appear like diarrhea, it is actually related to constipation and can be addressed by reducing the constipation. Diarrhea is uncommon in MS and is typically caused by another condition. Loss of bowel control can also occur in MS. The most effective strategy for managing bowel symptoms is to establish a regular bowel routine. I recommend that you read Bowel Problems – a publication from the National MS Society for a detailed description of bowel symptoms and the strategies used to manage them.

The most common bladder symptoms include a failure to store urine effectively, an inability to fully empty the bladder, or a combination of the two. I recommend that you read Urinary Dysfunction in MS, another booklet from the National MS Society for a description of the symptoms, the strategies used to diagnose them, and the treatments that are used. Managing these symptoms is important for your quality of life and your health, so don’t hesitate to discuss them with your provider.

Nurse Practitioner Response

Tracy Walker, NP, WOC

Can Do MS Programs Consultant

So … It depends! A glycerin suppository may be enough. It works by lubricating and gently stimulating the lower GI tract to empty. However, a lot of folks need a stronger chemical stimulant such as Dulcolax suppositories. Those can be purchased over-the-counter, but sometimes they do not dissolve quickly enough to provide fast reliable action. There is another version called the magic bullet that is Dulcolax, but in a faster dissolving form. If your pharmacy does not carry those, you can purchase them online. If those don’t work some folks will try mini liquid enema’s such as enemeez.   Every person is different, so you should ask your nurse, gastroenterologist, or other healthcare team members. 

Nurse Practitioner Response

Gail Hartley, MSN, NP, MSCN

Can Do MS Programs Consultant


A bowel retraining program can be very helpful for persons who have chronic constipation and irregular bowel movements, as well as for persons who have frequent loss of bowel control.  Retraining your bowel involves trying to go to the bathroom at the same time every day to train your body to have regular and predictable bowel movements. It may take several weeks to establish a new routine, but it is possible with consistent effort and the help of a nurse and other healthcare team members. 

Before starting a bowel program, discuss your current symptoms (ie constipation, incontinence) with your HCP.  Review your current dietary habits--are you getting enough fiber in your diet? Are you drinking enough fluids? Are you getting any exercise?  Are there medications that could be contributing to your symptoms?

The National MS Society has some great resources on managing bowel issues and can connect you with local experts who can help develop a retraining program.  I'd also recommend this checklist of ways to regulate your system, as well as this article and webinar on bowel and bladder issues, all created by fellow Can Do MS Program Consultants.  You can also access materials that we use at the 4-day CAN DO Program during the bowel and bladder workshops:

Bladder Instructions 2017

Bladder Slides 2017

I hope you find these resources helpful and you can take steps to improve your bowel timing and overall quality of life.

Nurse Practitioner Response
Lynn Stazzone, RN, BSN, MSN, NP
Can Do MS Programs Consultant

Thanks so much for your question. Bowel dysfunction can be characterized as constipation, involuntary defecation, or diarrhea. It is a common symptom in MS but probably underreported due to the nature of the problem. It can exacerbate limb spasticity and bladder dysfunction. Demyelination in the brain and/or spinal cord may interfere with nerve transmission which can effect voluntary motor function and impair anorectal sensation and reflexes. Generalized outside factors need to be taken into consideration including altered diet, impaired mobility, other diseases such as crohns or colitis, and adverse drug effects.

Without knowing your specific problems I will review general considerations. The basic intention of any management program is to establish a scheduled defecation pattern by utilizing any changes of diet and lifestyle before utilizing laxatives ,suppositories, or constipating agents. Pre-MS patterns and individual variations are important to consider in any bowel program.

For constipation, an adequate diet of fiber and fluids combined with timed evacuation and stool softeners is beneficial. If at all possible try taking less constipating medications such as anticholinergics (such as Oxybutinin), diuretics, and muscle relaxants while balancing the need to treat other symptoms of MS. Oral and rectal stimulants can be used occasionally, but harsh laxatives should be limited.

Diarrhea can be the result of the overuse of laxatives. Poor muscle control and loose stool results in incontinence, so caffeine intake as well as artificial sweeteners and sorbitol should be limited. A warm drink and a small meal in the morning as well as abdominal massage may elicit a bowel response which may accelerate stool to move. Bulk forming agents may also be useful.

There have been reports that biofeedback may improve constipation and incontinence in those patients with a limited degree of disability.

All this being said everyone is a unique individual and needs to talk with their healthcare provider to come up with an individualized care plan that works towards the goal of success.

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