Ask the Pharmacist

Q. My husband has MS (multiple sclerosis) and is experiencing some bowel incontinence. What could be causing this and what can I be doing to reduce these episodes?

A. Bowel incontinence is the inability to control bowel movements which can lead to accidental leakage and possible embarrassment as well as a withdrawal from participation in social activities.  MS is one of just many possible causes of this.

Others include having given birth (this is the most common reason and is why the condition is seen far more often in females than in males), having been diagnosed with irritable bowel syndrome or one of the inflammatory bowel syndromes, nerve damage related to diabetes or a spinal cord injury, impacted stool due to severe constipation, radiation damage to the rectum or cognitive impairment such as after a stroke or in someone with Alzheimer’s.

There are two types of bowel incontinence. Urge incontinence which occurs when the bowels have a sudden urge to empty and affected person has an inability to control and hold on until you are on a toilet. This results in anything from a little bit of stool leaking out while expelling gas to a complete bowel movement in your clothes due to loss of bowel control.  There is also passive incontinence which describes those individuals that are not even aware of their need to have a bowel movement and therefore empty their bowels anywhere.

Either type of incontinence not only lends itself to a need for a change of clothes and washing of the skin and surroundings but also having to deal with humility or embarrassment after such an episode. Even though this is not an infrequent occurrence for many that deal with conditions that predispose them to muscle or nerve damage around the bowels, it is still something we do not wish to experience, especially in a public setting.  Not only are we concerned about the emotional aspect that may occur, we are also concerned about our surrounding skin since our feces can cause skin irritations and/or ulcers.

In the case of MS, the condition impairs the signals that the brain receives with respect to the bowels and their need to empty. Also, our pelvic floor muscles are required to help us pass our stools and MS, and other disorders, may not allow these muscles to achieve this. When these muscles do not work as well, they can also weaken our sphincter muscles which lead to bowel or bladder incontinence. Bowel retraining can be tried to help reduce the number of incontinent (or accidental) episodes by encouraging the body to empty at a set time every day while you have access to a toilet.

There are a few suggestions to help you be more successful in bowel retraining:

  • Drink plenty of water. Many of us do not drink enough fluids or think we drink enough. It is suggested to ensure 6 to 8 glasses of water each day or to take half of your weight in pounds and drink that many ounces of water daily.
  • Set a pattern for your bowel movements. Attempt to empty your bowels right after eating since the process of eating and digesting food can help stimulate your bowels. Be sure to take your time on the toilet by giving yourself 10-15 minutes. Be sure to avoid straining however as that may weaken your anal sphincter muscles which can promote incontinence.
  • A warm/hot beverage in the morning can encourage a bowel movement so add coffee or tea (caffeinated or decaffeinated) to your breakfast routine.
  • A diet high in fibre is beneficial. Many are afraid to increase their fibre intake after having messy accidents to clean up but the fibre is important to help regulate or normalize the bowels. You can achieve this through eating plenty of fruits and vegetables along with whole grain breads and cereals. Try spreading a high fibre cereal over other foods throughout the day.
  • Exercise, if you are able, helps to get the bowels moving so try to incorporate some form of movement each day.
  • Biofeedback with the use of an electric probe inserted into the rectum may also be required in bowel retraining which helps monitor movement from the sphincter muscles.

Some people may require rectal stimulation with a gloved, lubricated finger to promote a bowel movement. Others may find that an abdominal massage helps to empty their bowels more completely. In any case, a bowel diary is a great way to keep track of your bowel movements and comparing results with the activities and foods that are consumed each day.