From the Guidelines
Bowel incontinence in multiple sclerosis (MS) should be managed with a stepwise approach, starting with conservative therapies such as diet, fluids, and bowel training, as these can benefit approximately 25% of patients 1. When considering treatment options, it's essential to prioritize a stepwise approach to manage bowel incontinence in MS patients.
- The initial management should focus on conservative therapies, including dietary changes, adequate fluid intake, and techniques to improve evacuation, as well as a bowel training program to manage diarrhea and constipation with diet and medications if necessary.
- For patients who do not respond to conservative measures, pelvic floor retraining with biofeedback therapy is recommended 1, as it can help improve awareness of bowel sensations and strengthen the pelvic floor muscles.
- In cases where conservative measures and biofeedback therapy fail, perianal bulking agents such as intraanal injection of dextranomer may be considered.
- For patients with moderate or severe bowel incontinence, sacral nerve stimulation should be considered after a 3-month or longer trial of conservative measures and biofeedback therapy 1, as it can help regulate bowel movements and improve continence.
- Regular reassessment with healthcare providers is crucial, as MS symptoms can evolve over time, requiring adjustments to the management plan.
- It's also important to note that medications like loperamide and fiber supplements can be used to reduce urgency and diarrhea and improve stool consistency, respectively.
- A multidisciplinary approach, including lifestyle modifications, medications, and specialized therapies, can help manage bowel incontinence in MS patients and improve their quality of life.
From the Research
Treatment Options for Bowel Incontinence in MS
- Percutaneous posterior tibial nerve stimulation has shown potential as an effective therapy for fecal incontinence in multiple sclerosis, with a response rate of 79% in one study 2.
- Conservative therapies, such as maintaining a high fibre diet, high fluid intake, regular bowel routine, and the use of enemas or laxatives, are commonly recommended, but the evidence to support their efficacy is limited 3.
- Bowel management in patients with MS is currently empirical, and there is a need for high-quality research on all aspects of managing bowel dysfunction in MS to improve patients' quality of life 4.
Management Strategies
- A thorough bowel assessment and adequate fluid and fibre intake are important for managing bowel dysfunction in people with MS 5.
- Pelvic floor exercises, biofeedback therapy, aerobic exercise, and anal plugs may be helpful for some people with MS 5.
- Pharmacological interventions, such as loperamide and psyllium fiber, can be effective in reducing fecal incontinence episodes, but may have different side effects and tolerability profiles 6.
Lifestyle Modifications
- Maintaining a regular bowel routine and high fluid intake can help manage bowel dysfunction in people with MS 3.
- A high fibre diet may be beneficial, but the evidence is limited 3.
- People with MS may need to use a range of strategies to manage their bowel, including dietary changes, lifestyle modifications, and medical interventions 4.