I have MS (4 years). I currently am dealing with not being able to completely empty when I pass stool without the aid of my handy-dandy hand held shower head (if you know what I mean).
I know this is gross, but what else can I do? If I am in a situation where I'm unable to "flush it out", I itch terribly, and have horrible discomfort (almost like constipation), until I can.
I am hoping that this is just the result of another lovely plaque invading and interrupting normal signals from brain-to-body parts... but I'm going on 3 months now. Should I be concerned?
Stool softeners, laxatives, etc. do not help. The problem is the loss of muscle control to push. Kegals (sp?) haven't helped much either.
Have you tried Miralax? Unsure if this is one of those laxatives you have used.
Do you have a gastrologist that you have discussed this with? There are so many new things that can help us folks with MS and it's unpredictability...like what may not work today may be working fine tomorrow. That is not always the case.
Before it gets worse I suggest making an appt with one as well as report this to your neurologist as it could be a sign that MS is progressing or a change in medication is in order.
yes, I have tries Miralax, with no changes.
i am currently on Tysabri, which is an infusion once every 4 weeks.
Have been on betaseron... very bad reaction. From that, put on Copaxone. After 26 months of that, MRI showed continued activity as though I was taking nothing at all.
I see a general neurologist, and an MS specialist.
I also have a urologist, and have mentioned this problem to my family doctor who suggested the laxative/high fiber diet.
Strangely enough, MSers learn to manage/cope with the oddities that the disease throws our way without running to the doctors everytime something new happens. That's kinda what this is... you learn how to manage, to a point, on our own (if you can). but, I am up to having to do this twice daily now, and just wondering if there's something going on with the nerves that are responsible for the contracting of the sphincter muscles... or what it might be.
How embarrassing to talk about this kind of thing. But, that is something we have to get over. Especially explaining to your spouse "what you were doing in there". Ugh. MS is so much fun.
Breakdown in your body's communication is definately going on.
I prefer an MS specialist to a regular neurologist (nothing is wrong with a regular neuro I feel that a specialist is just that, special ). I also have a urologist, gastrologist, gynecologist and my regular doctor.
Do you receive any of the MS magazines (free) that come out quarterly? They are full of information to handle this disease and all of it's quirks.
Years ago my legs wouldn't work for a short time and then suddenly I regained usage however lately I get weak right above my knees so I keep my cane handy...
There must be something out there that could help.
To help with foot drop, there is a muscle stimulator....muscle / nerve pain, TENS so I tend to think that there just may be an answer for you. Bowel & Bladder issues are common in our MS world.
Here's what I found:
The symptoms of multiple sclerosis (MS) are unpredictable and vary from person to person. A common symptom that effects approximately 68% of people with MS is bowel dysfunction. People can experience bowel dysfunction when demyelination in the central nervous system (CNS) interferes with nerve transmission needed for normal bowel function. This demyelination can affect muscle groups which are needed to produce normal bowel function. Other factors like slowed transit time of the intestines, muscle weakness, fatigue and lack of exercise can also contribute to the problem. Medications like sedatives/tranquilizers, diuretics, narcotics/analgesics, antidepressants, anticholinergics, antacids, iron supplements, and antihypertensives that are used to manage symptoms of urinary problems or depression might also alter bowel functions. In addition, many people with multiple sclerosis want to decrease their bladder incontinence by inappropriately limiting their fluid intake, which in turn increases their risk for constipation.
Common Bowel Problems
The reasons for bowel dysfunction vary, but the usual bowel problems reported by people with MS are constipation, diarrhea and fecal incontinence.
Constipation is the most frequently reported problem. The definition of constipation is infrequent (2 bowel movements or less per week) or difficult elimination of stool. Slowed transit time, altered fecal composition, decreased ability to expel feces and altered ability to acknowledge the urge to defecate may all cause constipation.
Diarrhea is less common than constipation and may even be a result of constipation. The definition of diarrhea is abnormal fluid stools. If hardened stool is retained, diarrhea may occur around the mass.
Fecal incontinence is the involuntary passage of stool. Contributing factors include: sphincter dysfunction, sensory loss in the rectum, medications and dietary problems.
Bowel Dysfunction Treatments
The treatment for bowel dysfunction includes patient assessment, interventions, medications, and bowel reflexes. Following these four steps can aid in helping the patient experience a more normal bowel program.
Step 1: Assessment of the personâs history is the beginning of the treatment for bowel dysfunction which includes:
o Frequency and type of bowel movements
o Usual time of day pattern
o Reliance on laxatives or enemas
o Current medications
o Comorbid medical conditions that may affect medications
o If assistance is needed for toileting, consider when help is available.
Step 2: Interventions should be designed to develop and maintain consistent emptying of the bowel. Use the following guide for dietary and fluid changes:
o A consistent habit and time of emptying (usually 1 to 3 days)
o Predictable bowel emptying
o Maintain a balance of stool that is easy to pass
o Provide for sufficient hydration with 1.5 to 2 liters per day of non-caffeinated, non-alcoholic fluids.
o Include 25 to 30 grams per day of dietary fiber. (*See Dietary Fiber)
o An exercise program shortens transit time through the gastrointestinal (GI) tract. Walking and active exercise are best, but when that is not possible, encourage as much activity as the person can do.
o A dietary supplement that can aid in bowel emptying is a combination of several food products high in dietary fiber* blended together. See the âbowel recipeâ listed below:
1 cup applesauce
1 cup unprocessed bran
Â½ cup of 100% prune juice
Dosage: 1 tablespoon at bedtime with an 8 ounce glass of water. Refrigerate mixture between uses. A dose in the morning can be added as needed.
*Dietary Fiber is an important component of bowel management to encourage consistent bowel emptying. Dietary fiber is beneficial in the management of both constipation and diarrhea. Its bulking action helps alleviate diarrhea and its softening action helps to prevent constipation. Fiber functions by binding water in the intestines in the form of a gel to prevent over absorption by the large intestines. This ensures that feces is bulky, soft and does not have delayed transit time. Delayed transit time generally results in constipation.
Chief dietary sources of fiber: whole grain breads and cereals, leafy vegetables, legumes, nuts and fruits. Increased fiber intake needs to be gradually introduced to allow the GI tract time to adapt. Too rapid an increase may result in flatulence, distention and diarrhea.
Step 3: Medications may be necessary if dietary and fluid changes are not adequate.
o Suppositories â act on colonic mucosa to produce peristalsis to initiate reflex emptying of the bowel (eg. Glycerin, Dulcolax, and mini-enemas).
o Stool softeners â adjust stool consistency; usually the effects of stool softeners take several days after initial use (eg. Dialose, Colace, and Surfak).
o Softeners with a laxative component may be used when additional softening or peristaltic stimulus is needed. They need to be given approximately 12 hours before the desired results (eg. Dialose Plus, Pericolace, and Senokot).
o Bulking formers â these agents add substance to the stool by increasing its bulk and water content (eg. Metamucil, Fibercon, and Citrucel, etc.).
o Osmotic laxatives such as Sorbitol, Milk of Magnesia and Lactulose act in both the small and large intestines to attract and retain water in the intestinal lumen increasing intraluminal pressure. These drugs may be an option for bowels that donât respond to other drugs.
Laxatives are oral stimulants that provide a chemical irritant to the bowel. Laxatives can become habit forming so should be used cautiously (eg. Pericolace, Milk of Magnesia, Senna, and Dulcolax).
In addition, routine use of large-volume enemas can result in overdistended bowel.
Changes in the bowel program may be needed, but changes should be one change at a time. Allow a 5 to 7 day trial period for each bowel program intervention.
Step 4: Routine reflexes can aid in managing bowel function. There are several methods to stimulate a routine reflex to empty the bowel. Stimulation techniques include mini-enemas and/or digital stimulation. After using one of these stimulation techniques the reflex to empty takes approximately 30 to 45 minutes. It is important that these stimulation techniques are used at the same time of day to help the body develop routine reflexes. It is most common to initiate this protocol after breakfast. Generally, the gastrocolic and duodenalcolic reflexes occur between 30 to 45 minutes after ingestion of a meal or drinking a hot beverage. The natural timing of reflexes needs to be considered when developing a bowel toileting routine.
o Digital stimulation is used to induce reflex contraction of the colon and relaxation of the anal sphincter muscle to facilitate defecation. A gentle clockwise rotation of the index finger against the anal sphincter wall for several minutes at a time can promote stool expulsion. This type of stimulation might need to be repeated until the bowel evacuation is completed.
Step 5: Colostomy is considered after the above interventions are ineffective in developing normal bowel function. A colostomy is a surgical operation that creates an opening from the colon to the surface of the body to function as an anus. The fecal matter is deposited in a bag that is on the outside of the body. This is not an uncommon medical procedure for some people with severe disease and/or slowed transit time. A colostomy can actually provide the much needed relief for patients and simplify care by caregivers.
Additional Bowel Intervention Tips include:
o Maintain regular mealtimes.
o Positioning aids help with elimination. An upright position allows gravity to assist in peristalsis and stool expulsion. Also, having knees higher than the hips and feet flat on a surface (eg. a small step-stool might work well) helps increase abdominal pressure to facilitate defecation. It also straightens the angle between the rectum and the anal canal to promote rectal emptying.
o Abdominal massage can also stimulate peristalsis. Massage the right groin upward, across and down to left groin.
o Breathing techniques can increase intra-abdominal pressure. By taking slow, deep breaths combined with abdominal muscle contractions (or leaning forward) help perform a Valsalva maneuver increasing rectal emptying.
I so appreciate you time, and advice. I will definitely try a few of the things you suggested (that I haven't already). I am also looking into finding a gastrologist in my area.
I wish you all of the best now and in the future.
I have a Prolasped Vagina and at times have to manually empty my colon. I saw a Proctologist who specialize in this area. Basiclly I have lost most of the ability to use my colon properly and although the reasons are different for us I think the solution he gave me will work for you. Put your thumb into your virgina and your pointer finger behind your anus and squeeze the fecal matter forward and out carefully not to contaminate your fingers. You can easily do this using tolet paper. I know, I know, gross... but it works. I need to have mine surgically corrected but as long as I can manage it I don't want to go under the knife. Hope this helps... good luck
Well, that sounds like something a contortionist would do (lol), but at this point, I'm willing to give anything a fair try.
Thanks for your advice.
Best of luck to you with your condition, and may you continue avoiding "the knife"