Symptom Management

Maintaining Dignity with Bladder and Bowel Problems

By Marie Namey, RN, MSN, MSCN

Bladder and bowel problems due to MS are distressing and may interfere with personal, social and vocational activities. Changes in elimination patterns can create feelings of loss of control, embarrassment, dependency, and isolation. Bladder and bowel problems can also disrupt sleep.

Many individuals with MS have tried using online MS forums to discuss these delicate issues. I encourage you to talk with your healthcare provider about your specific concerns. Nurses can be especially helpful in providing guidance for bladder and bowel concerns.

Bladder Facts:

• Adequate fluid intake is 1 1/2 to 2 quarts of fluid a day. Water is best, followed by decaffeinated tea or fruit juice.

• The urge to void occurs about 1 1/2 to 2 hours after drinking.

• Caffeine, aspartame and alcohol are bladder irritants.

• Smoking is a bladder irritant.

• Limiting fluid intake is harmful.

• It is not normal to leak urine, wake up more than once at night to void, or have frequent urinary tract infections (UTIs).

• Bladder infections in people with MS may result in increased MS symptoms, including spasticity and fatigue.

Plan of Action:

• Drink fluids all at once, i.e., drink 6-8 oz. at a time. If you sip, sip, sip you will feel the urge to urinate, urinate, urinate.

• Try to void about 1 1/2 to 2 hours after you drink.

• Stop drinking fluids about 2 hours before bedtime.

• Void right before bedtime.

• If you tend to get frequent bladder infections, you are probably not emptying your bladder completely. Drink cranberry juice to keep your urine more acidic and decrease the bacteria in your urine.

Bowel Facts:

• The goal is a comfortable bowel movement every day, every other day, or every 2-3 days.  

• For regular bowel movements you need fluid (1 1/2 to 2 quarts a day), fiber (20-30 grams a day) and some physical activity.  

• One-third cup Fiber One, All Bran or 100 percent Bran Buds provides half the fiber you need for the day.

• Greasy foods, spicy foods, or food intolerances (lactose) may cause loose stool and may result in involuntary bowel movements.  

Plan of Action:

• Eat regularly for regular bowel habits.

• Plan for a bowel movement each day about a half hour after eating or drinking something warm (the emptying reflex is strongest at this time).

• Sit on the toilet about 10 minutes and try to have a bowel movement. You may want to gently rock back and forth on the toilet. If nothing happens, leave the bathroom and try again later.  

• If you experience involuntary bowel movements or have trouble pushing the stool out, you might consider using a suppository to help stimulate bowel activity. You can purchase suppositories over the counter. It takes about 20 minutes for a suppository to work, if it is inserted along the rectal wall.  

• If you have not had a bowel movement in 5-7 days, it might be helpful to occasionally take milk of magnesia, citrate of magnesia or other laxatives to stimulate bowel activity.

• It may take 2-3 months to develop a pattern for bowel habits.

Bladder and bowel symptoms are common in MS and can be effectively managed. Speak with your healthcare provider about what you can do to keep the symptoms to a minimum. And remember, it is much easier to prevent bowel problems by establishing good habits than to deal with constipation or involuntary bowel movements after they have become a problem.

MARIE NAMEY, RN, MSN, MSCN has been part of the interdisciplinary team at the Mellen Center for MS Treatment and Research at the Cleveland Clinic Foundation since its inception in 1985. She is on the editorial board for Real Living with MS. She is a founding member and Treasurer of the International Organization of MS Nurses. She has served as secretary, vice president and president of the Consortium of MS Centers, and chairs the Advocacy Committee.

(Last reviewed 7/2009)