Bowel training is a conservative treatment that is generally aimed at people who have recurring constipation or diarrhoea, or limited or reduced sensation in their rectum due to nerve damage.

B&B

Common problems that occur in Multiple Sclerosis can make establishing a bowel training and management regime difficult.

  • Altered sensations (can be called tenesmus) is fairly common for people with M.S. You can get a feeling that you need to push when the bowel is empty and/or you can have no awareness that you need to go when the bowel is full. This can give you an unreliable and unpredictable bowel habit.
  • Inability to push due to weak and uncontrollable muscles.
  • Bowel spasms occurring when the bowel is full can cause faecal incontinence and/or urgency.
  • Fatigue.
  • Normal effects from reduced mobility and/or reduced oral intake.
General Points

Bowel symptoms can effect up to 50% of people with MS. Bowel symptoms in MS interfere with a normal bowel pattern causing unreliability.

A bowel training regime, initially, is to show the bowel a suitable pattern to follow. Rather than have the bowel dictating how and when it works. The bowel can be re-trained. However, it needs consistency. Aim for the bowel to move as regularly as required by you and establish a pattern that you will rely on.

Prescription

Every planned morning, your bowel training routine should follow a pattern to show the bowels a routine. You should follow this initially for 1 month to assess then continue for a further

1 month ( it can take 2 months to train the bowel.

Ideally your morning routine should look like the following:

  • food and fluid on wakening
  • movement, ie shower and getting dressed
  • sit on the toilet for 20 minutes even if you don’t feel the need.

Try to have a hot drink and a piece of fibre before you go to bed. This can also help the movement of faeces ready for stimulating the bowel to work in the morning.

Perhaps vary the fibre content of your breakfast, for example, alternate from brown toast, to porridge, to cereals (choose your own)

You have chosen to train the bowel to move every other day

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Other Bowel Training Tips
  • It may take a few months to see any improvement; therefore consistency of management is important to see any progress.
  • The bowels may move outwith the times of the regime, but still follow the regime if this happens.
  • The bowels may move outwith the times of the regime, but still follow the regime if this happens.
  • Vary your fibre intake and aim for 1 ½ litres daily. Take at least 2 pieces of fibre per day and vary the type of fibre so that your body doesn’t get used to digesting it.

If you have not moved your bowels for 4 days you need to action this, instead of allowing the bowel to become constipated.

In this instance you can increase your fluid intake further to act as a natural laxative before considering medication. If you need to take medication do this on the night  before you want the bowels to work.

An example of a bowel regime would look like the following. If taking laxatives take this along with your hot drink in the evening. You can also sit on the toilet every day if desired.

Bowel Training Diagram

This conversation, with my MS nurse, about bowel training came about, after a general chat about digestive problems and the possible significance of smooth muscle involvement.

My MS nurse informed me that it could take up to two months to establish a regular bowel movement pattern. However, after only one week, I was seeing an improvement in my motions.

Smooth muscle is responsible for massaging food through most of the digestive system. And, this smooth muscled comes under the control of the autonomic nervous system.

But, it takes conscious effort to evacuate the bowel. So, a muscle training regime would be wholly appropriate,

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