Failure to completely empty bowel – multiple sclerosis forum – ehealthforum gas vs electric stove safety

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.

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.

*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.

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 don’t respond to other drugs.

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.

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.