Treating and managing symptoms of neurogenic bowel dysfunctions should be taken case-by-case. There is no one treatment that ‘fits all’. Always, treatment interventions should be tailored to each individual’s needs to establish an as affective bowel management routine as possible.1
This article sets out the different treatment interventions that are possible, taking a stepwise approach. You should always talk to your doctor to ensure your treatment is right for you.
The “treatment pyramid” is a way to help guide healthcare professionals and patients through the treatment pathway for neurogenic bowel dysfunction, such as MS. It shows what options are available for managing bowel problems and encourages those living with MS to consider less invasive options where possible.
It is common that people living with a neurogenic bowel dysfunction start with basic treatments at the bottom of the pyramid, such as dietary changes, physical activity, and oral laxatives, for example. If such measures are insufficient, most clinicians will then recommend transanal irrigation.1
In the following, you will find an explanation of simple bowel management solutions your doctor may first discuss with you to help you manage your symptoms.
Taking care of your diet may help with your symptoms. By maintaining a healthy diet, symptoms such as stool consistency can be assessed together with a healthcare professional, and diet may then be adjusted accordingly.
Fluid intake is also important. You can easily check if you are consuming enough liquid by the colour of your urine: urine of a ‘pale straw colour’ indicates adequate hydration.2
Oral laxatives may also be taken to get things moving within the bowels. Commonly, oral laxatives include both stimulants that prompt increased bowel activity, and softeners, bulkers, and osmotics, all of which aim at modulating stool form and can be taken regularly to maintain a predictable stool consistency.1 When oral laxatives are taken, thought should be given to how the resulting bowel activity is managed.
Digital rectal stimulation is performed to stimulate the movement of stool into the rectum and initiate defaecation. A gloved, lubricated finger is placed through the anal canal into the rectum and rotated in a circular movement. This helps the external sphincter to relax and allow stool to be is passed, and/or the internal sphincter to contract, signalling colonic activity.
Suppositories are small round or cone-shaped medications you insert up your bottom where it then releases its medication. Often, the use of suppositories can initiate bowel movements within about 20-30 minutes.
Transanal irrigation (TAI) involves passing water into the bowel to enable faeces in the rectum and descending colon to be evacuated.1 Water is introduced into the bowel via a rectal catheter. TAI may be appropriate for people who experience faecal incontinence, constipation, abdominal pain associated with evacuation, bloating, or prolonged bowel evacuations.3
It has been found to improve symptom-related quality of life for people living with MS. By regularly emptying the bowel using TAI, controlled bowel function may be re-established to a high degree in people with bowel dysfunction. This enables the individual to develop a consistent bowel routine by choosing the time and place of evacuation.3
If you are living with faecal incontinence, efficient emptying of the distal colon and rectum with high-volume TAI can mean that new faeces do not reach the rectum for an average of 2 days, preventing leakage between irrigations. If you are living with constipation, regular evacuation of the rectosigmoid region with TAI can accelerate transit through the entire colon.3
TAI is usually recommended to people with MS for whom a conservative regime has been inadequate.1
Surgery is considered the last step in the treatment pyramid for neurogenic bowel dysfunction, reserved for people who have not found relief with other treatments like diet changes, medications, or transanal irrigation.1
Surgical options may include the Malone Antegrade Continence Enema (MACE), which creates a channel for flushing the bowel from the top down, and various nerve stimulation techniques. Other surgeries may include creating a stoma (colostomy or ileostomy), which allows stool to leave the body through an opening in the abdomen into a special bag. This procedure can greatly improve independence and quality of life but does also require careful ongoing management of the stoma and skin around the stoma.1
These procedures are usually only considered when all other options have failed, and the decision is made together with the patient and a specialist.1
Surgery is always tailored to the individual’s needs, and patients are carefully informed about both the benefits and potential risks before moving forward.
“If the bowels don’t function properly, there is often something else that doesn’t work either. Their whole life gets effected. Sex life, bladder and bowels, it’s really important that it all works.”
Anna | Healthcare Professional
To learn more about the effects bowel problems may have on your sexual relationships, click the link below:
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