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Assessing and managing constipation in MS

Wed, 2013-10-23 10:24 - Posted by Wendy Hartland, MS Specialist Nurse

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Over the years, I’ve learnt that assessing and managing constipation in people with MS isn’t always straightforward. Let me explain more.

A bog standard (excuse the pun) assessment would include asking the patient about lifestyle measures such as their dietary intake of fibre, fluid intake, medications, pre-existing medical conditions, psychological factors and exercise etc.

But other factors have to be taken into account with MS.

MS-specific concerns

Constipation in people with MS is usually multi-factorial in origin, for example, the physiological effects of MS itself, medications, restricted mobility etc. Unfortunately it is often the case that some of the underlying causes cannot be reversed, so we are left with symptom management.

That is, we cannot cure the MS and although we can review medication, often our patients rely on medications such as Baclofen and Oxybutynin that have the side effect of causing constipation. Asking our patients to increase their level of exercise, in particular standing, is not always an option.

The additional questions I want to ask include:

  • How mobile is the person? If I prescribe a laxative that causes urgency, will they be able to get to the toilet in time?
  • Do they rely on a care package? If I prescribe a laxative that works overnight, what time do the carers arrive in the morning?
  • How important is the problem to them? For some constipation is better than the alternative of risking diarrhoea.

​What do I recommend?

I encourage my patients to never miss breakfast, have a warm drink and ensure they have an understanding of the gastro-colic reflex, which in my opinion is underestimated and often postponed in our busy lives.

In patients with reduced mobility I tend to avoid bulk-forming laxatives such as Fybogel, as I have found less mobile patients tend to suffer with increase bloating and flatulence. Stimulant laxatives such as Senna, can cause urgency or cramps and ‘false alarms’, which can eventually try the patience of the most dedicated carer.

I recommend patients try osmotic laxatives such as Movicol, but low doses and titrate up e.g. ½ a sachet for 3 nights then ½ a sachet twice a day, increasing steadily until a therapeutic dose is found.

If you recommended the standard dose and your patient has an episode of incontinence because they couldn’t get to the toilet in time, they could stop taking the medication, and stop trusting you. Go slow and explain why.

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Wendy Hartland, MS Specialist Nurse