Constipation in Progressive MS: Causes, Treatments, and How to Get Relief

Constipation — having bowel movements less often than usual or stools that are hard or difficult to pass — can affect how you feel throughout your day, disrupt routines, and make other multiple sclerosis symptoms feel worse. Not being able to empty your bowels regularly is one of the more frustrating symptoms of MS.

“Constipation is very common in people living with MS; more than half of all patients experience it,” says Diana Vargas, MD, an assistant professor of neurology and neuroimmunology at Emory University in Atlanta.

“The more disability and the longer one carries the diagnosis, the more severe the constipation can be. This is a problem that can significantly affect day-to-day life and independence and place even more demands on caregivers,” she says.

Constipation may sound like a simple problem, but in MS it can have multiple overlapping causes. The good news: There are a variety of lifestyle strategies, medications, and supportive treatments that can help.

Keep reading to find out why constipation happens in MS, how to reduce your symptoms, and when to ask a healthcare provider for help.

Neurogenic Bowel Dysfunction

The main cause of constipation in MS is the former — the development of neurogenic bowel dysfunction, says Vargas.

This is caused by demyelination in nerves that help with the function of gut control. As a result, the colon moves stool more slowly, the muscles of the pelvic floor may not work correctly, and it can become difficult to fully empty the bowels, she says.

Constipation is also often linked with bladder problems, since both systems share some of the same nerve pathways, says Vargas.

This can mean:

• Not recognizing when you need to have a bowel movement
• Difficulty coordinating the muscles that move stool through the colon
• Weaker signals triggering healthy contractions of the bowel

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Reduced Mobility and Physical Activity

Physical activity plays an important role in bowel health and is frequently reduced in individuals with MS, especially in progressive forms, says Erin Wilkinson,
 a nurse practitioner at the Mellen Program for MS at Cleveland Clinic Nevada.

“Slow or difficult mobility, which becomes more common in progressive MS, reduces the natural intestinal movement (motility) that helps stool move through the colon.

Low Fluid Intake

Hydration is essential to minimize constipation, but many people with MS limit fluid intake to avoid urinary urgency, frequency, or incontinence, particularly those with neurogenic bladder, says Wilkinson.

When fluid intake is low, the colon absorbs more water from the stool, leading to harder, drier stools that are more difficult to pass.

Low Fiber Intake

A diet low in fiber is known to be a contributor to constipation. “Fiber, particularly soluble fiber, absorbs water to help form soft, bulky stool, which is easier to move through the colon,” says Wilkinson.

People not eating enough fiber are likely to have smaller stool volume, slower colonic transit, and increased straining.

Medication Side Effects


There are a number of medications that are commonly used in MS that will make constipation worse, says Vargas.

• Anticholinergics like oxybutynin which is prescribed for bladder symptoms
• Antidepressants like amitriptyline, commonly used for nerve-related pain
• Some antispasmodics like hyoscyamine
• Opioids when prescribed for pain control
• Iron supplements to help with anemia

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Even if MS is driving the constipation, the same proven lifestyle steps that relieve constipation in the general population can often improve it. “Lifestyle factors play a major role,” says Vargas.

Increase your fiber intake.
 Fiber in the diet is essential; the goal should be 20 to 30 grams (g) per day, says Wilkinson.

Fiber can be found in fruits, vegetables, and whole grains. Examples include:

• Apples
• Avocados
• Almonds
• Beans of all types
• Broccoli, carrots, Brussels sprouts
• Lentils, chickpeas
• Oats, quinoa
• Pears
• Strawberries
• Split peas

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Increase physical activity. Studies in people with MS show that even low-intensity activity, such as stretching, walking, or seated exercise, can stimulate the gastrointestinal tract, says Wilkinson.

Use a toileting plan. 
A bowel routine and adherence to a schedule can help with constipation.

“People with MS can set a regular time to use the bathroom — for example, a schedule set after a meal is a natural way to prompt bowel movements,” says Wilkinson.

If lifestyle measures aren’t enough, several classes of oral treatments may help. You should always discuss taking a laxative with your provider, even if it’s available over the counter.

• Bulking agents such as Metamucil (psyllium). These fiber supplements absorb water and increase stool bulk, which stimulates the bowel to move things along.
• Stool softeners are medicines that moisten and soften stool, making it easier and more comfortable to pass.
• Osmotic laxatives such as MiraLAX (polyethylene glycol) draw water into the intestines, increasing stool moisture and helping stool move through the colon more easily.
• Stimulant laxatives such as Senokot (senna) or Dulcolax (bisacodyl) activate the muscles of the intestinal wall to trigger a bowel movement.
• Secretagogues such as Amitiza (lubiprostone) or Linzess (linaclotide) promote the release of intestinal fluids, which can help speed up transit for people with more stubborn constipation.
• Prokinetic agents such as Motegrity (prucalopride) stimulate the gut’s natural muscle contractions to improve bowel movement frequency.

When oral treatments are not enough or produce inconsistent relief, rectal therapies may be recommended, says Vargas.

“Rectal stimulants include suppositories (for example, bisacodyl and glycerin) and mini-enemas (for example, docusate and sodium citrate). In order for these to be effective, the fecal matter needs to be close to the rectum,” she says.

Chronic use of rectal stimulants is discouraged and can be uncomfortable to do routinely.

“This involves gently flushing warm water into the rectum and lower colon to help empty the bowels. It is typically recommended when simpler bowel management methods are no longer effective and patients have severe symptoms that are not responding to all other measures,” she says.

Transanal irrigation can also help when there is incomplete evacuation, meaning all the stool doesn’t come out during the bowel movement and it’s uncomfortable, she adds.

Abdominal massage is a noninvasive technique that may stimulate bowel movement.

It typically involves:

• Using the flat part of the hand
• Moving in a clockwise motion across the abdomen
• Applying gentle but consistent pressure

Massaging for about 15 minutes can improve colonic movement, says Wilkinson. “Abdominal massage is especially helpful for low motility, those with limited physical activity, and sensory changes (knowing or being able to feel when needing to have bowel movement),” she says.

Constipation may feel embarrassing to discuss, but bowel problems are extremely common in MS, and health professionals address these concerns every day.

“Addressing constipation in MS is essential not only for comfort and daily functioning but also for preventing medical complications,” says Wilkinson.

There are significant effects if constipation remains untreated, according to Wilkinson.

• Quality of life impact includes abdominal discomfort or pain, bloating, prolonged toileting time, and decreased participation in social or work activities.
• Health and medical implications can lead to fecal impaction, which may require digital removal or manual disimpaction.
• Overflow incontinence can be seen if stool becomes impacted and liquid stool leaks around the obstruction leading to overflow fecal incontinence. This can be misinterpreted as diarrhea but can be a sign of untreated constipation.
• Overstretching of the rectum, reduced sensation of rectal filling and worsening neurogenic bowel dysfunction over time can be caused by chronic constipation.
• Hemorrhoids are more commonly seen with straining.
• Malnutrition and reduced appetite due to feelings of bloating which can diminish appetite, reducing fluid and fiber intake, ultimately worsening constipation.
• Constipation may worsen spasticity, the MS symptom of muscle tightness or spasms.

“Constipation should be a conversation with a health care provider to further create an action plan,” she says.

• Constipation is a very common MS symptom, especially in people with progressive disease, but there are many ways to manage it and improve daily comfort.
• MS-related nerve damage, reduced mobility, low fluid or fiber intake, and certain medications can all contribute to constipation.
• Lifestyle steps like increasing fiber, staying hydrated, moving more, and establishing a toileting routine can make a meaningful difference and are safe places to start.
• If symptoms persist, a range of oral medications, rectal treatments, abdominal massage, and bowel-training tools can help, but chronic constipation shouldn’t be ignored since untreated symptoms can lead to complications.