Osmotic laxatives, which are
favored by Namey, pull water
into the colon for greater bulk.
Examples include lactulose and
Miralax (polyethylene glycol),
which are powders you mix
with water or another beverage.
Bulk-forming agents such as
psyllium, hydrophilic mucilloid
and methylcellulose bulk up
the stool with natural vegetable
fiber. Bigger stool puts more
pressure on bowel walls, which
boosts the neural signal, which
aids motility. With these agents,
drink extra fluids. Stool soften-
ers, which Namey doesn’t find
as helpful, keep the stools soft
and moist, allowing them to
slide through the colon more
easily. It’s essential to drink a
lot of water while using these
drugs, too, which can be used
in conjunction with other
laxatives. Peristaltic stimu-
lants such as the plant-based
senna directly goose the nerves
in the bowel wall, stimulat-
ing muscle function. Certain
suppositories or mini-enemas
irritate the lining of the rectum,
causing it to release waste. And
there are prokinetic agents
such as metoclopramide, which
also stimulate bowel muscles.
Although stimulants may help
when people can’t push out their
stool, Namey is wary of their
long-term impact: “These are
like using dynamite to get things
out.”
Diarrhea may be related to
constipation
People with MS may also have
problems with bowel inconti-
nence and diarrhea. The runs
can be a neurological issue, but
incontinence is often related
to constipation. Fresh stool
leaks without warning around
impacted stool due to reduced
sensation and involuntary
relaxation of the anal sphincter.
Again, regular habits are key to
accident prevention by training
the bowel to keep on schedule.
And while training is in prog-
ress, get peace of mind by using
protective pants. The bulk-form-
ing agents can help to control
diarrhea, along with medications
that slow bowel contractions.
But it’s important to keep your
doctor informed, because anti-
diarrheal agents are prescribed
for short-term use only.
A few more ideas
You may also need to cut out
dietary irritants like caffeine
and alcohol. Biofeedback may
train you to pick up subtle
signals that stool is filling up the
rectum. In the rare event your
strategies just don’t work,
you’ll need to see a gastroen-
terologist for a lower G.I.
evaluation.
Just like exercise or diet,
a bowel program works
best when it’s tailored to
your personal lifestyle, hab-
its and routines. Use your
first brain to help your sec-
ond brain. And, as Namey
wisely counsels, “keep your
sense of humor.”
Rachel Adelson’s Live Wire Communications covers health, science and
technology.
