MSA Trust

06. Bowels

Bowel function can be equally as troublesome as the bladder.

Most commonly people with MSA experience increasing sluggishness of the bowel and risk a build-up of chronic constipation. You should aim to keep your bowel movements at least as regular as they were before you had MSA. If you had a tendency to constipation before being diagnosed with MSA then you should aim to improve this. Increasing your fluid intake and eating anything that tends to get your bowels going is a good start. Avoid too much bulk-forming foods such as wholegrain breads and pasta. In a normal bowel these help, but in MSA the power of muscle movement in the bowel is reduced and so bulk-forming substances can increase constipation.

If you take L-Dopa type Parkinson’s medication this may not work if you are constipated as it can’t be absorbed and the effectiveness of other medications may also be reduced. Constipation can cause all your MSA symptoms to be worse.

At any sign of reduced volume, frequency or increased effort and time to open your bowels then you need to consider taking a laxative. It is better to take a small regular dose to keep things going than wait until you are unable to go and then try to resolve the problem. Once the bowel is stretched with solid stool, even after achieving a good clear-out, it will not shrink back to normal size for some time, so you need to continue to take the laxative.

The feeling of needing to open your bowels frequently and not fully emptying can become problematic. This again can result in you avoiding going out of the house and being unable to relax and feel comfortable. So, if you are taking more than 20 minutes to open your bowels and/or are not feeling comfortable afterwards you need to discuss with your GP, nurse or continence team for other options in managing this. Finding a routine, regular time to go to the toilet and considering interventions that allow you to feel the situation is controllable, will all improve daily life.

Occasionally, people with MSA experience difficult to control loose stools persistently. When this happens medical assessment is important to ensure nothing else is causing the problem so that medication and practical ways to manage this can be implemented.

A factsheet about Bowel Management in MSA can be found here –

Key messages

  • Be aware of your bowel movements and aim to keep these as they were before you had MSA – volume, frequency, consistency. The Bristol Stool Chart can be a helpful guide
  • Increased time and effort on the toilet and/or reduced frequency and volume = constipation
  • A regular daily laxative to keep your bowel moving steadily is better than waiting until you can’t go and then trying to resolve the problem
  • Drink plenty – laxatives will not work if you do not have enough fluid in your system.

The MSA Trust is here to support anyone affected by MSA. If you have any questions about the information on this page, please contact us and we will do our best to help you.