Finding the Right Cause of GI Issues, and the Right Approach to Treating Them
Gastrointestinal (GI) symptoms are a common experience for people living with MS. And while they’re not always caused by MS itself, they can certainly have a direct impact on your life, especially if you’re dealing with a host of other symptoms.
Understanding the possible causes of GI issues – and adapting your eating choices to suit your individual needs – can improve comfort, nutrition, confidence, and your ability to live your life.
When Your Gut Gets in the Way
GI issues can be some of the most disruptive symptoms people face. But when your primary concern is MS, they can sometimes be pushed to the background – either by the person living with them, or by their medical team. After all, you’ve got a chronic neuroimmunological disease to manage, and that elephant in the room can easily take up all the attention.
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The reality is that even minor GI issues can wreak havoc on your daily life. You may find yourself planning your day around trips to the bathroom, avoiding certain foods or restaurants, or worrying about accidents when you’re not in a place you know well. And that’s just the tip of the iceberg — persistent discomfort, bloating, constipation or urgency, and beginning to fear food rather than enjoy it can all add to the complexity of dealing with GI problems.
If you’re experiencing persistent, recurring gut problems, they can have an outsized impact on our quality of life. And those issues need to be addressed appropriately – whether they’re directly related to MS or not.
If you’re regularly experiencing GI issues while living with MS, how do you know what’s causing them, and what can you do about it
Is it MS, or Something Else?
Let’s make one important distinction – everybody faces some sort of stomach issue from time to time. An occasional upset stomach or other GI symptoms don’t necessarily indicate a serious issue, it could just be part of life. But when things become persistent, recur frequently, or become predictable enough that you’re changing your behavior to avoid them, it may be time to look deeper.
“Adding to the Burden: Gastrointestinal Symptoms and Syndromes in Multiple Sclerosis,” a study conducted in 2013, found that nearly two thirds of the MS patients who took part reported some persistent GI issue, but noted many of those GI issues are common in people without MS as well.
While it’s difficult to define exact numbers, we know MS itself can cause GI issues. Bowel function is controlled by the nervous system and helps coordinate digestion and elimination. Because MS impacts the nervous system, it can impact these functions just like it can impact anything else. That can lead to issues like constipation, urgency, incontinence, and difficulty completely emptying the bowel.
MS can also be responsible for dysphagia – difficulty or pain when swallowing, resulting from neurological impairment affecting the muscles involved in swallowing. While that may not be a traditional “GI” issue, it’s something that can have significant impact on eating, drinking and your ability to get the nutrition you need.
But it’s important to understand that not every GI symptom experienced by someone living with MS is caused by MS itself. Just like anyone else, people with MS can be susceptible to things like celiac disease, irritable bowel syndrome (IBS), food intolerances and sensitivity, and a host of other common GI conditions. GI issues can also be triggered by medications, reduced mobility, diet, and hydration, among other things.
We don’t automatically blame MS for GI issues – but persistent or significant symptoms deserve discussion with a healthcare provider who’s familiar with your MS diagnosis, so preventable and treatable conditions aren’t overlooked. If clear answers don’t come from those discussions, it’s likely time to address them with your MS care team, and try to determine if MS is actually what’s causing the issues.
Where Nutrition and Other Interventions Fit In
Once you have a better idea of what’s causing your GI issues, the next question is obvious: what can you do about them?
The answer depends on what’s actually causing the problem, and there are important differences between treating a GI issue that’s directly related to MS and managing a condition that happens to exist alongside your MS. Nutrition can play an important role in both – but it may not look the same in each case.
If MS is affecting the nerves that control your bowel, for example, dietary changes may be just one part of a larger treatment plan. This is sometimes referred to as “neurogenic bowel dysfunction,” and managing it may involve establishing a regular bathroom routine, making sure you’re getting enough fluids and fiber, staying as active as your abilities allow, and taking a look at any medications you’re on that may be contributing to constipation or other bowel problems.
The goal isn’t simply to “eat better” and hope the problem goes away. For some people, medications or other adjustments may also be necessary. Your MS care team can help you develop a bowel management routine that takes your symptoms, mobility, medications, diet and daily life into account.
But what if your GI issues aren’t actually related to MS?
The short answer is that treatment may look very different. Someone with IBS, for example, may benefit from identifying specific foods that trigger symptoms, adjusting fiber intake, or working with a registered dietitian on a more detailed approach to managing their dietary and eating habits. Someone with celiac disease needs to completely avoid gluten to prevent damage caused by the disease. And someone with a food intolerance or sensitivity may simply need to reduce or avoid the food that causes their symptoms.
You may also hear about “anti-inflammatory” diets as a way to manage MS. While there’s good reason to pay attention to foods and eating patterns that support overall health and may help reduce inflammation, no particular anti-inflammatory diet has been proven to treat MS or its symptoms, because the inflammation that’s caused in the central nervous system by MS is different from the inflammation in the body that’s affected by diet.
Ultimately, there’s no single list of foods that will benefit everyone living with MS, and no opposite list of foods that everyone with MS needs to avoid. And furthermore, adding or eliminating foods without a clear reason can sometimes create new nutritional problems.
It’s helpful to think about nutrition as one tool that can be adjusted to meet the needs of your particular situation. If constipation is the problem, increasing fiber and fluids may help – but adding a large amount of fiber too quickly can actually make bloating and discomfort worse. If you’re dealing with IBS or a food sensitivity, identifying your individual triggers may be more useful than making broad changes to your diet. And if another medical condition is responsible for your symptoms, treating that condition directly is often the best approach.
It’s also possible that more than one thing is contributing to your GI issues. For example, MS-related bowel dysfunction can exist alongside IBS, certain medications may make constipation worse, and reduced mobility may complicate an already difficult bowel routine.
In those situations, there may not be one simple answer – and there’s unlikely to be one simple dietary change that solves everything. That makes it critically important that all medical and nutrition professionals you may work with are aware of your MS diagnosis, current medications and treatment plans, and any other symptoms that may impact the treatment of an unrelated condition.
Looking at the Whole Picture
The right approach to treating GI issues isn’t necessarily the most restrictive diet or the one that promises to “fix” your MS. It’s the approach that helps you manage the problem you’re actually experiencing, while still making sure your body is getting the nutrition it needs.
And that can ultimately give you something more important than a better diet: more freedom in your daily life.
Better management of GI symptoms can mean less time worrying about where the nearest bathroom is, more confidence eating with friends, fewer restrictions on travel or activities, and less mental energy spent thinking about what your gut might do next.
If GI symptoms are persistent, disruptive, or causing you to significantly change what or how much you eat, talk with your healthcare provider rather than trying to solve the problem through increasingly restrictive dietary changes on your own.
Your MS care team, primary care provider, gastroenterologist, or a registered dietitian can help determine what’s behind your symptoms and what approach makes the most sense for you.
