When I was little, it seemed that my grandmother and Mimi, her sister, were always concerned about my bowel movements, and those of other family members. If you didn’t go every day, it was time for prune juice. If you were cranky, it was because you didn’t go. The seemingly constant vigilance on the bowels was annoying, embarrassing and so old country. (We used the term old country to remind them that we were in modern times now, and in America; it was a chide to forget about how things were because those things are undoubtedly wrong and very outdated.) Now that I am, by all kinds of measures, grown-up, I realize my ignorance, and even admit to asking about the bowel habits of my grandkids from time to time.
Being in the wonderful group of people with MS, I hear a lot of discussions about symptoms and bowel habits get a bit of airtime. I can’t go, I haven’t gone, Why can’t I go? Patients get put on all kinds of protocols and are urged to eat fiber and drink lots of fluids, which is counter-intuitive when there are bladder issues. The tendency towards constipation is affected by medications, and the lower levels of exercise or body movement of the afflicted. (Yes, afflicted is a good word to describe the person who has MS.) We’ve pretty much been told that the nerves to the intestines aren’t working properly (but why?) and to do the best we can to manage the constipation.
Sometimes there will be the opposite bowel issue–diarrhea. [Or as my husband pronounces it in his Brooklyn accent that shows up now and then , di-ah-ree-ur.] Not very common with MS, they say; but it is often a side-effect of having chronic constipation. Again, there are no answers for why someone might get diarrhea or constipation or a combination of both (usually called irritable bowel syndrome), and there is always the suspense of when each might occur—–like a daily surprise. Then there’s the ever-dreaded fecal incontinence. From what I’ve read, this can also be a side-effect of constipation, which alters the muscles, nerves and sphincters of the rectum and anus. [I never, ever thought I'd be writing a post with rectum or anus in it, but there you go.]
With so many bowel issues in MS, you would think that someone would researching why they happen, and try to find an answer that’s different than the unquantifiable “Because of nerve damage or lesions”. [By the way, lesion load and placement aren't always directly connected to symptoms experienced. No one knows why that is, either.] The three current clinical trials for constipation and MS that are listed on http://www.clinical trials.gov are drug-related. Well, one is sort of a drug—it’s actually an oral dose containing 2500 eggs of the whipworm parasite. It’s being conducted in Germany and is actively recruiting, if you are interested. [Hey, anyone with severe enough anything will try what others call desperate measures. I won't judge you for trying!]
Which brings me to the next interesting tidbit I came across: “Accidental discovery that Fecal Microbiota Transplant (FMT) in 3 MS patients led to a reversal of the disease.” Wow, who wouldn’t want to find out what a fecal transplant was? Was this doctor a quack? And so I looked, and I read and I watched videos—all about poop. [My grandmother and Mimi would be so proud!]
Before I did, I asked myself what do I know about the colon? I know for sure that its excrement is known by many words, like feces and poop. I know that it absorbs water, salt and fat-soluble vitamins from the stuff the stomach and small intestine send down. I know that it has, in recent times, been discovered to be part of our “second brain” (enteric nervous system) because it’s lined with tissue that contains neurons and neurotransmitters. [Remember those tummy aches when you were nervous as a kid?] I also know that the colon contains good (and sometimes bad) microscopic bacteria (microbiota) and that these bacteria are affected by medicines we take and food we eat.
So, then, this fecal transplant? The basics are this: poop from a healthy donor gets processed and put into a patient that suffers from ulcerative colitis, or in one study, three recipients who had MS. The patients are not awake and it seems to be like undergoing a colonoscopy, but with a package of genuine goodness left behind. The theory behind its success on the patients with ulcerative colitis is that the microbiota from the healthy donor feces recolonize the sick person’s colon and all those good bacteria flourish and have a party! This flourishing is what stops the diarrhea, or in the case of the MS patients, constipation, and apparently helps the person to regain health. There is so much to say about that! I can’t find much info yet about the MS patients in particular, but I will find the real scoop soon.
I will end this by saying that there are many stories we hear about people ‘getting better’ after they change their diets, or lessen their stress, or avoid foods they are sensitive to. Why is that, if the gut isn’t somehow involved in the health of the whole person, even the person with MS? Right after this I’m posting a link that has a poop-load of information and I hope you read and watch.
ps I see on the clinical trials site that a lot of research on fecal biota transplants is in motion–mostly for ulcerative colitis, inflammatory bowel disease, or infection with the bacteria C. diff. (that organism is cited as the reason for hospital patients getting severe diarrhea during their stay.) No research set for MS, but I definitely think it should be.