The Link Between MS and the Gut

Multiple sclerosis (MS) is a chronic inflammatory condition that occurs when your immune system attacks the myelin sheath that covers and protects your nerve cells and is responsible for the speedy and efficient transmission of nerve signals throughout the body.

The inflammation that results can affect everything from your vision and musculoskeletal system to the way your gut functions, giving rise to many multi-organ symptoms.

Studies have shown that nerve dysfunction alters the way your gut functions, causing gastrointestinal distress or bowel dysfunction. It may also be involved in changes in the gut microbiome (the community of microbes that live in your gut and aid in digestion), which may be a potential cause of disease.

Still, the debate continues on whether gut dysfunction triggers MS or is a consequence of the disease. This article discusses bowel problems in multiple sclerosis, the link between the gut and MS, and how to manage symptoms.

Person experiencing digestive distress at home

dusanpetkovic / Getty Images

Bowel Problems With MS

MS can have several effects on the function of the intestines.


Constipation affects about half of the people with MS. It usually results from one of two causes. First, decreased gut motility due to interrupted nerve signals to the gut can cause constipation, bloating, and belly pain. Second, difficulty eating or swallowing may lead to inadequate water or fiber intake.

Drinking more water, increasing your fiber intake, and taking a laxative or stool softener (as recommended by a healthcare provider) may help relieve your constipation symptoms. 

Fecal Incontinence

Fecal incontinence (lack of control of the passage of stool) is a symptom that usually presents later in people with MS. It affects 50% at least once and 25% as a chronic problem. Fecal incontinence occurs when nerve signals from the gut to the brain become disrupted.

If you have bowel problems, you may want to keep a diary of your bowel function that you can share with your healthcare provider. They will perform a rectal examination assessing muscle tone, sensation, and any other problems that might affect your bowels. 

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by sharp belly pains, bloating, constipation, and diarrhea. It is more common in people with MS than in the general population. The reasons for this are unknown and therefore the connection is a focus of MS research.

Studies indicate that those with IBS and MS report far lower mental and physical health-related quality of life than those without IBS.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract. It includes two conditions: Crohn’s disease and ulcerative colitis. IBD and MS have long been associated with one another, but the exact link between the two is unknown.

Some researchers theorize that there may be common connections between the pro-inflammatory states of MS and IBD. IBD in people with MS is likely underreported. Some studies suggest a 1.5 to 5-fold increase in the risk of the development of MS in people with IBD. 

The Link Between MS and the Gut

A large and expanding body of evidence points to changes in the gut-brain axis as playing a crucial role in the pathogenesis (disease development) of MS. The gut-brain axis refers to how the gastrointestinal tract and central nervous system (brain and spinal cord) interact.

When the composition of the microbe community in the gut is out of balance, it is referred to as dysbiosis. It is associated with a proinflammatory state that contributes to central nervous system inflammation. This inflammation can cause gastrointestinal distress and changes in bowel function as your MS progresses. 

How to Manage Gastrointestinal Symptoms

Many factors, including your diet, where you live, and the presence of an infection, may contribute to disturbances that throw off the balance of your gut microbiome.

Helpful ways to manage or prevent gastrointestinal symptoms include making lifestyle changes like engaging in routine exercise, taking a probiotic, eating a balanced diet mainly consisting of natural fruits and vegetables, getting plenty of rest, and drinking adequate amounts of water.

Using over-the-counter medications like laxatives and stool softeners can help relieve constipation. Talk to a healthcare provider before starting these medications to ensure that they do not interfere with your MS treatments.


MS research has shown that nerve dysfunction alters the way your gut functions—causing gastrointestinal distress or bowel dysfunction—and may also be involved in changes in the gut microbiome, which may serve as a potential cause of disease.

Gastrointestinal problems linked to MS include constipation, fecal incontinence, irritable bowel syndrome, and inflammatory bowel disease.

A Word From Verywell

Gastrointestinal symptoms are extremely common among individuals with multiple sclerosis, but they can be well managed with proper treatment. You do not have to endure your symptoms alone or allow them to negatively impact your quality of life. A combination of medication and lifestyle changes may provide you with relief and prevent relapses.

Frequently Asked Questions

  • Is multiple sclerosis an inflammatory disease?

    MS is an autoimmune condition that is characterized by your own immune cells attacking the myelin sheath, a protein coat that protects your nerve cells. This process is associated with inflammation that may disrupt and destroy neurons throughout the central nervous system.

  • What are the most common comorbidities with MS?

    Comorbidities are conditions you have in addition to a diagnosed condtion. For MS, the most common comorbidities include depression, anxiety, hypertension (high blood pressure), high cholesterol, and chronic lung disease.

  • Is there a link between IBD and MS?

    There seems to be an association between multiple sclerosis and inflammatory bowel disease, especially in light of the similar environmental and genetic factors underlying the development of the two diseases. But the exact link between the two is unknown.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Donaldson GP, Lee SM, Mazmanian SK. Gut biogeography of the bacterial microbiota. Nat Rev Microbiol. 2016;14(1):20-32. doi:10.1038/nrmicro3552

  2. Preziosi G, Gordon-Dixon A, Emmanuel A. Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degener Neurol Neuromuscul Dis. 2018;8:79-90. doi:10.2147/DNND.S138835

  3. Jani B, Marsicano E. Constipation: evaluation and managementMo Med. 2018;115(3):236–40.

  4. Marrie RA, Leung S, Tyry T, et al. Functional gastrointestinal disorders negatively affect health-related quality of life in MS. Neurol Clin Pract. 2019;9(5):381-390. doi:10.1212/CPJ.0000000000000668

  5. Dziadkowiec KN, Stawinski P, Radadiya D, Al Abbasi B, Isaac S. Is multiple sclerosis an extra-intestinal manifestation of inflammatory bowel disease? Food for thought. Cureus. 2020;12(7):e9485. doi:10.7759/cureus.9485

  6. Kadowaki A, Quintana FJ. The gut-CNS axis in multiple sclerosis. Trends Neurosci. 2020;43(8):622-634. doi:10.1016/j.tins.2020.06.002

  7. Magyari M, Sorensen PS. Comorbidity in multiple sclerosis. Front Neurol. 2020;11:851. doi:10.3389/fneur.2020.00851

By Shamard Charles, MD, MPH
Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.