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MS Constipation – Medication Review and Macrogol — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationMS Constipation – Medication Review and MacrogolSCE Neurology

A 55-year-old man with MS has chronic constipation. He has tried increasing dietary fibre and fluids without improvement. He is on baclofen and oxybutynin. What should be the approach?

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Correct answer: A — Review medications (baclofen and oxybutynin both cause constipation), consider reducing anticholinergic burden, then use macrogol laxatives as first-line pharmacological treatment, and establish a regular bowel routine

Constipation in MS is multifactorial: reduced colonic motility (autonomic dysfunction), reduced physical activity, medications (antimuscarinics, baclofen, opioids), and reduced fluid intake. Management: (1) review and reduce constipating medications where possible, (2) ensure adequate fibre and fluids, (3) macrogol (PEG) laxatives as first-line, (4) establish a regular bowel routine (toilet timing, positioning), (5) suppositories or enemas if oral laxatives fail, (6) consider transanal irrigation for refractory cases. A: Constipation should be actively managed. C: Macrogol is first-line before stimulants. D: Very common in MS. E: Surgical is very last resort.

Reference: NICE NG100 MS; ABN MS Guidelines