Constipation is one of the most common and impactful challenges facing patients with MS. This may occur for a few reasons. MS could impact a person’s neural control of the gut. Alternatively, impairment in skeletal muscle function could impact the ability to have a normal bowel movements or influence the efficiency of the colon’s transit of stool. “For example, bowel movements require abdominal muscle contractions to generate the force of ‘expulsion,’ and weak abdominal muscles make it much more difficult to expel stool,” Dr. Levinthal says. “It is also well-known that the colon’s actions are impacted by activity level, and many MS patients suffer from impaired mobility that can lead to constipation.” Another common issue that MS patients experience is trouble with swallowing, which can limit dietary choices and, in some cases, even lead to choking episodes or inadvertent passage of food or drink into the lungs. This can occur because MS affects brain function, thus disrupting the nervous system regulation of the refined patterns of muscle coordination needed for swallowing.