ALS and Constipation: Causes and Management of This Symptom

Amyotrophic Lateral Sclerosis (ALS) is a progressive disease that damages the body’s nerves so that they eventually cease to function and die off. It’s a rare condition that starts in one localised part of the body such as the hands, neck or feet but which quickly spreads.

The nerves control almost everything in our body. They carry messages to and from the brain when we want to sit, stand and speak and are involved in a variety of essential functions such as the body’s heartbeat, breathing, blood pressure as well as bowel and bladder function.

There are a number symptoms of ALS. In the early days, symptoms may include loss of slurred speech and hand/leg weakness. For example, the individual may have trouble undoing buttons on their shirt or have issues with walking.

As the disease spreads, loss of the swallowing reflex, difficulty breathing and increasing paralysis become primary symptoms.

One issue from the early stage of ALS and throughout its progression can be constipation. Managing this can be challenging and lead to a poor appetite and loss of weight.

Here we take a look at what constipation means for individuals with ALS.

What is Constipation?

In a normal functioning bowel, food moves down the stomach and is liquified as the nutrients are removed from it. The muscles of the intestine contract to pass this digesting food along in a process called peristalsis.

Once the food reaches the large intestine, water is removed and what remains is a fairly solid and compact stool which is then excreted from the body.

Constipation is caused when the passage and digestion of food is affected in some way. While rapid transit can lead to diarrhea, slow movement will make the stools harder and more difficult to pass. A sign of constipation is if the individual has to strain when going to the toilet.

Constipation can happen to anyone for a variety of reasons including poor diet, delaying going to the toilet, taking certain medications and even as a result of lack of exercise. In individuals with ALS, constipation becomes a regular issue from the early stages of the disease and is likely to get worse as it progresses.

Causes of Constipation in ALS Patients

One of the biggest problems with ALS and constipation is the lack of mobility, especially as the disease begins to spread. Individuals may have reduced muscle strength and will therefore not move around as much which can have a significant impact on bowel function and efficiency.

Individuals living with ALS will generally need to make adjustments to their diet. As the swallowing reflex diminishes and it becomes more difficult to eat, individuals will be limited in terms of the range of food they can consume. Often this can mean a reduction in dietary fiber being consumed.

Drugs such as painkillers and other medication are likely to also have a significant impact when it comes to constipation.

Trouble swallowing can also mean that the patient consumes less fluids. Water is essential for the proper functioning of the digestive system as food is being broken down. There may be a temptation to reduce water intake to cut down having to go to the toilet, especially if general mobility is affected.

As the nerves sending messages to the muscles begin to deteriorate and the problem spreads throughout the body, issues can extend to the process of peristalsis and prevent stools from being moved down the intestine effectively.

That, in turn, ensures transit of waste is greatly slowed and more water drawn out of the stool making it more difficult to move. Towards the later stages of ALS, when the disease has damaged nerves across the whole body, this will be an even bigger problem and requires careful monitoring.

Management of Constipation in ALS patients

Bowel problems in ALS patients are not uncommon but there are ways to effectively manage it, particularly in the earlier stages of the disease.  

• The first is to make sure that the individual has plenty of fluids in their diet and get their fair share of dietary fiber. Too much fiber can cause constipation, but it can also be caused by an insufficient amount of fiber being consumed.
• High fiber foods include fruits and vegetables. People with ALS should also try to avoid highly processed foods and stick with fresh ingredients where possible.
• Paying attention to good habits and not ignoring the call of nature is also important.
• While it is still possible, exercise can help improve the regularity of bowel movements.

In the early days of the disease, constipation is relatively easy to manage but as things progress there may be additional help that is needed. The use of laxatives and stool softeners to control bowel movement is one option but needs to be approached with care.

Where medication is being used, the timing and dose can all have an impact on whether an individual becomes constipated or not. It’s important to work with medical professionals to ensure that this effect is minimised.

One of Many Symptoms

There are a wide range of symptoms that are associated with ALS. Constipation can be a problem from the early days of diagnose and become increasingly difficult to manage as the disease progresses. Maintaining a good level of fluid intake and eating a sufficient amount of high fiber foods can contribute to health and wellbeing in the short and long term.