Largely due to decreased activity and diminished diaphragm function, ALS/MND increases the likelihood of constipation occurring. Stools can become hard, infrequent and difficult to expel. Diet, medications, lack of fluids, and lack of exercise can also contribute to constipation.
Before turning to laxatives, natural changes can be effective. Exercise brings more blood, oxygen and nutrients to the intestines. Fluids are the most effective and most natural stool softener (drink eight 8-oz glasses, or five glasses of very warm water, daily). 20 to 35 grams of fiber each day helps to form soft, bulky stools and develop regular contractions. Other dietary aids include fruit and vegetable juices (particularly stewed prunes or prune juice), probiotic yogurt (such as Activia), clear soup, and one tablespoon of olive or vegetable oil. Natural supplements include a daily dose of vitamin C (500 mg) and magnesium (400 mg) as a preventative, with each dosage increased by 100 mg/day (or up to 1,000mg total).
Laxatives should be used only if natural methods are ineffective, beginning with the mildest type. Fiber laxatives increase the absorption of fiber. Available without a prescription, some use natural fiber, while others use synthetic cellulose. However, these must be accompanied by a high fluid intake, which can be difficult and therefore inadvisable for those with difficulty swallowing.
Stool softeners, or emollient laxatives, increase the water content of the stool and greatly reduce the amount of straining needed to have a bowel movement. They are often ideal for ALS/MND patients, as they can be used when fiber and fluid intake is difficult. They are also helpful when decreased diaphragm ability makes it difficult to bear down and push.
The use of harsher laxatives should always be discussed with a primary physician. They include hyperosmotic laxatives (suppositories), which draw water into the bowel from surrounding body tissues; lubricants, which use mineral oil to coat the stool but should not be used with even the slightest swallowing issues; and stimulant laxatives. A successful laxative for ALS patients has been docusate sodium (50 mg) with sennosides (8.6 mg), the generic version of Peri-Colace, which is widely available and inexpensive.
While most ALS patients experience constipation, some medications and foods can cause the reverse problem of diarrhea or overly loose stools. Traditional solutions include burned toast, the BRAT diet (bananas, rice, applesauce and toast), chamomile or peppermint tea. If diarrhea persists, over the counter medications (prescription not required) like Imodium or Kaopectate can help.
If you or your physician have any questions or would like to discuss our viewpoints regarding these medications, please email us at [email protected]