Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. ALS causes loss of muscle control, eventually making it difficult to speak, eat, move and breathe. But does ALS also affect bowel function?
Overview of ALS
In ALS, motor neurons that control voluntary muscle movements gradually degenerate and die. As these motor neurons are lost, the brain loses its ability to initiate and control muscle movement. Without these motor neurons, the muscles weaken and atrophy.
The effects of ALS are usually first noticed in the arms and legs. Early symptoms include:
- Tripping or falling
- Dropping things
- Weakness in arms, hands, legs or feet
- Impaired walking or running
As ALS progresses, muscle weakness and atrophy spread to other parts of the body. Symptoms often include:
- Difficulty using arms and hands
- Difficulty speaking or swallowing
- Muscle cramps and twitches
- Weight loss
In later stages of ALS, muscle weakness affects breathing and vital functions. Complications can include:
- Shortness of breath
- Respiratory failure
- Pneumonia
- Inability to cough or swallow
Does ALS Affect Bowel Function?
Many people with ALS do experience changes in bowel function and control as the disease progresses. Common bowel-related symptoms include:
- Constipation
- Diarrhea
- Difficulty passing stool
- Leaking stool
- Gas and bloating
There are several reasons why ALS can negatively impact bowel function:
Weakened abdominal muscles
Defecating and passing stool requires contracting the abdominal muscles to generate pressure and move the stool through the bowels. As ALS weakens abdominal muscles, this process becomes more difficult.
Loss of voluntary control over sphincter muscles
Sphincter muscles control the anus and rectum, allowing stool to pass through and holding it until an appropriate time. As ALS damages nerves controlling sphincter muscles, people lose voluntary control over bowel movements.
Slowed movement of stool through intestines
Peristalsis is the contraction of intestinal muscles that pushes food and stool through the digestive tract. ALS can impair peristalsis, slowing down the movement of stool and leading to constipation.
Medications
Drugs used to help manage other ALS symptoms, like muscle relaxants, pain relievers and antidepressants, may cause side effects like constipation or diarrhea.
Diet changes
Difficulty swallowing often leads people with ALS to change to a soft food diet. A lack of fiber from fruits, vegetables and grains can contribute to constipation.
Immobility
Physical activity normally helps move stool through the bowels. As mobility decreases with ALS progression, lack of activity allows stool to sit in the intestines longer, leading to constipation.
Dehydration
Staying hydrated is important for healthy bowel function. Difficulty swallowing can make it harder for people with ALS to drink enough fluids, resulting in dehydration and constipation.
Managing Bowel Problems in ALS
While ALS itself cannot be cured, treatments and lifestyle changes can help manage bowel dysfunction and improve comfort. Strategies include:
Dietary Changes
- Eat high-fiber foods like fruits, vegetables, whole grains
- Drink 6-8 glasses of fluid daily
- Limit dairy products if constipated
- Limit fatty, spicy or gas-producing foods if experiencing diarrhea
Bowel Regimen
- Establish a regular time to use the bathroom each day
- Use abdominal massage and splinting techniques to aid bowel movements
- Try squatting position on the toilet to mimic natural position for defecation
Physical Activity
- Perform range of motion exercises for arms and legs
- Do gentle core-strengthening exercises
- Go for walks or do other activities within physical limits
Medications
- Laxatives, stool softeners, fiber supplements for constipation
- Anti-diarrheal medications for diarrhea
- Antibiotics for bowel infections
- Medications to reduce gastric reflux, gas and bloating
Bowel Care Techniques
- Use laxatives, enemas, or manual disimpaction if needed
- Try transanal irrigation systems to regulate bowel movements
- Consider colostomy or ileostomy for severe cases
The Impact of Bowel Dysfunction on Quality of Life
For many people living with ALS, losing control over bowel function is embarrassing, frustrating and depressing. Constipation and incontinence can severely impact quality of life.
In one survey of ALS patients:
- 63% reported constipation
- 26% experienced fecal incontinence
- 56% said bowel symptoms significantly reduced their quality of life
Bowel problems can also contribute to isolation and withdrawal from social situations. Some people may limit leaving home due to fears of public accidents.
Open communication with family, caregivers and medical providers is important for managing bowel issues in ALS. Being proactive and using all available treatments can help restore dignity and improve quality of life.
Conclusion
ALS frequently affects the muscles, nerves and mobility involved in bowel function. Many people with ALS experience issues like constipation, diarrhea and loss of sphincter control. By understanding the mechanisms involved, making dietary changes, following an effective bowel regimen and using medications or bowel care techniques, it is often possible to significantly improve bowel symptoms.
While bowel problems associated with ALS can reduce quality of life, being proactive with management strategies helps maintain dignity and comfort. Working closely with healthcare providers allows people with ALS and their caregivers to optimize bowel function and focus their energy on enjoying the present.