How can constipation be treated?

Constipation is a fairly common problem among people with ALS, and it has a variety of causes. Difficulty swallowing or a loss of appetite can lead to changes in dietary composition. Spending most of the time sitting or lying down, as well as reduced mobility, are associated with decreased stimulation of bowel function. This can be compounded by direct weakness of the abdominal muscles, which can also affect motor bowel function.

Another factor is medication used to treat ALS, which can reduce bowel activity (as a side effect). When treating constipation in ALS patients, it is therefore important to identify the underlying causes. The first step is to examine dietary composition. A high-fiber diet and the use of special bulking agents and swelling agents—such as flaxseed—can increase the fiber content of meals and thereby stimulate bowel activity. This requires adequate fluid intake.

Additional measures include physical therapy to support mobility, maintaining an upright body position as often as possible, and, if necessary, colon massage (external massage of the abdominal wall in the direction of normal bowel movements to stimulate bowel transit). If symptoms persist despite dietary changes and physical measures, the use of “laxatives” is an option. Commonly used medications include^Movicol® (macrogol),^Dulcolax® (bisacodyl),^Laxoberal® (sodium picosulfate), and other medications, each of which is available in the form of tablets, drops, suppositories, or enemas.

Constipation is a common problem in the general population, even among those without ALS. As a result, the majority of primary care physicians and specialists in general practice and internal medicine have experience and expertise in treating constipation.