Neurologic Causes of Chronic Constipation: An Overview

What Is Chronic Constipation?

Chronic constipation is a persistent and ongoing condition where a person experiences difficulty or has infrequent bowel movements. It is typically diagnosed when the symptoms persist for at least three months, despite attempts to improve bowel regularity.

Chronic constipation can have various causes, like low fiber and inadequate fluid intake. Certain medications, such as pain medications (for example., opioids), antacids with aluminum or calcium, and some antidepressants, can cause constipation as a side effect. Chronic constipation can be associated with underlying medical conditions, such as irritable bowel syndrome (IBS), hypothyroidism, neurological disorders (Parkinson's disease), and pelvic floor dysfunction. Stress, anxiety, and depression can impact bowel function and contribute to chronic constipation.

What Are the Symptoms of Chronic Constipation?

The symptoms of chronic constipation may vary from person to person, but some common signs and symptoms may include:

• Infrequent bowel movements.

• Difficulty passing stools or straining during bowel movements.

• Hard, dry stools.

• A feeling of incomplete bowel evacuation.

• Abdominal bloating or discomfort.

• Rectal pain or discomfort.

• Manual maneuvers (such as pressing on the abdomen) are needed to assist with bowel movements.

What Are the Neurologic Causes of Chronic Constipation?

Neurological diseases can play a role in chronic constipation by affecting the nerves that control the gastrointestinal tract muscles. Here are some neurological causes of chronic constipation:

• Parkinson's Disease: Parkinson's disease is a progressive neurological disorder that affects movement control, including the gastrointestinal tract muscles. The slowed movement of the intestines and reduced coordination of the muscles can lead to chronic constipation.

• Spinal Cord Injury (SCI): SCI can damage the spinal cord's nerves, affecting the signals that control bowel function. Depending on the level and severity of the injury, chronic constipation can result from impaired nerve function.

• Multiple Sclerosis (MS): Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system, including the nerves responsible for regulating bowel function. Damage to the nerves can disrupt regular muscle contractions and coordination of the intestines, leading to constipation.

• Hirschsprung's Disease: Hirschsprung's disease is a congenital condition with a lack of nerve cells in a portion of the colon, leading to functional obstruction and chronic constipation since the affected segment of the colon cannot usually propel stool.

• Autonomic Neuropathy: Persistent constipation can arise when the nerves that control the autonomic nervous system, responsible for regulating involuntary bodily functions, including digestion, are damaged. This can occur in diabetes, amyloidosis, and other neuropathies.

• Stroke: A stroke, a disruption of blood flow to the brain, can affect the nerves that control bowel function. Depending on the location and extent of the stroke, it can result in chronic constipation.

• Other Neurological Disorders: Certain other neurological disorders, such as muscular dystrophy, Charcot-Marie-Tooth disease, and Ehlers-Danlos syndrome, can impact the nerves that control the muscles of the gastrointestinal tract. These conditions result in chronic constipation.

It is important to note that each case of chronic constipation is unique, and the specific neurological cause and severity of symptoms may vary. For chronic constipation linked to neurological conditions, it is crucial to undergo a thorough assessment and receive a diagnosis from a healthcare provider specializing in neurology or gastroenterology. This evaluation will help determine the underlying cause and establish an effective treatment plan.

How Is Diabetes Associated With Chronic Constipation?

Diabetes can potentially impact bowel function and contribute to chronic constipation. Here are some ways in which diabetes can be associated with chronic constipation:

• Neuropathy: Diabetes can cause damage to the nerves, a condition called neuropathy. Neuropathy can affect the nerves that control the digestive tract muscles, leading to slowed or weakened contractions (peristalsis) that propel stool through the intestines, resulting in constipation.

• High Blood Sugar Levels: Elevated blood sugar levels resulting from uncontrolled diabetes can impact the moisture level of stool. High blood sugar levels can draw excess water from the intestines, resulting in harder and drier stool that is more difficult to pass, leading to constipation.

• Medications: Some medications used to manage diabetes, such as certain types of oral antidiabetic drugs or Insulin, can affect bowel function and contribute to constipation as a side effect.

• Diet and Lifestyle: Poor dietary choices and a sedentary lifestyle, which can be risk factors for diabetes, can also contribute to constipation. A diet low in fiber, inadequate fluid intake, and a lack of physical activity can disrupt normal bowel function and result in constipation.

What Is the Treatment of Chronic Constipation in Neurologic Diseases?

The treatment for constipation in neurological diseases typically involves a multi-faceted approach that addresses the underlying neurological condition, promotes bowel regularity, and manages any contributing factors. Here are some common treatment options for constipation in neurological diseases:

• Medications: Various drugs may be used to manage constipation in neurological diseases. These include laxatives, stool softeners, and prokinetic agents that promote movement of the intestines. The selection of medication is contingent upon several factors, including the severity of constipation, the underlying neurological condition, and other relevant considerations.

• Fiber Supplements: Fiber supplements, such as Psyllium husk or Methylcellulose, may be recommended to increase bulk and soften stool, which can help promote regular bowel movements. However, fiber supplements should be used cautiously in some neurological conditions, as they may sometimes worsen symptoms.

• Fluid Intake: Staying adequately hydrated by drinking fluids, especially water, can help soften stool and facilitate bowel movements. Unless contraindicated by other health conditions, it is crucial to ensure sufficient fluid intake is maintained.

• Diet Modifications: Dietary changes, such as increasing high-fiber foods like fruits, vegetables, whole grains, and legumes and avoiding low-fiber foods like processed foods and dairy products, can help improve bowel function. A registered dietitian or healthcare provider can provide specific dietary recommendations tailored to the individual's needs and underlying neurological condition.

• Bowel Retraining: Bowel retraining techniques, such as establishing a regular bowel routine, can help retrain the bowels to have regular bowel movements. This may involve scheduling time for bowel movements, creating a relaxed environment, and using relaxation techniques during bowel movements.

• Physical Activity: As tolerated and appropriate for the individual's condition, regular physical activity can help stimulate bowel function and promote regular bowel movements.

• Pelvic Floor Therapy: Pelvic floor therapy, which involves exercises and techniques to strengthen the pelvic floor muscles, may be beneficial in cases where pelvic floor dysfunction contributes to constipation. A pelvic floor physical therapist can guide appropriate exercises and techniques.

• Enemas or Suppositories: In some cases, enemas or suppositories may help relieve severe constipation. However, these should be used with caution and only under the guidance of a healthcare provider.

• Adjustments to Medications: If medications being taken for the underlying neurological condition contribute to constipation, a healthcare provider may consider adjusting the medication regimen or exploring alternative options.

• Other Interventions: In some cases, more invasive interventions, such as manual disimpaction or other bowel evacuation techniques, may be necessary for severe cases of constipation.

Conclusion

Chronic constipation can be attributed to neurological conditions such as spinal cord injury, multiple sclerosis, and Parkinson's. To determine the underlying cause and develop an appropriate treatment plan for chronic constipation associated with neurological conditions, it is crucial to undergo a thorough evaluation and receive a diagnosis from a healthcare provider with expertise in neurology or gastroenterology. The treatment approach may encompass personalized lifestyle adjustments, medications, and other interventions tailored to meet the specific requirements of the individual and address the underlying neurological disorder.