An external condom catheter provides an excellent solution for urination problems. I’ve used one 24/7 for quite a while now with great success. From my own personal experience, nothing breaks a man’s spirit more than putting a diaper on him. It’s understandable if a PALS is bed-bound or has diarrhea, but it is possible to schedule bowel movements to a certain degree. Constipation and spending countless hours on the throne is another issue.
Constipation was a topic that I always use to take lightly, until I had severe problems with it. I reached a point after my peg tube operation where constipation had caused me extreme pain. I was so inflamed and impacted that a manual “ROTOR ROOTER” job was required to resolve the problem. Talk about pain. I screamed more than my wife did when she was in labor – only I didn’t have the option for an epidural. I now take constipation very seriously and I’ve learned several things about it that I would like to share with you, so that perhaps you may avoid going through what I did.
Resolving constipation would be so simple if only we could watch our diets, drink enough fluids, go to the bathroom when needed and be more active. Life with ALS just isn’t that simple though. As the muscles involved in chewing, moving food toward the back of the mouth, and swallowing weakens in ALS, eating and drinking become less pleasurable and more time-consuming. Difficulties with chewing or swallowing may cause PALS to eat soft foods that are processed and low in fiber. Foods that are high in fat and sugar and those that tend to be low in fiber content, such as eggs and dairy foods, may cause or aggravate constipation.
Constipation is a symptom that has different meanings to different individuals. Most commonly, it refers to infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool, the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories or laxatives in order to maintain regularity. Constipation occurs when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. As a result, stools can become hard and dry. Constipation may cause the stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. Neurological disorders can slow the movement of stool through the colon and rectum.
It seems like there is no one best bowel program that can be applied to everyone. What works for one, may not work for another. Each one of us has unique life styles and other variables that come into play with constipation. A number of factors can disrupt normal bowel function, including inadequate fluid intake, a low-fiber diet, inattention to bowel habits, age, the combination of reduced activity and progressive motor neuron dropout, depression, and even stress. Many medications, including painkillers, antidepressants, tranquilizers, blood pressure medication, diuretics, iron supplements, and calcium supplements can cause or worsen constipation.
There is a general concept that low intake of fiber or fluids may commonly cause constipation. Western diets often provide only about 1/3 of the daily levels of fiber intake recommended by nutritionists. Hence, fiber, often provided as supplements or over the counter drugs, is widely used to treat constipation. Fiber clearly increases stool bulk and frequency, and decreases transit time in healthy people, and may benefit individuals with relatively minor or occasional constipation. However, the few studies in which dietary fiber has been used to treat chronic constipation have not demonstrated significant benefit. Thus, many conclude that low fiber intake cannot be a cause of chronic constipation, and that increasing fiber intake is unlikely to offer significant benefit for patients with more severe constipation. Nevertheless, a high fiber diet should be tried before embarking on long-term drug treatments or special testing.
There is also a belief that constipation can occur from drinking insufficient liquid. Even small changes in stool water content can considerably alter stool consistency. Osmotic laxatives work by this rationale. These agents (e.g. milk of magnesia or lactulose) help retain water in the stool. Normally, the colon absorbs very large amounts of water -- almost 90-95% of the water that enters it daily. Therefore, simply adding a small amount of fluid to one's diet, say 1 or 2 additional glasses of liquid, will not have an effect on constipation. So far, research does not support increasing fluid intake to relieve constipation, but dehydration should be avoided.
If you use laxatives frequently, you may develop lazy bowel syndrome, a condition in which your bowels become dependent on laxatives to function properly. In fact, laxative use can cause a number of problems, including poor absorption of vitamins and other nutrients, damage to your intestinal tract and worsening constipation. A doctor should determine when a patient needs a laxative and which form is best.
My doctor prescribed a combination of liquid Enulose (lactulose) and liquid Senna in my peg to regain some regularity; it usually does the trick. If that doesn’t work or if I want to plan an outing and have a bowel movement before I go out, I break out the big guns – liquid glycerin suppositories by Fleet. They can be administered while sitting on the throne and work in minutes. Bombs away!
Hope this helps
Pat McClellan
Limb onset 5/02, Dx 2/03, W/C 4/04, Bipap 11/04, Peg 10/05, Hospice 1/06