Constipation is a common symptom for both children and adults with DMD and other neuromuscular disorders and can be very uncomfortable and dangerous if untreated (Kraus et. al. 2016). Although comparatively less studied than the muscles involved in chewing and swallowing, muscles involved in defecating (pooing/pooping) can also be severely affected by Duchenne. It has been shown that food and stool takes longer to pass through the gastrointestinal tract in adults with DMD compared to healthy adults (Cascio and Goetze et. Al. 2016).
Adequate intake of fluids and fibre can often prevent constipation from occurring, but where this is not successful, it is important that constipation is treated promptly and regularly. Stool softeners, laxatives, and stimulants can be used to deal with constipation and prevent it from occurring:
- Osmotic laxatives work by increasing the water content of your stool to make it easier to pass. These include medications such as Movicol, Macrogol, Lactulose, etc. These are often prescribed for long-term use in adults with DMD and can be effective in treating severe constipation/faecal impaction.
- Hyperosmotic laxatives such as glycerin suppositories and enemas similarly work by attracting water into the bowels to make stools softer. These are inserted up the rectum and have a typically more immediate effect, but are not recommended for long-term use due to the potential for loss of nutrients (e.g. bicarbonate) from the bowel.
- Stimulant laxatives such as dulcolax and senna stimulate the muscles around the gut to move your stool through your intestine. It is unknown whether the benefit of these laxatives is reduced in adults with neuromuscular disorders due to their reduced muscle function.
- Bulk forming laxatives are fibre supplements which increase the fluid content and bulk of stools. However, these can worsen symptoms if fluid intake is not increased and are not very useful.
“To manage constipation I have fruit, veg and fruit juice daily, and usually use one sachet of Movicol every 2nd day, and every day if becoming more difficult. It works very well, and I rarely have problems”.Mark, UK
“I use the Peristeen anal irrigation system that uses water to empty out the bowel, inserted into the rectum using a rectal catheter whilst sitting on the toilet. The water stimulates the bowel and flushes out the stool, leaving the lower half of the bowel empty. My carers received training in the system from a registered nurse and the system is prescribed by my doctor. It took me a while to get used to, but once I got used to it I found it very useful and effective, as it relieves the strain and minimises the strength required when going to the toilet”.Mithun, UK