What is constipation?

Constipation is defined as bowel movements that become more infrequent (compared to your usual schedule), are difficult to pass and/or are hard

Why does it occur in individuals with a NBIA disorder?

• Constipation may be due to decreased activity and a sedentary lifestyle caused by NBIA symptoms
  • Constipation can worsen dystonia (involuntary muscle spasms); dystonia can make it hard to be active, and lack of activity can cause constipation
  • Once an individual falls into this cycle, it is difficult to break out
• It may be a side-effect of the medications (and/or diet) used to treat NBIA

How can it be treated?

• Bowel training/regimen
  • A series of steps that can be used to try to restore or improve bowel function
  • Usually takes 2-3 months to treat constipation

Step 1: Diet and fluid intake

• Eat meals at the same times each day
• Include fruits, vegetables, whole grain breads and cereals in daily meals
• Drink 6 to 8 glasses of fluid daily (not including caffeine or alcohol)
• Drink warm liquids after waking up and with breakfast (stimulates bowel activity)
• Establish a relaxed, regular time of the day for bowel movements (about 1/2 hour after a meal is best)

If there is no improvement after two weeks, add Step 2

Step 2: Fiber supplement (bulk former)

• Increases stool mass so bowel movements are more frequent
• Prevents stool from being stored in the intestine too long and getting dry/hard
• Over-the-counter medications like bran, Metamucil and Fibercon
• Use daily (they are not habit forming)
• Drink 6-8 cups of liquid daily with fiber supplements
• Don’t increase the amount of fiber supplements too quickly
  • Can result in gas formation or stomach fullness
• May take 2-3 months to correct constipation

If there is no improvement after a few months, add Step 3 (may skip straight to Step 3 if stools are very hard)

Step 3: Stool softener

• Increases water content in the stool so it is softer and easier to pass
• Over-the-counter medications like Colace and Surfax
• Use daily (they are not habit forming)
• Begin with one a day (increase to one each morning and evening if needed)

Steps 4 and 5 should be used sparingly

Step 4: Laxatives and suppositories

• Laxatives
  • Should be used with caution
  • Activate the bowel through chemical irritation
  • Long-term use may harm the bowel
• Suppositories
  • Empty bowel through rectal stimulation
  • Stool must be present in the rectum for a suppository to work
  • Suppositories must make contact with the inside wall of the rectum to work

Step 5: Enemas

• Habit-forming
• Should only be used when nothing else works

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