How Ataxia Can Affect Digestion and Gut Health

Digestive problems aren’t always symptoms of ataxia, a group of conditions that interfere with muscle coordination and cause balance and movement issues. However, gastrointestinal (GI) symptoms can occur with certain forms of ataxia.

Ataxia often results from damage to the cerebellum, the part of the brain that controls muscle coordination. There are many types of ataxia — some are hereditary (passed down via genes in families) while others develop from head injuries, medications, or other health conditions.

While certain forms of ataxia can affect gastrointestinal health, others aren’t known to cause GI symptoms. Here’s what you need to know about ataxia, digestion, and gut health.

Understanding the Brain-Gut Connection

To understand how certain ataxia types can affect the digestive system, it can be helpful to understand the brain-gut connection. The enteric nervous system is the section of your nervous system that controls the GI tract. There are even more neurons (nerve cells) in your enteric nervous system than in your spinal cord.

Some of the neurons in the GI tract are sensory neurons. They sense movement, hunger or fullness, and types of nutrients in the gut. Other neurons in the GI tract are motor neurons, which control muscle activity and support the process of digestion.

The brain-gut connection is the connection between the enteric nervous system and your central nervous system (brain and spinal cord). Remember, ataxia starts within the brain, specifically the cerebellum. Different types of ataxia can affect your digestion and gut health because of this critical connection.

Friedreich Ataxia and the Gut

Friedreich ataxia is the most common type of hereditary ataxia. Symptoms usually appear before age 25. Symptoms of Friedreich ataxia can include trouble walking, high arches of the feet, and slurred speech. According to one study, around 64 percent of people with Friedreich ataxia experience bowel dysfunction symptoms. The most common GI symptoms of Friedreich ataxia are:

• Constipation — Having a hard time pooping or being “blocked up”
• Bowel incontinence — Leaking or not being able to control when you poop

Researchers don’t fully understand how bowel symptoms develop in Friedreich ataxia, but they suspect that dysfunction of autonomic nerves and pelvic nerves may be to blame. Autonomic nerves regulate digestion and other unconscious processes. Other factors, like medications for Friedreich ataxia symptoms or diet changes, might also contribute to GI issues.

Because bowel symptoms are so common in Friedreich ataxia, your doctor may want to evaluate your bathroom habits regularly. They may recommend laxatives or bowel irrigation to improve GI symptoms.

Friedreich Ataxia and Inflammatory Bowel Disease

Research suggests that inflammatory bowel disease (IBD) may be more common in people with Friedreich ataxia than in the general population. IBD includes Crohn’s disease and ulcerative colitis, both conditions that involve chronic (long-term) inflammation in the digestive tract.

Gluten Ataxia and the Gut

Gluten ataxia is a rare type of ataxia that can develop in some people when they eat foods that contain gluten. If you have gluten ataxia and eat foods containing gluten (such as bread or pasta), your immune system attacks your nervous system and causes ataxia symptoms.

For some people, gluten ataxia is related to celiac disease. But this isn’t always the case — you may be gluten-sensitive without celiac disease and still experience gluten ataxia. Gluten ataxia may or may not involve digestive symptoms of celiac disease, including:

• Abdominal pain
• Bloating
• Diarrhea

The most effective way to manage gluten ataxia is by following a gluten-free diet. To do this, avoid foods containing gluten or replace them with gluten-free alternatives. Doing this not only helps prevent GI and general ataxia symptoms but also minimizes damage to your cerebellum.

Spinocerebellar Ataxia Type 3 and the Gut

Spinocerebellar ataxia type 3, also called Machado-Joseph disease, is a hereditary, degenerative form of ataxia that usually begins between ages 40 and 70. The main symptoms of spinocerebellar ataxia type 3 are muscle twitching, neuropathy in the hands and feet, and an unsteady gait. However, research suggests it’s also associated with disruptions in the gut microbiome (which includes bacteria and other living things in the gut).

One study evaluated bladder and bowel symptoms of spinocerebellar ataxia (including type 3 and others). In this study, 31.4 percent of participants reported bowel symptoms. Most bowel symptoms seen in the study were mild and didn’t have a major impact on participants’ quality of life. This study didn’t have a control group (group of people without spinocerebellar ataxia for comparison), so the percentage may be similar to that of the general population.

Other research on bowel symptoms in spinocerebellar ataxia type 3 found that around 13.3 percent of participants experienced constipation. Diarrhea was less common in spinocerebellar ataxia type 3, affecting just 6.7 percent of participants.

Research indicates that managing gut health may help manage Machado-Joseph disease and reduce symptoms. To do this, your doctor or dietitian may recommend taking probiotics or simply changing what you eat. Probiotics are foods that contain live bacteria that support your gut health and help control potentially harmful gut bacteria. Many fermented foods, like yogurt and kimchi, contain probiotics, but you can also take probiotics in the form of supplements.

Sporadic Ataxias and Gut Health

Sporadic ataxia is a group of ataxia conditions that aren’t linked to your family history. Researchers believe genes might still be involved, but those genes have not been identified yet. In these ataxias, doctors can see brain changes that occur because of the loss of neurons. Brain scans usually don’t detect such changes in certain hereditary ataxias, including Friedreich ataxia.

In some people, ataxia represents the initial constellation of symptoms of another condition called multiple system atrophy (MSA), which includes typical ataxia symptoms plus issues with the autonomic nervous system. These issues can include problems with digestion and bowel function.

The most common digestive symptom of MSA is constipation. When you experience constipation, any stool you produce may be dry and solid. Ongoing constipation can cause you to develop painful hemorrhoids and anal fissures.

Rarely, MSA can cause bowel incontinence. Bowel incontinence might cause unexpected leakage of stool when you don’t feel the urge to go to the bathroom. If you do feel the urge, you may not be able to hold your stool in long enough to reach the nearest bathroom.

Sporadic ataxia and MSA are rare and not well understood, and they don’t affect everyone in the same way. Work closely with your healthcare team to manage any digestive symptoms you experience if you have sporadic ataxia.

Talk to Your Doctor

If you have ataxia and experience digestive symptoms like bloating, constipation, or bowel incontinence, tell your doctor. Your gastrointestinal symptoms may or may not be related to ataxia, but it’s worth looking into if you experience GI symptoms frequently.

Your doctor might recommend keeping a journal of when your digestive symptoms occur, what they are, and what led up to them. They might also use tests to evaluate your ataxia progression. Once your doctor determines the cause of your digestive symptoms, they can recommend diet changes or treatments to help you manage them.

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