Medication Side Effects And The Gut
The interactions between PD medication ingestion and the gut can play a major role in motor fluctuations the phenomenon in which a patients response to Levodopa varies widely during the day. A recent APDA webinar helps to explain this interplay.
Delayed gastric emptying
Delayed gastric emptying can interfere with medication absorption. Medication doses that are ingested by mouth may sit in the stomach before being transported to the small intestine where they are absorbed. Delayed gastric emptying could be responsible for dose failures when a dose of medication does not have a robust enough effect.
Protein effect
Levodopa crosses the wall of the small intestine via a molecule in the intestinal wall that transports amino acids, the building blocks of protein. When dietary protein is also present in the small intestine, then there are fewer transporters available for Levodopa to use. A patient may therefore experience the protein effect, in which he or she feels that medication is not as effective after a high-protein meal. Sources of dietary protein include: beef, chicken, pork, fish, eggs, nuts and dairy.
Helicobacter pylori and small intestinal bacterial overgrowth
About a third of PD patients are infected with Helicobacter pylori, a common bacteria which can cause gastritis and ulcers. Infection with Helicobacter pylori has been linked to worsened motor fluctuations. It can be diagnosed with a urea breath test that analyzes exhaled air.
What Should I Watch Out For If I Have Chronic Constipation
Chronic constipation can lead to fecal impaction due to the accumulation of stool which dries out in the intestine. This dry mass then becomes increasingly difficult to evacuate. In this case, the use of stimulant laxatives will not be effective in evacuating the stool and will cause painful contractions of the colon muscles that will be felt as abdominal pain. Enema is then preferable.
Chronic constipation can also lead to watery diarrhea. In this case, the contractions of the colons muscles allow liquids from the intestine to pass around the dry mass.
When Parkinsons Interferes With Gastrointestinal Function
This 63-minute audio with slides by Dr. Peter A. LeWitt discusses the effect of Parkinsons disease on the gastrointestinal system, with particular focus on constipation. Improving GI function can have a positive impact on the consistency of benefit from Parkinsons disease medications. Highlights of recent research into Parkinsons disease originating in the GI tract, developing biomarkers for early diagnosis, and others.
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Food Diet Guidance To Avoid Constipation For Parkinson People
When we talk about the proper Management of Constipation in Parkinsons Disease. Eat a balanced diet with ample of fibers.
Good sources of fiber are fruits, vegetables, whole grains, Green leafy, sprout, etc. Check the below list of Fiber items.
Name: High Fiber of Fruit
1 medium-sized Ripe Banana: 2.6 gm.
1 medium-sized Orange: 2.4 gm.
1 medium-sized Muskmelon: 0.9 gm.
1 medium-sized without peeled Cucumber: 0.7 gm.
1 medium-sized Apple with skin: 4.4 gm.
1 medium-sized Grape: 3.9 gm.
1 medium-sized Watermelon: 0.4 gm.
1 medium-sized Kiwifruit: 2 gm.
100 gm Blackberries: 7 gm.
medium-sized Watermelon: 0.4 gm.
mustard greens are not only rich in fiber but full of Vitamin C, Vitamin K,
Why Do I Get Constipated
We are still learning about constipation in PD and why it happens. Here is what we know:
Parkinsons Disease
The same changes that occur in brain cells in Parkinsons disease may also occur in nerve cells in the spinal cord and the intestinal wall. These changes may slow down the muscles that push food through the intestines.
Medications
Medications used to treat PD in particular, the class called anticholinergics and the medication amantadine, used to treat dyskinesia are known for causing constipation. If you are on these medications, your healthcare provider may be able to reduce your dose or switch you to a different one. But for some people, the benefits of the medication outweigh the possibility of constipation.
Because people with Parkinsons disease experience difficulty with their movement, they often become less active. People with PD who increase their movement experience better overall functioning, which includes their digestive system.
Many people with Parkinsons disease limit their fluids to avoid making frequent trips to the bathroom. When a person drinks less liquid, the gut may not have the lubrication it needs to have a bowel movement, which contributes to constipation.
Genetic Predisposition
It is possible to have a family predisposition to constipation. Ask family members what solutions work for them. Your body may respond to the same strategies.
Individual Body Chemistry
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The Healthy High Fiber Breakfast Menu For Proper Management Of Constipation In Parkinson Disease
We have shared a few breakfast ideas, You can try for Parkinsons patient.
South Indian fiber-rich breakfast options
Jowar palak Appe makes a great option for fiber-rich south Indian breakfast.
Another option for high fiber breakfast: Oats dosa, buckwheat dosa, Rava dosa, oats mutter dosa.Avoid tea and coffee for breakfast. Always have tea or coffee one hour before or one hour after your breakfast, the objective is to let the digestion take place and the nutrients get absorbed.
Treating And Managing Bowel Problems
The first step in dealing with bowel disorders is to talk to your doctor. He or she will probably review your medication to see if this is a contributory factor. Whilst it is usually possible to control any difficulties with diet, fluid intake and exercise, your doctor, or Parkinsons nurse specialist if you have one, will be able to advise further, and may, for example, prescribe laxatives in severe cases of constipation. If you have any alarm features such as unintentional weight loss or rectal bleeding, then you may need to be referred for specialist assessment.
The following healthcare professionals can also advise on aspects of bowel care:
- A dietician will be able to advise on diet and fluid.
- A physiotherapist may be able to help with advice and abdominal exercises which will help in passing stools.
- A speech and language therapist can help with swallowing problems. They may be able to advise on ways of relaxing your throat, and give guidance on posture and exercises to help overcome any difficulties you have.
- An occupational therapist may also be able to suggest practical ways to overcome any difficulties you have with eating and drinking.
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Demographic Information Of Pd
Demographic variables of PD-C and PD-NC groups were compared in Table . The age and age of onset of PD-C group were significantly older than that of PD-NC group . The disease duration of PD-C group was dramatically longer than that of PD-NC group . The LEDD of PD-C group was significantly higher than that of PD-NC group . There were no significant differences in gender, educational level, side of onset and clinical type between PD-C and PD-NC groups .
Table 1 Demographic variables of PD-C and PD-NC groups. **: P< 0.01 *: P< 0.05.
Bladder Issues With Pd
Bladder problems can also occur with PD and as a result of drugs used to treat PD. Two of the most common problems are:2
- The need to urinate often
- A sudden, strong urge to urinate
Your doctor might tell you your bladder is overactive or irritable. A loss of bladder control can also happen with PD, though this is not as common.2
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When Should You See A Doctor
Sometimes constipation can be a symptom of more severe illness, including colorectal and other types of cancer. See your doctor or other health care provider if your bowel habits change and are accompanied by any one of the following:
Visit the NIH National Institute of Diabetes and Digestive and Kidney Diseases educational page on constipation for more information on possible causes and treatments.
Urinary Issues In Advanced Parkinsons Disease
Urinary dysfunction and symptoms in PD are most commonly caused by overactivity of the detrusor muscle, or the muscle of the bladder, which contracts excessively despite the fact that it is not filled with urine. This causes an increased urge to urinate and/or an increased frequency of urination, which can be especially prominent at night. In advanced PD, this could culminate in urinary incontinence, or involuntary release of urine. Mobility issues which make getting to the bathroom slower and more cumbersome, compound the problem.
Always remember that people with advanced PD may have other medical problems that affect their urination such as an enlarged prostate. Make sure to have a complete evaluation before assuming that the problem is only related to PD. It is also essential to keep in mind that if changes in urination occur suddenly, there could be a urinary tract infection present.
Once other medical issues and urinary tract infection are ruled out, there are a number of approaches to the issue of urinary incontinence in a person with advanced PD:
Unfortunately, for some, the above available options may not be sufficient to effectively treat urinary incontinence in advanced PD. If this is the reality, it becomes extremely important to keep the skin dry with frequent changes of incontinence products to prevent skin breakdown and the potential development of skin infection.
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What Causes Constipation In People With Parkinsons Disease
During digestion, the muscles of the intestine contract simultaneously to move the food bolus through the intestine and excrete the undigested material in the stool.
Parkinsons disease causes degeneration of the neurons that control the intestine muscles, which slows down the digestive process and stool elimination. As a result, stool stays longer in the last part of the intestine, the colon, where liquid is reabsorbed by the intestinal wall, making it dry and harder to evacuate.
Symptoms of the disease can increase constipation problems. For example, less physical activity leads to less bowel stimulation. Difficulty chewing and swallowing may reduce the tendency to adopt a fibre-based diet and to drink enough water and beverages .
Some medications can also cause a decrease in the frequency of bowel movements. Talk about this with your doctor.
Constipation is common in the general population. Lifestyle and diet changes can often solve this problem.
- Make sure you eat enough vegetables and fruit, fresh or cooked.
- Add fibre to your meals .
- Increase your water intake . If you increase your fibre intake without drinking more water, you will be even more constipated. Try to drink more often and in small amounts.
- Eat several small meals during the day.
- Avoid coffee and alcohol since they cause dehydration.
- Do physical activity 15 to 30 minutes per day to stimulate your intestine.
- Drink slightly warmed prune juice.
Gastrointestinal Issues In Advanced Parkinsons Disease
Problems with motility of the gut can be a major source of difficulty throughout the disease course and can be particularly problematic in advanced PD as well. . Constipation, which can be one of the earliest symptoms of PD is a very common problem throughout the disease course. Two gut issues that tend to be particularly problematic in people with advanced PD are abdominal pain and fecal incontinence.
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Bladder And Constipation Problems
Parkinsons commonly leads to problems with constipation and bladder control, including urinary urgency, frequency, retention and nocturia.
These problems add to the challenge of living with Parkinsons and can have a negative effect on a persons quality of life. It is important to seek help in managing these problems, as both issues can be effectively managed.
Dietary Fibre For Constipation In Parkinsons Disease
Be guided by your doctor, but general suggestions include:
- Choose easy-to-eat fibrous foods such as soft fruits. Consider mashing or pureeing fruits to make them easier to eat. Make sure to include the skin, where most of the fibre is found.
- Eat at least two pieces of fruit and five serves of vegetables every day.
- Eat homemade vegetable soups.
- Sprinkle a tablespoon of bran, psyllium husks or chia seeds on your breakfast cereal or add the bran to baked products such as cakes. However, avoid bran if you have swallowing problems.
- Fibre supplements may be helpful, but you must drink enough fluids for these to work properly. Avoid fibre supplements if you have problems swallowing.
- Dont increase dietary fibre too quickly or youll risk bloating and abdominal cramps. If discomfort occurs, cut back your fibre intake, increase your fluid intake, apply a hot water bottle to your abdomen and see your doctor.
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What Types Of Medications Can Help Me
You also have access to over-the-counter medications in pharmacies or by prescription. Ask your pharmacist or doctor for advice and they will be able to help you choose.
- Emollient laxatives increase the volume of water in the feces and make the stool softer and easier to evacuate. They generally take effect within 1 to 3 days. Their effectiveness is often limited in people living with Parkinsons disease.
- Functional fibres are fibre supplements that trap water in the stool to increase its mass.
- Stimulant laxatives stimulate colon muscle activity to promote stool evacuation. Their effect is often immediate, but they should not be used to treat chronic constipation because they can irritate the intestinal wall and create dependency.
- Osmotic laxatives , lactulose and magnesium hydroxide) attract and retain water in the colon to facilitate and improve stool passage. This is usually the treatment of choice for physicians.
The Gastrointestinal Tract And Parkinsons
As promised in a previous blog, I now return to the topic of the gastrointestinal tract and Parkinsons disease . As most of you know, GI symptoms are very common in PD. We will discuss what those symptoms are, why they occur, and the current research that links what is happening in the gut to theories as to why PD occurs at all. Many of you have suggested gut-related topics for this blog including a discussion of symptoms such as bloating and constipation, and a discussion of the use of probiotics in PD. I will address these issues as well. Submit additional topics that you would like to read about here.
GI symptoms can be among the most bothersome of the non-motor symptoms of PD. Constipation is the most common of these symptoms, affecting 80-90% of people with PD. APDA has a helpful brochure with practical tips to prevent and treat constipation in PD.
GI pathology in Parkinsons disease however, can involve the entire GI tract and includes sialorrhea and dysphagia . In addition, delayed gastric emptying, in which the digestive contents are held up in the stomach and do not move normally into the small intestine, can cause sensations of nausea and bloating.
The gut has its own nervous system
The gut as a biomarker
Entry to the brain
How do Lewy bodies propagate?
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Toilet Habits And Constipation In Parkinsons Disease
Suggestions for good toilet habits include:
- Go to the toilet as soon as you feel the urge to pass a bowel motion. Hanging on can contribute to constipation.
- Use the correct posture on the toilet to help you pass a bowel motion place your elbows on your knees, bulge out your stomach, straighten your spine and put your feet on a footstool.
- Avoid holding your breath and dont strain when you are on the toilet. Allow yourself plenty of time.
- Use a warm washcloth pressed against your back passage or gently massage with one or two fingers to help to relax the muscles.
- Talk to your doctor or pharmacist about medicines to help soften your bowel motions.
Proper Management Of Constipation In Parkinson Disease
Today our topic is Proper Management of Constipation in Parkinson disease. Constipation is a common challenge for Parkinsons patients.
Most of Parkinsons patient has complained Constipation. Constipation Means when the movement of bowel becomes difficult or less frequent. Some people have bowel movements daily some of them do 3 times a day. Some people have bowel movements not regular in a week.
Due to constipation, PD people affect psychological and social distress and consequently losing the quality of life. Sometimes, Parkinsons caregiver is confused about how to do proper management of constipation in Parkinsons disease?
But trust me you can do proper Management of Constipation in Parkinsons Disease with the help of a good lifestyle and a proper diet.
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Why Might Constipation Be A Parkinson’s Symptom
This 62-minute audio with slides is presented as an interview of two neurologists and explains how the gastrointestinal musculature is well enervated and, therefore, affected by the loss of dopamine and deposits of alpha synuclein, just as the brain is. Management options are discussed, and recent research into the microbiome and the gut/brain connection in Parkinsons disease.
How Does Parkinsons Disease Affect The Digestive System
Parkinsons disease can affect the digestive system in a number of ways.
Dopamine is a neurotransmitter that plays a role in controlling muscle movement in the body. It can stimulate muscles in the digestive tract to help the digestive system function.
Parkinsons disease can lead to dopamine deficiency, which can cause a persons digestive system to slow down or function inefficiently. This in turn can result in constipation.
Parkinsons disease can also impair the normal function of the stomach, causing the stomach contents to empty into the small intestine too slowly. Health experts call this condition gastroparesis.
Gastroparesis is common in individuals with Parkinsons disease and can cause a person to develop symptoms
- stool softeners, such as Colace and Docusate
- lubricants, such as mineral oil
- stimulants, such as Correctol and Dulcolax
One of the most common laxatives doctors use to treat chronic constipation, such as that in people with Parkinsons disease, is polyethylene glycol, an osmotic laxative.
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