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Is Constipation A Symptom Of Parkinson’s Disease

Stay Away From Red Meat

Addressing Symptoms of Constipation in Parkinson’s

Parkinsons patients are recommended to stay away from red meat while constipated. This is because red meat contains proteins and unhealthy fats that are difficult for the body to digest quickly. Red meat is also rich in iron, which is hard on the digestive tract and so can easily contribute to the constipation problem.

Parkinsons Disease And The Gut

Parkinsons disease is primarily a neurological condition however, symptoms also manifest outside of the brain itself, including within the gut . This article aims to provide a simple background to Parkinsons disease, and some insights into how these GI symptoms may arise and how we can treat them. Increased awareness of these often-overlooked GI issues in Parkinsons might lead to better understanding of the condition by researchers, as well as improved treatment and quality of life for patients.

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.

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Increasing Your Fibre Intake

Eating the right amount of fibre and drinking enough fluids can help if you have constipation.

To get more fibre in your diet:

  • choose a breakfast cereal containing wheat, wheat bran or oats, such as Weetabix, porridge or bran flakes.
  • eat more vegetables, especially peas, beans and lentils.
  • eat more fruit fresh, stewed, tinned or dried. High fibre fruits include prunes or oranges.
  • drink plenty of fluids throughout the day to avoid dehydration. Lots of fluids are suitable, including water, fruit juice,
  • milk, tea and squashes. Cut out caffeine to avoid overstimulation of your bladder.

If you find it difficult chewing high-fibre food, you can get some types which dissolve in water. You can also get drinks which are high in fibre.

Try to increase how much fibre you get gradually to avoid bloating or flatulence .

A dietitian can give you further advice. Ask your GP, specialist or Parkinsons nurse for a referral.

Managing Depression In Parkinsons Disease

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People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.

Here are some suggestions:

  • For information and support on living well with Parkinsons disease, contact our Information and Referral line.
  • As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
  • You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .

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What Is Rem Behavior Disorder And How Is It Connected To Parkinson’s

A: REM behavior disorder is different than other sleep problems, like insomnia. People who have it may jerk or kick it’s as though they are acting out their dreams. In a similar pattern to anosmia, people with idiopathic REM sleep behavior disorder have at least a 50 percent chance of eventually developing Parkinson’s disease.

Background: The Stomach Parkinson’s And Levodopa

Levodopa is not absorbed from the stomach, but the stomach plays an important role in controlling how levodopa reaches the parts of the small intestine where it is absorbed. Some medicines, including dopamine agonists and anticholinergics, can also delay gastric emptying, as can severe stomach acidity, although over-treatment of this problem can also prevent the break-down of levodopa tablets, leading to incomplete absorption.

Unfortunately, gastric emptying can be delayed by Parkinsons itself or by constipation caused by the colon-gastric reflex. Levodopa tablets may remain in the stomach for a long time, leading to delayed absorption in the small intestine and a delayed response to the treatment.

An enzyme called dopa-decarboxylase that is present in the stomach lining can convert levodopa trapped in the stomach into dopamine, making it unavailable to the central nervous system. Also, dopamine formed in the stomach may stimulate gastric dopamine receptors, leading to stomach relaxation and reduced gastric motility, and this can worsen the problem.

Liquid levodopa may improve motor fluctuations by ensuring better absorption than standard preparations, especially when taken after meals. Subcutaneous infusion of the dopamine agonist apomorphine is effective in controlling motor fluctuations by bypassing the gastrointestinal tract.

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Drink Plenty Of Water

Drinking plenty of water is important for all Parkinsons patients, but it is even more important for those who frequently experience constipation.

Research suggests that drinking not enough water is the main reason of constipation in Parkinsons disease. A study in patients with Parkinsons disease conducted in Japan showed that decreased water intake from early life was strongly linked to constipation in patients.

The First Motor Symptoms Of Parkinsons Disease

Constipation and Parkinsonism Common Ailment in Parkinson’s Disease

When people ask what are the early signs and symptoms of PD? the answer they are typically expecting is one that involves motor symptoms. Early motor symptoms of PD can be a subtle rest tremor of one of the arms or hands . A rest tremor is one that occurs when the limb is completely at rest. If the tremor occurs when the limb is suspended against gravity or actively moving, this may still be a sign of PD, but may also be a sign of essential tremor.

The initial motor symptom of PD may be a sense of stiffness in one limb, sometimes interpreted as an orthopedic problem . This sense of stiffness may be noted when a person is trying to get on his/her coat for example. A person may also experience a sense of slowness of one hand or a subtle decrease in dexterity of one hand. For example, it may be hard to manipulate a credit card out of a wallet or perform a fast, repetitive motor task such as whisking an egg. A person may notice that one arm does not swing when he/she walks or that one arm is noticeably less active than the other when performing tasks. Another motor sign may be a stoop with walking or a slowing down of walking. A family member may notice that the person blinks infrequently or has less expression in his/her face and voice.

These motor symptoms may be very subtle. Bottom line if you are concerned that you may have an early motor or non-motor symptom of Parkinsons disease, make an appointment with a neurologist for a neurologic exam to discuss your concerns.

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Parkinsons Disease Is A Neurodegenerative Condition

Parkinsons disease is a chronic condition in which neurons within a region of the brain responsible for the control of movement break down and die. These neuronal cells use a chemical called dopamine to communicate with each other. It is this complex dopamine-based communication between neurons that is responsible for control of movement. Death of these neurons is referred to as dopaminergic neurodegeneration, and directly leads to the movement-related symptoms of the condition . These include tremors, changes in posture, stiffness, and a slowness of movement, also referred to as bradykinesia.1,2

Importantly, and often little appreciated, is the fact that Parkinsons disease can also affect neurons outside of the brain. Neuronal connections are made throughout the body, and connect all parts of the body to the brain and spinal cord, including to the GI tract. In particular, Parkinsons interferes with normal communication between the central nervous system, and the esophagus and stomach.3 Parkinsons can also affect the enteric nervous system, a network of neurons that functions with a considerable level of independence from the brain and central nervous system, and that is highly involved in controlling the intestinal tract and digestion.3,4 By affecting both the central and enteric nervous systems, Parkinsons disease may give rise to an array of GI symptoms.

Causes Of Constipation In Parkinsons Disease

The ways in which Parkinsons disease can increase the risk of constipation include:

  • lack of dopamine in the brain impairs control of muscle movement throughout the body. Bowel muscles can become slow and rigid
  • uncoordinated bowel motions the bowel muscles may be weak and unable to contract, or they may clench instead of relaxing when trying to pass a motion
  • eating problems dietary fibre containing insoluble fibre adds bulk to your bowel motions and can help prevent constipation. However, if a person with Parkinsons disease finds it difficult to chew or swallow, they may avoid eating fibrous foods
  • drinking problems you need water to plump up the dietary fibre in your bowel motions. Swallowing difficulties may discourage a person with Parkinsons disease from drinking enough fluids
  • sedentary lifestyle lack of exercise slows the passage of food through your intestines. Parkinsons disease reduces muscle control, so lack of exercise is common
  • medications many different medications can cause constipation. Medications used in the treatment of Parkinsons disease may slow bowel movements or cause a decrease in appetite.

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The Gastrointestinal Effects Of Parkinson’s Disease

Surveys show that between 20% and 40% of people with Parkinson’s disease suffer from serious constipation . Larger numbers of people with PD have related gastrointestinal issues such as bloating, a feeling of fullness and nausea. As the disease progresses, all of these GI problems become more common. In rare cases, serious complicationssuch as megacolon and perforation or tearing of the colonmay arise from these GI problems.

The connection between the two may seem odd on the surface, but research shines some light on these unpleasant consequences of the disease.

A large survey of healthy people who were followed over several years revealed that men who reported having less than one bowel movement daily had a 2 to 7 times higher risk of developing PD than that of men who had daily bowel movements their risk was four times higher than that of men who had two or more bowel movements a day.

Considering Gi And Non

Parkinson

GI symptoms have a significant influence on the quality of life of those living with Parkinsons, and can reduce the effectiveness of medications such as levodopa. As an example, drooling and difficulty swallowing can result in difficulty taking oral prescriptions. Similarly, gastroparesis can result in changes in response to levodopa treatment by affecting absorption of the drug into the blood stream, and, therefore, into the brain.20,29,39-41 The result of this can be more severe motor-fluctuations in patients, as is also seen in those with other GI conditions that can decrease levodopa absorption, such as small intestinal bacterial overgrowth, or infection with Helicobacter pylori.42 The significance of this is that through appropriate treatment of non-motor and GI symptoms of Parkinsons disease, there is potential for patients to also experience improvement in their response to treatment for motor-symptoms, for a broad improvement in quality of life.

Daniel Levy, PhD, Health Researcher & Writer
First published in the Inside Tract® newsletter issue 211 2019
We thank Maria Marano, Information and Referral Associate, and Julie Wysocki, Director, Research Program, with Parkinson Canada for reviewing this article.

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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.

Fluids For Constipation In Parkinsons Disease

Be guided by your doctor, but general suggestions include:

  • Try to drink six to eight glasses of fluid every day. Water is best, but you can also include fluid in the form of soup, juice, tea and coffee.
  • Limit drinks that cause dehydration such as alcohol, tea and coffee.
  • Spread your drinks throughout the day.

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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.

What Examinations May I Need To Have

Overcoming Constipation in Parkinson’s Disease

Your GP or specialist will probably ask a series of questions to find out what the problem is. These may include:

  • When did the trouble start?
  • How often does it happen?
  • Can you feel when your bladder or bowel is full?
  • Are you having difficulty emptying your bladder or bowel?
  • How often are you using the toilet?

Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body. You may be asked to keep a chart for several days of how often you use the toilet and how much you drink.

You may also be asked for a urine sample to test for infection and they will normally carry out a physical examination.

Bladder or bowel problems can be complex in Parkinson’s, so sometimes specialist tests or X-rays may be needed. All of these can usually be done in an outpatient department or clinic.

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Study Reveals Ibs Risk

BERLIN — Irritable bowel syndrome may be a more frequent symptom in Parkinson’s disease than constipation, researchers reported here.

In a case-control study, about a quarter of Parkinson’s patients had IBS compared with only 5% of healthy controls , according to Tuomas Mertsalmi, MD, of the University of Helsinki, and colleagues.

On the other hand, the prevalence of constipation was higher among Parkinson’s patients, but the difference from healthy controls wasn’t significant, they reported at the Movement Disorders Society meeting here.

“Gastrointestinal symptoms in Parkinson’s disease are more complex than just constipation,” Mertsalmi told MedPage Today. “Usually constipation is just seen as decrease bowel frequency, but it is also about straining during defecation, hard and lumpy stools, and diarrhea in these patients.”

Previous work has shown that the majority of patients with Parkinson’s suffer from gastrointestinal symptoms. About 70% have been estimated to have constipation, which is considered to be a premotor symptom of the disease and is one of the strongest risk factors for Parkinson’s, Mertsalmi said.

IBS is among the most common functional gastrointestinal disorders, and is characterized by symptoms of abdominal pain or discomfort, and alteration of bowel habits.

All patient with a pre-existing diagnosis of IBS were excluded, he added.

Disclosures

Contact Our Information And Referral Helpline

The Parkinson Canada Information and Referral Helpline is a toll-free Canada-wide number for people living with Parkinsons, their caregivers and health care professionals. We provide free and confidential non-medical information and referral services. When you have questions or need assistance, our information and referral staff help connect you with resources and community programs and services that can help you. We provide help by phone or email, Monday to Friday, 9:00 a.m. 5:00 p.m. ET.

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How Is Constipation Treated

The treatment of constipation typically begins with optimization of fiber and fluid intake. While fiber may be increased through changes in diet, it can be challenging to get people to change their long-standing dietary habits. For many people, the addition of bulking agents such as psyllium or methylcellulose is an inexpensive and simple way to increase fiber. Polyethylene glycol, guar gum and lactulose are other choices that have less texture though may be more expensive than bulking agents. For an occasional patient stimulant laxatives or prescription medication is necessary to control symptoms of constipation.

Neil R. Greenspan, MD, FACG Gastroenterology Associates Providence, RI

Treatment For Constipation In Parkinsons Disease

Proper Management of Constipation in Parkinson Disease

Your doctor may suggest various treatments to help combat constipation, including:

  • dietary changes, including more fibre rather than refined or highly processed foods, and water
  • moderate exercise
  • good toilet habits
  • avoidance of unnecessary medicines that contain substances known to cause constipation
  • laxatives, particularly agents that bulk and lubricate the stools
  • treatment for any other medical problem that may be contributing to your constipation, such as haemorrhoids .

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Avoid Eating White Rice And White Bread

While brown rice may help relieve constipation, white rice may have the opposite effect. Unlike brown rice, white rice lacks fibers and nutrients. Its rather rich in starch content, which is slowly digested and cause significant bloating.

Similar is the case with white bread. It is made of wheat that lacks most of its fiber content. This caused the stool hard and makes it difficult for the colon to remove it from the body. Therefore, try to avoid using white bread or anything made from white floor like cakes, cookies, donuts, and bagels.

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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