Final Thoughts: What Has Worked For Me
Some of the prescription medications that have helped me include: Amitiza, Linzess, Movantik, Relistor, Symproic, and Trulance. Plus I made sure to exercise, massage my stomach in a circular motion at least once a day, drink warm/hot water in the morning before eating, and use probiotics. I also tried to do things that helped make me feel more relaxed. In my experience, a combination of these things is what truly helps maintain a healthy bowel, which results in better PD symptom control by allowing medication to be maximally absorbed.
What Examinations May I Need To Have
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.
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.
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What Is Constipation And Why Is It Important
Constipation is the most common gastrointestinal complaint affecting approximately 15 % of the North American population. Certain subgroups have an even higher risk . It is remarkable that for such a common disorder there is great debate on the definition of constipation. A committee of experts in the field include in the definition 2 or more of the following: abnormalities of stool frequency , abnormal stool form, straining at stool, sense of incomplete evacuation or obstruction to passage of stool, and the use of manual maneuvers to aid in passage of stool .
Diagnosis Of Constipation In Parkinsons Disease
Diagnosis of constipation may include:
- medical history
- detailed description of symptoms
- physical examination.
Medical problems other than Parkinsons disease can also cause constipation. Your doctor may wish to do tests to rule out other possible causes. The tests depend on the medical condition under investigation.
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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.
Causes Of Constipation In Pd Patients
Some of the factors that increase the risk of constipation are:
- Lack of dopamine: This lessens the control over the muscle movements all over the body, which slows down the intestines muscles.
- Uncoordinated bowel movement, wherein the intestines muscles might be weak and unable to contract, or might contract instead of relaxing when trying to defecate.
- Food issues. Foods that contain insoluble fiber add bulk to the bowel movement, and might help prevent constipation. However, many PD patients have trouble chewing or swallowing, therefore, they avoid eating foods rich in fiber.
- Drinking Issues. The swallowing difficulty PD patients suffer from makes them avoid drinking enough liquids.
- Not getting enough exercise slows down the food in the intestines.
- Many different medicines can cause constipation. Medications used for Parkinsons disease, especially anticholinergic drugs that help stop the involuntary movements of the muscles might slow down bowel movement or cause lack of appetite.
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Treatment For Constipation In Parkinsons 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 .
Dietary Recommendations For Seniors With Parkinsons
Constipation is common among aging adults with Parkinsons because of issues with the bowel muscles associated with digestion. Eating high-fiber foods can help older adults naturally address constipation and promote healthy digestion. Oatmeal is a great source of dietary fiber, and its also rich in protein, which can boost muscle strength and offset Parkinsons-related mobility issues. Bananas, split peas, lentils, sweet potatoes, and chickpeas are also great sources of dietary fiber.
Aging adults with Parkinsons have an increased risk of developing cardiovascular issues, so eating heart-healthy foods is essential. In addition to limiting the consumption of foods high in fat and cholesterol, seniors with Parkinsons should add fatty fish, such as salmon, tuna, and mackerel, to their diets because they offer added protection against heart disease. These varieties of fish also contain high amounts of vitamin D and beneficial omega-3 fatty acids, which offer a variety of brain-boosting benefits for seniors with Parkinsons.
Drinking plenty of water is essential for proper digestive function, and its one of the best ways for seniors with Parkinsons to address constipation. Regularly drinking water is also beneficial for aging adults living with Parkinsons disease because it boosts circulation, which is critical to delivering nutrients to the brain as well as the various joints and soft tissues involved in movement.
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Parkinsons Disease And The C Word
Youve seen the commercials about diarrhea. Its not something to be embarrassed about, but we try to make light of it by calling it by some other name like the runs, the squirts, the trots, Montezumas revenge, or the really polite word: dysentery. When it comes down to it, they all mean the same thing: RUN!
The blessing of Parkinsons disease is we dont have to deal with the trots or the squirts as others do. We get to deal with that other word we dont want to talk about: constipation. You know, that plugged up feeling you get in which you have to poop but you cant. And for people with PD, this can be a real stopper. When youre at that place of blockage, you want to get some of that miracle stuff they advertise and be one of the thousands who poop with ease.
What to do?
There is no miracle pill, and you dont want yet another medication. And as user-friendly as marketers want you to believe Metamucil is, if youve got PD, get rid of it. For whatever reason, it hardens once digested in a person with PD and will only make things worse. MiraLax is a good substitute. It is a clear, fairly inexpensive liquid, and is recommended by doctors to ready patients for colonoscopies. And it is safe for adults.
Constipation also affects medications. It causes the stomach to empty more slowly, disallowing the pills to enter the intestine where they are absorbed more efficiently. Constipation has also been linked to bowel cancer and, really, who wants that? PD is enough.
Problems Caused By Limited Mobility
Some people with Parkinsons might soil their underwear. This is because mobility problems can make it difficult to wipe after using the toilet. If this is the case, it might help to use wet wipes, a bidet, or an adapted bottom wiper. An occupational therapist or the Disabled Living Foundation can offer further advice.
Bowel problems are common. But you should tell your GP if there are any changes in your bowel habits, particularly if you see blood in your stool. Some problems are difficult to avoid, but there are things you can do to make them less likely to happen.
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What Causes Constipation In People With Parkinson’s Disease
In some people with Parkinson’s disease, constipation may occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity. If this system is not working properly, the intestinal tract may operate slowly, causing constipation.
Also, medications used to treat Parkinson’s disease can cause constipation.
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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A New Toilet Or An Alternative
If you have real difficulties getting to the toilet, it may be possible to get a grant to build a new one, perhaps downstairs. An occupational therapist can advise you on this.
Not all homes are suitable for building new toilets, so a commode might be needed. A commode is a moveable toilet that doesnt use running water. It looks like a chair, with a container underneath that can be removed and cleaned after someone has used it. They can be very discreet.
Constipation And Parkinsons Disease
Constipation is one of the most commonly reported GI symptoms of Parkinsons disease, affecting 60-80% of patients.17,18 Constipation occurs when movement of material through the GI system slows down. This slowing can result from the direct effects of Parkinsons disease upon the action of intestinal muscles that would normally act to massage material through the intestines in a wave-like action , or indirectly through side-effects of some medications.19 In severe cases, accounting for approximately 7% of those with a parkinsonism, compromised peristalsis can lead to complete gut blockage resulting in further symptoms such as cramping, abdominal pain, vomiting, and bloating.16
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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.
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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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.
What Causes Constipation
Constipation is almost always due to slow passage of stool through the colon or anus/rectum as passage through the small bowel is typically normal. Constipation may be associated with a number of medical conditions including diabetes and underactive thyroid. Of great importance to the readers of this newsletter is that many neurologic disorders are associated with constipation. In addition to the neurologic disease itself, reduced mobility may aggravate constipation. Many drugs used to treat neurologic disorders and other diseases may worsen symptoms of constipation. It is important for patients to notify their physicians if they think their medications have affected their bowel movements as in most cases this side effect can be easily managed.
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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.
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.
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How Can I Help Myself
It is easy to become obsessed with bowel activity, but it is not necessary to have a bowel movement every day it can be quite normal for some people to empty their bowels only three or four times a week. What is important is that passing stools does not cause pain or unnecessary strain. Focus on what is normal and healthy for you and remember that bowel activity is affected by food and exercise, so will vary according to what you are eating and doing.
Remember that learning to manage your bowels will take time and patience, so dont expect to solve problems overnight. It may take a few weeks to adjust diet etc, so be patient. There are also plenty of ways you can help yourself.