Constipation in Parkinson’s Disease

Constipation, like other autonomic disturbances, often accompanies Parkinson’s disease. Research has shown that in many cases, constipation may precede the appearance of other movement symptoms of the disease. However, Parkinson’s disease may not be the only cause, and it is essential to identify or rule out additional, rarer factors contributing to difficult bowel movements. For example:

• Lack of physical activity and patient mobility
• Lack of Fiber in the Diet
• Insufficient fluid intake – taking certain medications
• Hypothyroidism
• Intestinal cancer
• Kidney failure

 Why is constipation bad and what are its consequences? Constipation can lead to many serious problems in a person:

• Nausea (combined with nausea due to the intake of dopaminergic drugs can be very unpleasant)
• Vomiting
• Poor and unpredictable absorption of medications (this can lead to worsening of the patient’s movement well-being)
• Bloating
• Abdominal pain
• enlargement of the colon
• Intestinal perforation

Constipation can also have an emotional impact on patients with Parkinson’s disease. Often, patients feel most comfortable if defecation occurs at the beginning of the day, bringing a sense of relief and a “good day” feeling. Conversely, on days without defecation, anxiety and stress may occur, along with related motor deterioration.  How can the risk of constipation be reduced? Add physical exercise. Exercises can be very simple—15-minute daily walks, possibly several times a day; seated torso twists and turns (based on the “remember-do” principle), regular joint exercises; workouts on home trainers with minimal load. Follow the principles of a healthy diet.

• Meal at the usual time
• Do not skip any meals
• Regular bowel movements at approximately the same time each day (ideally about thirty minutes after eating)
• Include fiber in your diet (whole grain bread, oatmeal, and bran flakes)

Liquid.

• Increase fluid intake – it is recommended to drink about 4-8 glasses of water every day. Senna tea and prune and beet juice are also beneficial
• Hot drinks can have a laxative effect, but they are most effective when consumed in the morning.

If lifestyle changes are ineffective, psyllium-based laxatives may help ( contribute to increasing stool volume and bowel evacuation), lactulose syrup (like Duphalac), or glycerin suppositories. If constipation is prolonged and chronic, microenemas (like Microlax, they are fast-acting and usually cause multiple bowel evacuations – recommended for morning use) may be required. If necessary, various methods can be used simultaneously. However, for the safe use of laxatives, consultation with a doctor or pharmacist is often required. In particularly severe cases of constipation in Parkinson’s disease, botulinum toxin injections into the anal sphincter may be possible.