Parkinson's disease and constipation

Constipation is a common complication of Parkinson’s disease but it can be managed with medical treatment, extra fibre in the diet and lifestyle changes.

Parkinson’s disease is a progressive, degenerative neurological condition that affects the person’s ability to control their body movements. Symptoms result from the degeneration of nerve cells in the middle area of the brain, which causes a deficiency in the availability of dopamine. Dopamine is a brain chemical necessary for smooth, controlled movements.

Symptoms
The symptoms of constipation include:

• Dry and difficult to pass bowel motions (poo)
• Less than three motions a week, on average
• Feeling the need to strain on the toilet
• The bowel doesn’t feel empty afterwards.
  A range of causes

• Insufficient dopamine – lack of the brain chemical (neurotransmitter) dopamine impairs muscle movement throughout the body. Bowel muscles can become slow and rigid.
• Uncoordinated bowel – the bowel muscles may be weak and unable to contract or they may clench instead of relax when trying to pass a motion.
• Eating problems – dietary fibre is indigestible, so it adds bulk to the bowel motions and prevents constipation. However, if chewing and swallowing are difficult, a person with Parkinson’s disease is less likely to eat fibrous foods.
• Drinking problems – water is needed to plump the dietary fibre in bowel motions. Swallowing difficulties may discourage the person with Parkinson’s disease from drinking enough fluids.
• Sedentary lifestyle – lack of exercise slows the passage of food through the intestines. Parkinson’s disease reduces muscle control, so lack of exercise is common.
• Medications – many different drugs can cause constipation. Medications used in the treatment of Parkinson’s disease (especially anticholinergic drugs) may slow bowel movements or dampen appetite.

• Lethargy
• Nausea
• Abdominal pain
• Twisted bowel
• Obstructed bowel
• Bowel incontinence (leakage or diarrhoea)
• Urinary incontinence (caused by pressure against the bladder)
• Urinary tract infections.

• Medical history
• Detailed description of symptoms
• Physical examination.

• Dietary changes including consuming more fibre and water
• Moderate exercise
• Good toilet habits
• Avoiding unnecessary medicines that contain substances known to cause constipation such as calcium and aluminium
• laxatives
• An enema – this may be part of the initial treatment
• Treatment for any medical problem that may be contributing to the constipation, such as haemorrhoids.

• 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 homemade vegetable soups.
• Sprinkle a tablespoon of bran on your breakfast cereal or add the bran to baked products such as cakes. However, bran should be avoided if you have swallowing problems.
• Fibre supplements may be helpful. However, you must drink enough fluids for the supplements to work properly. Avoid fibre supplements if you have swallowing problems.
• Don’t increase dietary fibre too quickly or you’ll risk bloating and abdominal cramps. If discomfort occurs, cut back your fibre intake, increase your fluid intake, apply a hot water bottle to the abdomen and see your doctor.

• Try to drink six to eight glasses of fluid every day. Water is the best drink.
• Avoid drinks that cause dehydration such as tea, coffee and alcohol.
• Spread your drinks throughout the day.
• Cut back on milk drinks, as milk can cause constipation in some people.

• Consult closely with your doctor, physiotherapist or health care professional when devising your exercise program.
• Aim for at least 15 minutes of exercise every day.
• Spend a few minutes warming up and cooling down. This could include marching in place or stretching.
• Start with the easiest exercises first. Slowly introduce the more difficult exercises as your fitness increases.
• Only exercise when other people are at home who can help if necessary.

• Go to the toilet as soon as you feel the urge to pass a bowel motion. Avoid hanging on.
• Use correct body posture on the toilet – it can help you pass a bowel motion. Place your elbows on your knees and put your feet on a footstool.
• Avoid holding your breath and don’t strain when you are on the toilet. Allow yourself plenty of time.
• Use a warm washcloth pressed against your anus or gentle massage with one or two fingers to help to relax the muscles.
• Talk to your doctor about medicines to help soften your motions.

• Constipation develops suddenly
• You have bloody bowel motions
• Passing a bowel motion causes pain
• You have unexplained weight loss
• Constipation is still there after three weeks despite your best efforts.

• Your doctor
• Your neurologist
• Your local continence clinic or service
• Parkinson’s Victoria Tel. 1800 644 189
• Independent Living Centre Tel. (03) 9362 6111
• National Continence Hotline Tel. 1800 330 066
• Continence Foundation of Australia Tel. (03) 9347 2522
• Victorian Continence Resource Centre Tel. (03) 9816 8266

• Constipation is a common complication of Parkinson’s disease.
• Constipation can be managed with appropriate medical treatment, extra fibre in the diet and lifestyle changes.
• See your doctor if the constipation does not resolve within three weeks, despite your best efforts.

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