Constipation in Parkinson's Disease

It's what you don't have...

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Constipation - an uncomfortable symptom. DElight / E+ / Getty Images

Constipation

Constipation is technically defined as having less than 3 bowel movements per week but reality is that everyone differs in their normal frequency.  Some may pass stool twice a day, while for others having a bowel movement every two or three days is normal.  So constipation for the purpose of this discussion will refer to a decrease in what is your normal frequency resulting in hard bowel movements that are difficult to pass.

In Parkinson’s disease, constipation is the most commonly reported gastrointestinal symptom. It may in fact predate the appearance of motor symptoms by years and is therefore considered a premotor symptom of this disease.  This doesn’t mean that everyone with constipation develops Parkinson’s disease but instead implies that in those that develop Parkinson’s disease, a history of constipation is more common compared to those that don’t develop the disease.  The Honolulu-Asia Aging Study which followed Japanese-American men for over 10 years, showed this strong correlation.  Although it was designed to primarily looking at the development of dementia in this group, they also found that those men who had less than one bowel movement per day were 2.7 times more likely to develop Parkinson’s than those who went once daily and four times more likely to develop PD than those subjects that had two or more bowel movements per day.

 

There are other causes of constipation in Parkinson’s disease as well including poor fluid intake, a diet low in fiber and lack of exercise.  When dealing with constipation in this setting, medications must also be reviewed. Parkinson’s drugs such as levodopa, dopamine agonists, amantadine and anticholinergics (like Artane and Cogentin) can result in fewer bowel movements as well as medications that may be taken for pain (particularly opioids) and anti-depressants.

We are also not immune to other conditions that cause constipation in the general population such as irritable bowel syndrome and colorectal cancer. Therefore proper evaluation is recommended. 

How do you deal with this symptom? What can you do to help improve and regulate your bowel movements? Here are a few tips:

  1. Drink more fluid!  Try and drink approximately six to eight glasses (8 oz. each) of fluid daily (about 1500 ml).  Note that this does not include coffee or alcohol both of which can actually dehydrate you, making your constipation worse.
  2. Eat more fiber! A high fiber diet in men contains 30 – 38 grams of fiber whereas for women the range is 21 – 25 grams.  High fiber foods include fruit (with skin on such as apples or those that have edible seeds such as strawberries), whole grain pasta, cereal and bread, seeds, nuts and legumes and a variety of vegetables. For some suggestions to help you increase the finer in your diet, click here. If you have other dietary requirements or preferences, then consulting a dietician to develop a personalized diet specific to your needs, may be helpful.
  1. Exercise regularly! Exercise helps a multitude of motor and nonmotor symptoms including constipation.
  2. Add in bulk-forming laxatives. These include bran and Metamucil or other formulations such as FiberCon and Citrucel. The key is to start with only a small amount of these supplements and to gradually increase their amounts in order to avoid excessive gas and cramping. Also keep in mind that taking stool bulkers in the absence of increasing your fluids will only result in worse constipation.
  3. If all else fails, then a short course of a laxative or stool softener may be required. However if your symptoms persist longer than seven days despite their use, seek medical attention to rule out any other conditions that may be causing your discomfort. Also prolonged use of these products can actually make your symptoms worse.

Although it may seem like a rather insignificant issue, like other nonmotor symptoms constipation and the discomfort associated with it, can be responsible for a poor quality of life. But with a consistent approach and patience this symptom can be managed.

References Used:

Abbott, R. D., H. Petrovitch, L. R. White, K. H. Masaki, C. M. Tanner, J. D. Curb, A. Grandinetti, P. L. Blanchette, J. S. Popper, and G. W. Ross. "Frequency of Bowel Movements and the Future Risk of Parkinson's Disease." Neurology 57.3 (2001): 456-62. Web.

Pfeiffer, Ronald P. "Gastrointestinal and Swallowing Disturbances in Parkinson's Disease." Parkinson's Disease: Non-motor and Non-dopaminergic Features. By C. W. Olanow, F. Stocchi, and Anthony E. Lang. Chichester, West Sussex, UK: Wiley-Blackwell, 2011. 263-66. Print.

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