First in a new series of blogs titled ‘Living Well with Parkinson’s Disease – Sorting the Motherhood Stuff’, Drs Natalie Palavra and Paul Silberstein discuss ‘Constipation in Parkinson’s Disease’.
Dr Palavra introduces the blog in this short video.
What is constipation?
Constipation occurs when bowel movements become less frequent or stools become more difficult to pass. Constipation is generally defined as less than 3 bowel motions per week, but the exact number can vary depending on what is ‘normal’ for you. Other features of constipation include passing hard stool, straining or experiencing a feeling that the bowel is not completely empty after a motion.
Why is constipation important in PD?
Constipation is one of the most common features of Parkinson’s Disease (PD), affecting up to 79% of patients. Many patients experience constipation for many years before being diagnosed with PD. It is important to manage constipation because it may cause discomfort and impair absorption of PD medications, leading to poor symptom control and impaired quality of life. If not managed, constipation can lead to more serious complications.
What causes constipation in PD?
Constipation is part of the disease process in PD, and results due to alterations in gut motility. Gut bacteria may also play an important role in PD. Low water intake, inadequate physical exercise and certain medications can all contribute to constipation in PD.
Treatment of constipation in PD
The good news is that there are many strategies that can be used to improve constipation. Changes to diet and lifestyle can result in significant improvement. A variety of medications can be helpful if diet and lifestyle changes are insufficient.
- Diet and lifestyle
- Increasing water consumption and avoiding liquids that can dehydrate (e.g. caffeine, alcohol) can be helpful. You should discuss whether this is suitable for you with your doctor.
- Increasing fibre consumption with grains and high fibre fruits / vegetables (with skin on) can also be helpful. Again, prior to commencement, talk about this with your doctor, particularly if you have swallowing issues.
- Exercise daily to help activate the gut.
- Keep track of bowel motions by keeping a “bowel diary.”
- Go to the toilet as soon as you feel the urge.
- Laxatives are medications used to treat constipation. There are many different types. Some work by softening or lubricating the stool making it easier to pass. Others work by increasing gut contraction. Discuss with your doctor which one would be best for you.
- Enemas help to stimulate the gut and are sometimes used when oral laxatives are insufficient.
M. Lubomski, R.L. Davis, and C.M. Sue, Gastrointestinal dysfunction in Parkinson’s disease. Journal of Neurology (2020) 1377-1388.
M. Lubomski, A.H. Tan, S.Y. Lim, A.J. Holmes, R.L. Davis, and C.M. Sue, Parkinson’s disease and the gastrointestinal microbiome. Journal of Neurology (2020) 2507-2523.
J.F. Johanson, J. Kralstein J, Chronic constipation: a survey of the patient perspective. Alimentary Pharmacology & Therapeutics (2007) 25, 599-608.
A.J. Pedrosa Carrasco, L. Timmermann, D.J. Pedrosa, Management of constipation in patients with Parkinson’s disease, Parkinson’s Disease (2018) 4, 6
F. Stocchi, M. Torti. Chapter 27: Constipation in Parkinson’s Disease, International Review of Neurobiology (2017), 134, 811-826.
J.S. Mac Fadyen, G.M. Vernon, Constipation and PD. Parkinson’s Disease Foundation. (2016). Retrieved 12.2.21 from: https://www.parkinson.org/sites/default/files/attachments/constipation_16.pdf