Constipation

Why Does Constipation Occur So Frequently With Parkinson's?
There appear to be two main reasons for the frequency of constipation with PD:
1. Medications used to treat PD (levodopa, selegiline, amantadine, dopamine, agonists, anticholinergics, and others) can lead to constipation, often by slowing peristalsis – the movement of the GI tract that moves food through the stomach, intestines, and colon.
2. PD may cause some degeneration of the nerves of the GI tract.
Other possible reasons: people with PD often have a craving for sweets, which contribute to constipation. Also, very few people drink enough fluids or eat enough fiber.

Why is Constipation a Cause for Concern?
At first, constipation may seem like more of a nuisance than a real concern. However, a person who is frequently constipated, over a long period of time, may experience fecal impaction, also known as bowel impaction – a condition where dry, hard feces accumulate in the colon and cannot be passed. Sometimes watery feces may pass around the impaction, as diarrhea, leading the person to believe he/she is not constipated. Bowel impaction can be very painful, and may require hospitalization.

What Causes Constipation?
One or several factors may be involved:
1. Not eating enough.
2. Not eating enough fibers.
3. Not getting enough exercise.
4. Not going to the toilet when you feel the urge to pass a stool.
5. Not staying on the toilet 20 to 30 minutes.
6. Not bending your legs and thrusting forward with abdominal pushing in order to expel feces.
7. Poor fluid intake.
8. History of laxative abuse.
9. Medications and certain medical conditions such as Parkinson's and other neurological disorders.

What Changes Do I Have to Make in My Diet to Decrease Constipation?
It is important to get enough fiber and fluids each day.
1. You should eat plenty of whole wheat bread, bran muffins, and high fiber cereals (oatmeal, “All Bran,” “Fiber One”), 2-3 servings per day minimum.
2. Eat at least three servings of fresh fruit daily (oranges, apples, bananas) and include dried or stewed prunes several times a week as needed.
3. One serving of raw vegetable such as carrots or celery and one serving of a leafy green vegetable (cabbage, spinach, lettuce) daily.
4. Drink a minimum of 5 glasses of water or fruit juice daily.

What If Fiber and Fluids Are Not Sufficient to Manage Constipation?
Diet should be your first treatment for constipation. However, sometimes peristalsis (muscle action in the large intestine) is slowed enough in Parkinson's disease that other therapies may be indicated. If you get plenty of fibers and fluids, yet have fewer than three bowel movements per week, it may be necessary to take further steps.
1.One remedy used in hospitals is called a prune juice cocktail. Mix ½ cup applesauce, 2 Tbsp miller's bran, and 4-6 oz. prune juice. Store in refrigerator. Take a tablespoonful per day at first, gradually increasing until you find the amount that works best. Most people find this mixture quite palatable.
2. Some patients report that a serving of prunes or prune juice including pulp 2-3 times per week is beneficial.
3. You may need a fiber supplement, such as Metamucil, Citrucel, or Unifiber. Metamucil and Citrucel can be stirred into liquids, and are found in most drug stores and grocery stores. Unifiber can be mixed with liquids or stirred into thicker foods, like mayonnaise, applesauce, cooked cereals, and other foods; and, if needed, can be used in tube feedings. Your pharmacist can order Unifiber from the supplier.
4. Manual abdominal massage from the bottom of the ribcage to the top of the pubic bone, performed 2-3 times daily, sends mechanical signals to the bowel to "keep things moving."
5. Train yourself to “honor the urge” to have a bowel movement. Be aware that the natural position for evacuating the bowel is squatting. Raised toilet seat devices may aid mobility, but are not ideal for bowel function. Try hiking your feet up on a small bench while sitting on the toilet.
6. Ask your physician about using an over the counter stool softener such as Colace or Peri-Colace. If bowel motility is good but stool is dry and hard to pass, health practitioners also advise occasional use of infant sized glycerin suppositories to soften stool in the lower colon and reduce straining.

Why is Exercise Important?
Exercise, along with eating, begins the peristalsis or gentile gut movements. These occur two to three times a day and move the chyme (food mixed with water) into the colon. Unless there is bulk in the diet, the food moves along sluggishly and does not stay wet. The water is absorbed and hard stool fills the rectum. Bulky foods encourage the peristaltic action to push the food through the bowel, while refined foods without bulk cause a decreased gut action. When the food stays for along time in the bowel there is more time for the bacteria to form gas and for the slow movement to cause a hard stool.

Why Can't I Use Enemas and Laxatives?
Enemas cause large amounts of water to flow into the colon. This dilute water when it is expelled takes important electrolytes from your bowel and leaves the bowel lazy and noncontractile. It inflames the lining and can eventually destroy the nerves that make you want to defecate, thus leaving you chronically constipated. Enemas may be dangerous and should be avoided if possible. Many laxatives also deprive your body of its fluid and cause pain with cramping and watery stools. Laxatives stimulate the nerve endings of the colon, causing rapid removal of bowel contents. Over time, stimulant laxatives damage the lining of the colon, causing even greater problems with constipation.

If you have further questions or continue to have problems with constipation, please feel free to speak with Joan Ellen Gereg, R.N., M.S., our nurse practitioner.

Associated Neurologists, P.C.
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