Lucky 7 tips for Parkinson's disease constipation

This image provided by our website artist Jonny Acheson who is an artist, a physicians and a person with Parkinson’s.

What are the common symptoms of constipation in Parkinson’s?

Constipation: This is a symptom that can precede the onset of obvious motor changes in Parkinson’s disease. Over time, changes in the stretching and contractions of the muscles in the gastrointestinal tract (referred to as gut motility) can have an impact on medication absorption, as slow or erratic intestinal transit of food may affect how consistently medication is absorbed. Most cases can be managed with increasing fluid intake and dietary modifications, and also by over-the-counter drugs. In severe cases of gastroparesis (i.e., the stomach not emptying), prescription medication may be necessary.

Useful Strategies to Treat Constipation

There are several tips that can help to address constipation in Parkinson’s disease. Here are 7 of my favorite.

Tip 1: What about water?

An easy, inexpensive, and highly effective approach: drink more water. The gastrointestinal tract and the intestines need water to move and eventually expel stool. Traditionally, six to eight glasses (8oz each) of fluid per day has been recommended, excluding carbonated and caffeinated beverages.

Tip 2: What about fiber?

Natural sources of fiber that can supplement the diet include fruits and vegetables, cereals, and snacks. Over-the-counter supplements can be helpful, but these supplements require water to be effective. The supplements often pull water into the gut, so if you are not drinking, they can potentially lead to dehydration.

Tip 3: What about probiotics?

These substances are over-the-counter, and while there are few studies, they are usually safe and many patients report that they are useful. We must however be careful as everyone has a different gut microbiome, and therefore without knowing your baseline it is possible that some of these compounds could make you worse. The best tip is to monitor your response and report back to your healthcare provider.

Tip 4:What about activity?

Exercise promotes bowel health and inactivity worsens constipation. Going for a walk or exercising on a recumbent bike can be helpful for constipation. Bonus fact is that even 20 minutes a day of walking has been shown to improve depression so you could kill two birds with one stone.

Tip 5: What about position?

The “squatting position” when defecating has been considered conducive and natural for helping bowel movements. Placing a foot-stool under your feet can help to achieve an optimal position to address constipation.

Tip 6: What about medications?

Lubiprostone revealed a benefit for patients with Parkinson’s disease enrolled in a clinical trial. Over-the-counter options can work to increase the bulk of the stool and to draw in fluid to facilitate movement, or to stimulate a bowel movement. There are also multiple routes of administration of medications and some routes may be preferred over others.

Tip 7: What about laxatives?

Some laxatives can affect electrolyte balance (such as magnesium, calcium, and sodium). The effects of electrolyte imbalance should not be underestimated. There can be resultant heart rhythm changes or other health complications. Some laxatives may also result in cramping or gas, or even drug dependence. It is important to talk to a doctor about all health conditions and medications to avoid unexpected risks of laxatives or drug-drug interactions.

Mechanisms of Action for Laxatives

There are many different types of laxatives, with different ways of acting upon the body. Here are a few to consider.

Bulk Producing

These laxatives provide a substance that, when taken with water, can promote a bulkier and softer stool that is easier to pass. Examples include psyllium husk powder (such as Metamucil), methylcellulose (Citrucel), guar gum (Benefiber), and calcium polycarbophil (such as FiberCon). Water consumption is critically important to support the mechanism of action of laxatives. Bulk producing laxatives may produce results in one to three days.

Osmotic Laxatives

These laxatives increase the flow of water into the colon and facilitate stool passage. Examples include magnesium hydroxide (Milk of Magnesia), polyethylene glycol (MiraLax), lactulose, and sorbitol. Some osmotic laxatives contain sugar molecules, which may be an important consideration for diabetics. Results from osmotic laxatives commonly occur in one to three days.

Stool Softeners (Emollient Laxatives)

These laxatives contain surfactants, which help wet the stool and prepare it for easier passage. An example includes docusate (Colace). These may take a week or more to take effect.

Bowel Stimulants

These work by triggering intestinal contractions to move stool through the colon. Examples include bisacodyl (Correctol, Dulcolax), senna derivatives (Senokot), and castor oil. Effects can be quick, but cramping and diarrhea may occur. Prolonged use is not recommended because of the risk of possible dependence.

Suppositories

Suppositories are medications that are inserted into the rectum (about one inch), past the anal sphincter. These medications stimulate contractions that help expel stool. Typically, these are bullet shaped and may contain stimulant laxatives or lubricants. Examples include biscodyl (Dulcolax) and glycerin (Fleet, Pedialax).

Enemas

This is a process of injecting fluid into the rectum by inserting a tube that allows fluid to flow into the colon. This type of laxative procedure may be necessary when stool is impacted, but is not recommended for routine use. Enemas may contain mineral oil, sodium phosphate, or bisacodyl.

Bonus Tip: If everything you try fails to work for your constipation, what medications should you discuss with your doctor?

There are only 2 randomized trials with enough data to comment on a benefit for Parkinson’s constipation.

ENT-01 (Squalamine Phosphate) was a randomized, placebo-controlled trial with 150 PD patients and it revealed significant improvement in daily bowel movements, stool consistency, and ease of passage.

Lubiprostone (Amitiza) was a randomized, placebo-controlled trial for constipation in Parkinson’s and it was well-tolerated and effective in increasing spontaneous bowel movements.

Dr. Michael Okun is co-author of the books the Parkinson’s Plan and Ending Parkinson’s. His blogs are available free at PDplan.org and parkinsonsecret.com