Lucky 7 tips for Parkinson's disease constipation

We have been getting a flood of questions about the tips to treat constipation after our recent Living with Parkinson’s Tip of the Day. In that video we reviewed 3 tips for Parkinson’s constipation. Below we expand to the lucky 7 tips.

Constipation: This is another symptom that precedes 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 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 methods and habits that can help address constipation in Parkinson’s disease. Here are a few strategies to consider.

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.

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.

What about probiotics?

These substances are over-the-counter, and while there are few studies, they are safe and many patients report that they are useful.

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.

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.

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 stool and draw in fluid to facilitate movement, or they can stimulate a bowel movement. There are also multiple routes of administration of medications and some routes may be preferred over others as a personal preference.

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 produceresults 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 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.

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside

He also serves as the Medical Advisor for the Parkinson’s Foundation.

To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.