Constipation with Parkinson’s. Causes and Treatment

Parkinson's disease (PD) is a neurological disorder that affects movement and cognition. Even though it is known as a movement disorder, other non-motor symptoms of PD include difficulty swallowing, nausea, and constipation.

Key takeaways:
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    Constipation is common in Parkinson's disease, but research shows that it may be evident in people several years before developing the motor symptoms of PD.
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    Constipation in Parkinson's may be due to a decrease in dopamine or the presence of Lewy Bodies in neurons of the digestive tract.
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    See your medical practitioner if you or your loved one with Parkinson's has constipation. The cause needs to be determined to initiate appropriate treatment.
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    Lifestyle modifications such as increasing exercise and the intake of fluids and fiber can reduce the incidents or severity of constipation.

The discomfort of constipation can potentially impact a person's quality of life. In addition, if chronic constipation is under-treated, it can lead to further physical complications and severe illness.

What is constipation?

Constipation occurs when a person has fewer bowel movements with increased difficulty passing stools (bowel movement.) Because stools may be "hard and dry," a person may need to strain when having a bowel movement - usually defined as three or fewer bowel movements per week; that number may vary depending on a person's regular bowel routine.

A person with constipation may also feel like they haven't completely emptied their bowels after they've had a movement. If constipation is ongoing and lasts three months or longer, it is "chronic constipation."

What causes constipation in Parkinson's?

Constipation is a prominent non-motor symptom associated with PD, with estimates that at least 60% of people with Parkinson's have problems with constipation. There are several possible causes in someone with PD, with some requiring further research.

Studies suggest that constipation may be an early sign of Parkinson's and can occur years before the motor symptoms of PD are evident. In addition, one study shows that people with constipation are at a higher risk of developing Parkinson's than those without constipation.

Because dopamine, a neurotransmitter, is deficient in people who have Parkinson's, it is responsible for (bradykinesia) slowed motor symptoms of PD. The same dopamine deficiency may also be responsible for reduced muscle movement associated with digestion. This neurological impairment may also affect the rectal sphincter responsible for incomplete emptying of a bowel movement.

In addition, researchers discovered clumps of alpha-synuclein (Lewy bodies) lining the digestive gut of a person with PD. The same protein abnormality is responsible for brain changes in Parkinson's. Moreover, research suggests that the constipation severity early in the condition could contribute to a faster onset of dementia in PD.

Other contributing causes of constipation include:

  • Sedentary lifestyle. Lack of physical activity may decrease the muscle movement needed to stimulate gastric motility.
  • Decreased fluid intake. Lack of fluids may cause stool to be hard, dry, and slower to move through the colon.
  • Lack of dietary fiber intake. A decreased intake of fruit, vegetables, and other fiber-rich food can reduce bowel movement.
  • Difficulty swallowing. Difficult swallowing (dysphagia) will result in decreased fluid and nutritional intake, causing bowels to be sluggish.
  • Side effects of medications. Medications regularly used for Parkinson's treatment, including Levodopa and dopamine, may contribute to constipation. Opioid analgesics will also slow bowel motility.

Complications of constipation:

  • Abdominal discomfort, nausea, and bloating. Due to constipated stool in the colon causing increased accumulation of gas in the bowel.
  • Rectal bleeding. Due to increased pressure on the lower bowel and rectum.
  • Bowel incontinence and diarrhea. Loose stool can leak around the constipated stool, causing incontinence.
  • Urinary incontinence. Due to increased pressure on the bladder from the bowels.
  • Urinary tract infections (UTI). It is more difficult to empty your bladder due to pressure from your bowels, thereby increasing the risk of UTI.
  • Bowel obstruction. Impacted stool in the colon may cause a bowel obstruction.
  • Delirium. Constipation and fecal impaction are risk factors for delirium in older adults.
  • Decreased absorption of medications. Due to constipation and slower gastric motility. A decrease in absorption can affect symptoms of Parkinson's when drugs like Levodopa are not absorbed effectively.

How to treat constipation

If you or your loved one has PD and having ongoing issues with constipation, you need to contact your healthcare provider. You may need a physical examination, lab tests, x-ray, or other investigative exams to determine the cause. The cause will influence recommendations regarding the type of treatment. Lifestyle modifications initiated to improve gastric motility and reduce the effects of constipation can begin at any time.

Exercise

Increase physical activity by walking or joining a walking club or an exercise group. Use your gait aid if your balance is a concern. A recommended 20-30 minutes per day is ideal. Check with your healthcare provider before beginning an exercise routine that is new for you.

Increase fluids

Increase fluid intake to at least eight glasses of fluid each day, preferably water. Limit caffeine and alcohol.

Increase fiber

Increase daily consumption of dietary fiber by increasing fruit and vegetable intake. Use whole-grain bread and pasta instead of processed foods. If you have trouble swallowing, mash fruit, sprinkle bran on cereal, or add to other baked goods.

Improve toilet routine

Go to the bathroom as soon as you feel a bowel movement coming on. Give yourself time, and try not to hold your breath and strain. Your healthcare provider may recommend a stool softener.

There is no specific prescription medication designated for "constipation in Parkinson's," but several medicinal treatments are available over the counter. Lifestyle modifications should be the first line of treatment before you, and your healthcare provider considers medication. Since you may be on several drugs to treat Parkinson's, you must consult your medical practitioner or pharmacist before using any over-the-counter preparation.

Stool softeners

Pull water from the intestines to soften the stool. (e.g., docusate sodium and docusate calcium).

Fiber supplements

Add bulk to your stool but also need to include an increased fluid intake to facilitate the movement of stool. Fiber supplements may not be helpful in severe constipation due to increased bulk, which may further increase constipation.(e.g., Metamucil, Fibercon).

Irritants/stimulants

Cause contraction of intestines and are a more potent form of laxative. (e.g., bisacodyl).

Suppositories

Suppositories inserted into the rectum lubricate the stool and facilitate bowel movements. (e.g., biscoydal and glycerin).

Constipation may be an early indicator of Parkinson's disease and can be challenging to manage. However, practicing healthy living and lifestyle modifications can help you or your loved one maintain a regular bowel routine. Contact your medical practitioner if you have constipation. A physical examination and a medication review may assist in determining the cause so that proper initiation of treatment may commence.

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