Parkinson's disease and constipation

Constipation is a common complication of Parkinson’s disease, but it can be managed with lifestyle changes such as adding extra fiber to your diet, and with medical treatment. Many people with Parkinson’s disease notice difficulties with constipation before they notice motor symptoms such as tremor or stiffness.

Parkinson’s disease is a progressive, degenerative neurological condition that affects a person’s ability to control their body movements. Its symptoms result from the degeneration of nerve cells in the middle of the brain that make and store dopamine, a brain chemical needed for smooth, controlled movement. As these nerve cells degenerate, dopamine levels fall.

Symptoms of constipation in Parkinson’s disease#

• Dry, hard bowel motions and difficulty passing them.
• Fewer than three bowel motions a week, on average.
• Feeling the need to strain on the toilet.
• Feeling that the bowel is not empty after passing a motion.

Causes of constipation in Parkinson’s disease#

Parkinson’s disease can increase the risk of constipation in several ways:

• Lack of dopamine in the brain impairs control of muscle movement throughout the body. Bowel muscles can become slow and rigid, may be too weak to contract, or may clench instead of relaxing when you try to pass a motion. This can lead to uncoordinated bowel motions.
• Eating problems. Insoluble fiber adds bulk to bowel motions and helps prevent constipation, but if a person finds it hard to chew or swallow, they may avoid fibrous foods.
• Drinking problems. You need water to plump up the fiber in your bowel motions, but swallowing difficulties may discourage a person from drinking enough fluids.
• A sedentary lifestyle. Lack of exercise slows the passage of food through the intestines, and reduced muscle control makes inactivity common.
• Medications. Many medications can cause constipation. Those used to treat Parkinson’s disease, especially anticholinergic medications, which help block involuntary muscle movements, may slow bowel movements or reduce appetite.

Complications of chronic constipation#

Chronic constipation can cause further problems, including:

• Bowel incontinence (leakage or diarrhea).
• Urinary incontinence, caused by pressure against the bladder.
• Urinary tract infections (UTIs).
• Lethargy (feeling drowsy, low in energy or sluggish).
• Nausea.
• Abdominal pain.

Diagnosis of constipation in Parkinson’s disease#

Diagnosis may include a review of your medical history, a detailed description of your symptoms and a physical examination. Medical problems other than Parkinson’s disease can also cause constipation, so your doctor may want to do tests to rule out other possible causes. The tests depend on the condition being investigated.

Treatment for constipation in Parkinson’s disease#

Your doctor may suggest various treatments to help, including:

• Dietary changes, including more fiber, such as wholegrain cereals, brown rice, pasta and bread, pulses such as lentils and beans, and fruit and vegetables, rather than refined or highly processed foods.
• Drinking more water.
• Moderate exercise.
• Good toilet habits.
• Laxatives, particularly agents that bulk and lubricate the stools.

Dietary fiber#

Be guided by your doctor, but general suggestions include:

• Eat at least two pieces of fruit and five serves of vegetables each day.
• Choose easy-to-eat fibrous foods, such as soft fruits, and consider mashing or pureeing them to make them easier to eat. Include the skin, where most of the fiber is found.
• Eat homemade vegetable soups.
• Sprinkle a tablespoon of bran, psyllium husks or chia seeds on your breakfast cereal, or add bran to baked goods such as cakes. Avoid bran if you have swallowing problems.
• Fiber supplements may help, but you must drink enough fluids for them to work. Avoid fiber supplements if you have swallowing problems.
• Do not increase dietary fiber too quickly, or you risk bloating and abdominal cramps. If discomfort occurs, cut back your fiber intake, increase your fluids, apply a hot water bottle to your abdomen and see your doctor.

Fluids#

Be guided by your doctor, but general suggestions include:

• Try to drink six to eight glasses (up to 2 liters) of fluid every day.
• Limit drinks that can cause dehydration, such as alcohol, tea and coffee.
• Spread your drinks throughout the day.

Exercise#

Be guided by your doctor, but general suggestions include:

• Talk with your doctor, exercise physiologist or another healthcare professional when planning your exercise program.
• Aim for at least 30 minutes of exercise every day.
• Spend a few minutes warming up and cooling down, for example by marching in place or stretching.
• Start with the easiest exercises first, and slowly introduce harder ones as your fitness increases.
• Only exercise when other people are at home who can help if needed.

Remember that too little exercise and fluid, combined with an increase in dietary fiber, can worsen constipation for some people.

Toilet habits#

Suggestions for good toilet habits include:

• Go to the toilet as soon as you feel the urge to pass a bowel motion. Holding on can contribute to constipation.
• Use the correct posture on the toilet: place your elbows on your knees, bulge out your stomach, straighten your spine and rest your feet on a footstool.
• Avoid holding your breath, and do not strain while on the toilet.
• Allow yourself plenty of time.
• Use a warm washcloth pressed against your back passage, or gently massage with one or two fingers, to help relax the muscles.
• Talk to your doctor or pharmacist about medicines to help soften your bowel motions.

Getting help for constipation in Parkinson’s disease#

See your doctor promptly if:

• You remain constipated for three weeks.
• Constipation develops suddenly.
• You have bloody bowel motions.
• Passing a bowel motion causes pain.
• You have unexplained weight loss.

Key points#

• Constipation is a common complication of Parkinson’s disease, but it can be managed with lifestyle changes such as adding extra fiber, and with medical treatment.
• Many people with Parkinson’s disease notice constipation before they notice motor symptoms such as tremor or stiffness.
• Symptoms of constipation include feeling that the bowel is not empty after passing a motion.
• Chronic constipation can cause further problems, and diagnosis may include a physical examination.
• Your doctor may wish to do tests to rule out other possible causes.

Where to get help#