Studies show as many as 80% of people with Parkinson’s suffer from constipation. Constipation is defined as fewer than three bowel movements per week. One of the effects Parkinson’s has on the autonomic nervous system seems to be the slowing down of food through the gastrointestinal tract, which can result in constipation.
In this episode
Movement disorder specialist Cherian Karunapuzha, MD (better known as "Dr. K"), discusses definitions relating to constipation, causes of constipation, treatments for constipation, how constipation can impact your medication absorption, constipation's connection to other symptoms, and more.
To download the transcript, click here.
- According to the Rome IV Criteria, constipation can be diagnosed if you have any two of the following symptoms for at least six months:
- Fewer than three spontaneous bowel movements per week
- Straining for more than 25% of each attempt to defecate
- Lumpy or hard stools 25% of the time or more
- The sensation that your bowel movement is incomplete
- The need to manually disimpact your stool 25% of the time
- Dr. K emphasizes that a person with Parkinson's should have a bowel movement every single day so that the gut does not get infected and so medication is properly absorbed
- Constipation can be one of the earliest signs of Parkinson’s, sometimes occurring 10 years or more before the appearance of slowness, stiffness, or tremors
- Constipation often increases as Parkinson’s progresses
- Constipation is a direct symptom of Parkinson’s because of damage that is caused to the nerves that line the gut. Other autonomic systems may also be affected because the same type of nerves line these systems as well.
- 80 – 90% of people with Parkinson’s will develop constipation and/or gastroparesis, the slowing down of your entire gut or bowel system (which can manifest as constipation, bloating, nausea, vomiting, or heartburn)
- Addressing constipation is important for two reasons. First, consistent constipation can cause infection; second, constipation affects the proper absorption of your medications. To address constipation, Dr. K recommends:
- 1) Increase fiber, drink prune juice, eat raisins or other dried fruits, and drink a tall glass of water with every single medication dose
- 2) Add over-the-counter medications that add fiber (Metamucil) and pull water into the gut (Miralax, Milk of Magnesia). The trick with taking these laxatives is to take them regularly rather than when you need them. When laxatives are taken only as needed, it is easy to either take too many or too few, then “yo-yo-ing” between constipation to diarrhea. Before beginning any over-the-counter medication, however, speak with your physician
- Drinking water helps to carry carbidopa/levodopa through your stomach and into the small intestine, where the medication is absorbed
- Does tea or coffee count for fluid intake?
- The liquid component of whatever you are drinking always helps, but because caffeine is a diuretic, you may quickly urinate much of what you just drank
- An advantage of caffeine is that caffeine behaves as a prokinetic, which promotes movement within your gut
- While exercise has not been shown in formal studies to decrease constipation, many people have found it to be very useful in helping minimize the symptom
- Some Parkinson’s medications, such as amantadine or Artane, may actually increase constipation. Medications taken unrelated to Parkinson’s may also have this effect, such as older-generation antihistamines or Tylenol PM
- Fecal incontinence may happen as a result to the damage to the nerves of this system. Dr. K says there are two general types of fecal incontinence: when you don’t have enough control of your bowel system and therefore you leak fecal matter, or the opposite, when you may feel the need to “go” but you don’t have enough strength to poop. For the latter, Dr. K recommends using a squatty potty or pushing your tailbone all the way to the back of the toilet to increase the upward resistance on your body
- Indigestion may be impacted by slowness of the gut, but if indigestion is occurring frequently, consult a a gastroenterologist who can determine if there are other causes
- The same slowness that affects your bowels impact your throat and swallowing muscles, which manifests itself as difficulty swallowing
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*The Third Season of the Parkinson’s Podcast is made possible through generous support in honor of Dr. Margaret Hilgartner.