Constipation and Parkinson’s Disease

According to Dr. Duncan Forsyth, a consultant geriatrician who specializes in constipation in Parkinson’s, constipation often has several causes:

A Parkinson’s diagnosis is a life changing event. Suddenly, the most basic functions can become more difficult. Bowel movements are no exception. Constipation is estimated to occur in approximately 50-60% of Parkinson’s patients, and may manifest long before other motor symptoms appear (Abbott, 2003). What complicates the discussion and diagnosis is that every individual’s bowel movements vary in everything from frequency to consistency. In terms of timing, what may be irregular or slow for one person may be another person’s normal. This is why it is important to avoid comparing your experiences to those around you, especially if something seems unusual or uncomfortable to you.

Most people will experience occasional constipation for various reasons at some point in their lifetime, but chronic constipation is a more serious concern. The main diagnostic criteria of chronic constipation involve at least two of the following symptoms for a minimum of twelve weeks within a year:

Straining to pass stool more than 25% of the time
More than 25% of stools are lumpy or hard Sensation of incomplete evacuation more than 25% of the time
Sensation of anorectal blockage for more than 25% of the time
More than 25% are facilitated by manual maneuvers (e.g., digital evacuation or support of the pelvic floor)
Fewer than 3 bowel movements per week (Gastrointestinal Society, 2014)

As evident from the diagnostic criteria, two people may both be experiencing constipation yet have very different symptoms.

What Causes Constipation?

Your large intestine’s primary role is to absorb water and sodium from food before creating stool. Muscles in the large intestine work to move the stool along to be eliminated – hence the term bowel movement. When insufficient water or fibre is consumed, stools may appear lumpy or hard and be excreted as small pellets or one hard piece. The longer a stool remains in the large intestine, the more pressure is exerted on the bowels. This often causes rectal pressure/fullness, sensation of incomplete evacuation, bloating and abdominal pain. It can also cause malaise, loss of appetite and back pain. Further complications, such as hemorrhoids and rectal bleeding, are typically due to strain when passing stools (Healthline, n.d.).

According to Dr. Duncan Forsyth, a consultant geriatrician who specializes in constipation in Parkinson’s, constipation often has several causes:

Poor fluid intake
Reduced activity levels
Reduced food intake
Effects of drugs
Direct effects of Parkinson’s on the nerves that control bowel function, which leads to a slowing of bowel transit time (Parkinson’s UK, 2011)

Some of the medications in your regimen may contribute to constipation. Anticholinergics – which block involuntary movements of the muscles – can have the dual effect of decreasing appetite as well as slowing bowel movement (State of Victoria, 2015). Levodopa, dopamine agonists and amantadine can also contribute to constipation (Parkinson’s Disease Foundation, n.d.). Other contributing drugs include narcotics, sedatives, antacids, antispasmodics and iron supplements (Okun, 2011). For people with Parkinson’s the benefits of continuing to take a drug such as levodopa outweighs a side effect like constipation, however, chronic constipation may be a good reason to re-evaluate dosage for painkillers and supplements. This is just one reason why it is important to mention whether or not you are experiencing constipation to your doctor, so you can help identify a medication regimen that works for you.

You may have heard that constipation can be counted as an early sign of Parkinson’s disease. In 2009, a study led by Dr. Walter A. Rocca at the Mayo Clinic in Rochester, Minnesota discovered that individuals with Parkinson’s are approximately twice as likely to have a history of constipation as those without. While the study does suggest that Parkinson’s disease typically has a long preclinical period, the many causes of constipation mean that it cannot be understood as a specific marker of Parkinson’s disease (Hendry, 2009).

Constipation Prevention and Management

Whether you experience constipation or would like to avoid it, making some lifestyle changes can help you manage digestion as well as increase your overall health.

Incorporate more whole grains, fruits and vegetables into your diet, avoid processed foods and ensure that you drink 6 to 8 glasses of fluids daily.
Avoid diuretics such as caffeine and alcohol.
Have set meal times as well as establish a regular time of day for bowel movements (Carter, n.d.). Warm foods and beverages at breakfast can encourage bowel movements in the morning – not a bad reason to reach for that herbal tea or oatmeal!
Exercise. Exercise accelerates breathing and heart function which encourages movements in other parts of your body while toning and strengthening the walls of your large intestine. Aerobic exercise – also known as cardio – stimulates heart rate and encourages the pumping of oxygenated blood to muscles. Common aerobic exercises include walking, running and cycling. A brisk 10 – 20 minute walk is one of the best exercises for constipation relief. Yoga can also have its benefits. Some yogis believe that certain positions strengthen stomach muscles, help with digestion and relieve constipation (Orenstein, 2009). If you plan on increasing your activity level to help manage your health, it is important to first consult with a healthcare professional. Remember to start off with the easiest exercises and incorporate more difficult ones as your fitness level increases. As with most activities, moderation is key; extreme exercise can sometimes cause diarrhea.

Laxatives

You may be tempted to use laxatives or stool softeners to help manage constipation. This may be a viable alternative only after attempting to modify your diet or incorporating more exercise into your routine. Speaking with a physician as well as avoiding the use of any type of laxative or stool softener for longer than a two week period is advisable. If you are considering using these products, it is important to know the different types available to you.

Bulk-forming laxatives or fibre supplements are widely considered the safest type of laxative you can take. Fibre laxatives absorb liquid in the intestines to soften stool. The increased bulk leads to bowel stimulation, triggering movement. Stool softeners or emollients on the other hand, do not cause bowel movement but can help reduce straining. Stimulant, saline, hyperosmotic laxatives or combination products should only be taken upon advice from your physician. Homeopathic supplements are another option, however keep in mind that research and regulation of these products are minimal (American Parkinson Disease Association, 2013).

The Bottom Line

It may be tempting to ignore symptoms of constipation out of embarrassment, but this condition should not persist unaddressed. If you experience a sudden change in bowel movements, see your physician or neurologist. They should be able to assess your condition and make recommendations while considering your current medication regimen as well as your medical history. They may be able to refer you to a dietician or physiotherapist who can help recommend food and exercises that will be beneficial for you. The good news is that many of the life changes recommended for Parkinson’s disease double as excellent ways to manage or prevent constipation.

Please note that this article is intended as a general guide. If you would like more information about gastrointestinal disorders, The Gastrointestinal Society is an excellent BC-based resource. You can reach out to them by calling 1-866-600-4975 or visit their website at www.badgut.org. The Gastrointestinal Society as well as Parkinson Society British Columbia are unable to answer specific, urgent medical questions. The best advice will come from an expert who knows your medical history.

Sources

Abbott RD, Ross GW, White LR, Sanderson WT, Burchfiel CM, Kashon M, Sharp DS, Masaki KH, Curb JD, Petrovitch H. (2003). Environmental, life-style, and physical precursors of clinical Parkinson's disease: recent findings from the Honolulu-Asia Aging Study. Accessed April 30, 2016 from http://www.ncbi.nlm.nih.gov/pubmed/14579122

American Parkinson Disease Association. (2013). Constipation & PD. Retrieved April 29, 2016, from http://www.parkinsonassociation.org/wp-content/uploads/2013/06/APDA-Constipation-and-PD.pdf

Carter, Julie. (n.d.) Constipation in Parkinson’s Disease. Retrieved April 28, 2016, from http://www.parkinson.org/sites/default/files/Constipation%20in%20Parkinson%27s%20Disease.pdf

Gastrointestinal Society. (2014). Constipation. Retrieved April 26, 2016, from http://www.badgut.org/wp-content/uploads/GIS-PIH-CO.pdf

Healthline. (n.d.) What causes constipation? Retrieved April 28, 2016 from http://www.healthline.com/symptom/constipation

Hendry, Joene. (2009). Constipation: an early sign of Parkinson’s? Retrieved April 28, 2016, from http://www.reuters.com/article/us-constipation-parkinsons-s-idUSTRE5B04R520091202

Okun, Michael. (2011). Parkinson’s Treatment Tips for Constipation. Retrieved April 28, 2016, from http://movementdisorders.ufhealth.org/2011/09/12/parkinsons-treatment-tips-for-constipation/

Orenstein, Beth. (2009). Exercising Constipation Out of Your Life. Retrieved April 29, 2016 from http://www.everydayhealth.com/digestive-health/exercise-and-constipation.aspx

Parkinson’s Disease Foundation. (n.d.). Gastrointestinal Issues. Retrieved April 26, 2016 from http://www.pdf.org/en/gastrointestinal_problems_pd

Parkinson’s UK. (2011). Q&A: Bladder and Bowel Problems in Parkinson’s. Retrieved April 26, 2016, from http://www.parkinsons.org.uk/content/qa-bladder-and-bowel-problems-parkinsons

State of Victoria. (n.d.). Parkinson’s disease and constipation. Retrieved April 26, 2016, from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/parkinsons-disease-and-constipation

This content was published in the Summer 2016 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.

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