Constipation in Parkinson’s Disease

Constipation is a frequent complaint of patients suffering with Parkinson’s disease, especially those being treated with anticholinergic medicines, but it may be treated quite effectively with change in medications, proper dietary fiber intake and lifestyle measure.When there is difficulty in passing stool, or when the interval between passing stools is lengthened beyond three days, a person may be said to be suffering from constipation.

Causes of Constipation in Parkinson’s Disease

  • Treatment with anticholinergic medication such as trihexyphenidyl and benztropine may cause constipation.
  • The autonomic nervous system, which regulates the smooth muscle functions, may be impaired in a patient with Parkinson’s disease, causing slowing down of the peristalsis (movement in intestinal tract), thereby leading to constipation.
  • Inadequate dietary fiber and/or water intake.
  • Lack of sufficient exercise or physical activity.
  • Stress and depression.
  • Resisting the urge for defecation because of the associated pain in hemorrhoids.
  • Frequent use of laxatives may cause secondary constipation.
  • Antacids containing calcium and aluminum.
  • Medications such as iron compounds, narcotics and antidepressants.
  • Milk causes constipation in some people.

Complications of Constipation

Apart from the distress caused by constipation, it may further lead to other complications such as :

  • Loss of appetite
  • Nausea
  • Abdominal pain
  • Fecal impaction
  • Incontinence
  • Urinary retention
  • Urinary tract infection
  • Acute mental confusion

Management of Constipation in Parkinson’s Disease

  • Constipation can be prevented by making sure that the patient with Parkinson’s disease eats a healthy diet with sufficient dietary fiber. Often this is difficult due to problems with chewing and swallowing but this can be overcome by cutting up the food into smaller pieces or by mashing up the food to a semi-solid consistency. Fruits with edible seeds, such as strawberries, have high fiber content, as also vegetables, whole grain bread, and bran.
  • Drinking plenty of water and liquids is very important but coffee and soft drinks should be avoided. Large amounts of milk is also not advised as it causes constipation in some people.
  • Regular exercise is very important, even just moderate physical activity can be beneficial.
  • Avoiding medications causing constipation, such as antacids containing calcium and magnesium.
  • Laxative overuse should be avoided
  • If medicines used for treatment of Parkinson’s disease, such as anticholinergics, are the cause of constipation, dose alteration or alternative medicines may be tried.
  • Stool softeners and laxatives, or an enema may be needed to treat constipation.

According to a study published in the scientific journal of the American Academy of Neurology, men with constipation are three times more likely to develop Parkinson’s disease as opposed to those without constipation. Obviously, constipation alone is not the deciding factor, but if it is associated with family history of Parkinson’s disease or other motor problems, the chances of developing the disease are increased. More work needs to be done on this research which could help identify early Parkinson’s disease symptoms or those who may be at risk of developing this disease later in life.

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