Parkinson’s and Constipation

During digestion, the muscles of the intestine contract simultaneously to move the food bolus through the intestine and excrete the undigested material in the stool.

Parkinson’s disease causes degeneration of the neurons that control the intestine muscles, which slows down the digestive process and stool elimination. As a result, stool stays longer in the last part of the intestine, the colon, where liquid is reabsorbed by the intestinal wall, making it dry and harder to evacuate.

Symptoms of the disease can increase constipation problems. For example, less physical activity leads to less bowel stimulation. Difficulty chewing and swallowing may reduce the tendency to adopt a fibre-based diet and to drink enough water and beverages (1.5 litres per day).

Some medications can also cause a decrease in the frequency of bowel movements. Talk about this with your doctor.

Constipation is common in the general population. Lifestyle and diet changes can often solve this problem.

• Make sure you eat enough vegetables and fruit, fresh or cooked.
• Add fibre to your meals (whole wheat products, legumes, prunes, dried apricots, apples, berries, nuts).
• Increase your water intake (8 to 10 glasses per day). If you increase your fibre intake without drinking more water, you will be even more constipated. Try to drink more often and in small amounts.
• Eat several small meals during the day.
• Avoid coffee and alcohol since they cause dehydration.
• Do physical activity 15 to 30 minutes per day to stimulate your intestine.
• Drink slightly warmed prune juice.

You should feel the benefits of these changes within 4 to 12 weeks. Maintain a healthy diet and exercise program to get your bowel into its new routine.

You also have access to over-the-counter medications in pharmacies or by prescription. Ask your pharmacist or doctor for advice and they will be able to help you choose.

• Emollient laxatives (ColaceⓇ) increase the volume of water in the feces and make the stool softer and easier to evacuate. They generally take effect within 1 to 3 days. Their effectiveness is often limited in people living with Parkinson’s disease.
• Functional fibres (psyllium and bran) are fibre supplements that trap water in the stool to increase its mass.
• Stimulant laxatives (SenokotⓇ, DucolaxⓇ) stimulate colon muscle activity to promote stool evacuation. Their effect is often immediate, but they should not be used to treat chronic constipation because they can irritate the intestinal wall and create dependency.
• Osmotic laxatives (polyethylene glycol (PEG), lactulose and magnesium hydroxide) attract and retain water in the colon to facilitate and improve stool passage. This is usually the treatment of choice for physicians.

Chronic constipation can lead to fecal impaction due to the accumulation of stool which dries out in the intestine. This “dry” mass then becomes increasingly difficult to evacuate. In this case, the use of stimulant laxatives will not be effective in evacuating the stool and will cause painful contractions of the colon muscles that will be felt as abdominal pain. Enema is then preferable.

Chronic constipation can also lead to watery diarrhea. In this case, the contractions of the colon’s muscles allow liquids from the intestine to pass around the “dry” mass.

Finally, passing dry stool requires intense and repeated pushes. The pressure exerted on the veins of the anus can lead to their inflammation and dilation. This can lead to bleeding and pain when the stool passes through the anal canal (hemorrhoids).

You can help your loved one by encouraging them to change their lifestyle and diet habits. You may also benefit from these changes.

Constipation is an early symptom of Parkinson’s disease. It often appears several years before the diagnosis of the disease. It must be treated by your doctor to avoid severe complications, such as a blockage of the intestine.