Constipation is a common problem for people with Parkinson’s. At first glance, constipation may seem more of a nuisance than a real concern, yet constipation adds to the burden of having Parkinson’s and has a negative effect on the person’s quality of life.

It is important that you seek help in managing your constipation because the good news is that it can be managed and it should not be allowed to interfere with your enjoyment of life. Discuss it with your GP or call the Continence Helpline on 0800 650 659

What is constipation?

Constipation is the infrequent passage of hard dry bowel actions that are difficult to pass. There is a wide variation in frequency from 3 times per day to 3 times per week. The normal bowel motion (not constipated) is soft formed and easy to pass and the person has a feeling the bowel is completely empty. If you are straining to empty your bowels and or your bowel action is hard and dry, you are constipated and you need to take action.

Parkinson's and constipation

There are three main ways that Parkinson’s may cause constipation.

• Firstly, Parkinson’s can affect the muscles of the bowel causing slowness and rigidity. The bowel is further robbed of stimulation if your mobility is reduced. This results in the bowel action (faeces) not being propelled quickly enough through the bowel and constipation develops.

  Emptying the bowel can be more difficult because of poor coordination of the back passage (anal) muscles. These muscles may contract instead of relaxing making it difficult to pass the bowel motion completely.

• Secondly, medicines used to treat your Parkinson’s may be a factor in constipation either by directly affecting your bowel - slowing them up or by affecting your appetite. Anticholinergic drugs in particular, cause constipation (Amantadine/Symmetrel, Levodopa, Benserazide/Madopar and Levodopa, Carbidopa/Sinemet).

• Thirdly, chewing and swallowing difficulties can make eating adequate amounts of dietary fibre hard to achieve. Fibre is found in fruit, vegetables and grains and is important in keeping the bowel action formed and soft. Drinking sufficient fluid is essential in preventing constipation. You may find this difficult if your swallowing is affected.

Treating constipation

If left untreated constipation can lead to several problems. You may feel unwell, lethargic and nauseated - worsening the constipation as you will not feel like eating and drinking adequately.

Severe constipation can mimic diarrhoea with loose bowel action from irritation caused by the hard stool in the bowel. The loose bowel action often results in bowel incontinence - leakage from the bowel before getting to the toilet.

Constipation can also disturb your bladder causing you to void more frequently and more urgently and may even result in you being incontinent (leaking urine before you reach the toilet). It may also be more difficult for you to empty your bladder and this may result in urinary tract infections.

Preventing and managing constipation

There are four simple steps to prevent and manage constipation. These are:

• Eat well

Eat a healthy diet rich in dietary fibre. We need at least 30gm of fibre each day. Eat at least 2-3 serves of fruit, 5 serves of vegetables and 5 serves of cereals and bread. It is important to get the balance right as just adding fibre to your diet without increasing your fluids can cause or worsen constipation.

• Drink well

Drink 1.5 - 2 litres of fluid each day unless otherwise advised by your doctor. Spread your drinks evenly throughout the day although you can taper off a little towards bedtime. Remember, fluids and fibre work together to prevent constipation.

• Exercise regularly

Keep moving. Aim to exercise for 30 minutes most days. Remember that walking is great exercise.

• Practice good bowel habits

Go to the toilet when you get the urge to open your bowels, this is the most effective time to completely empty your bowels. Most people get the urge first thing in the morning after breakfast or following a meal. Eating stimulates the bowel.

Get into the correct sitting position on the toilet. Sit on the toilet, elbows on knees, lean forward and support feet with a footstool. Relax and bulge out your tummy, relax your back passage and let go (don’t hold your breath). When you have finished firmly draw up your back passage.

If you have tried these four steps for 2 - 3 weeks and your constipation has not improved seek help. The following health professionals will be able to advise you:

• Doctor

• Continence Nurse Advisors

• Continence Helpline 0800 650 659

Laxatives

Laxatives are medicines that help you pass a bowel motion. Laxatives are not the first step in the treatment of constipation but may be necessary if the steps outlined above do not work.

There are four types of laxatives and each has a different mode of action:

• Fibre supplements or bulking agents

  Psyllium (Metamucil) and Isphaghula (Fybogel) are examples of fibre supplements. Fibre supplements should only be used if adequate fluids can be taken each day.

• Softeners

  Docusate Sodium (Coloxyl) is an example of a softener and is ideal for people with Parkinson’s. It should be taken every day.

• Stimulants

  Bisocodyl (Durolax) and Senna (Senokot) are examples of stimulants.

• Osmotics

  Lactulose (Duphalac), Sorbitol (Sorbilax) and Polyethylene Glycol (Movicol) are examples of osmotics.

The laxative that best suits you will depend on your degree of mobility, your fluid and fibre intake and bowel function. Talk to your GP before starting any of these medicines.

For more information

Visit your GP

Call the Continence Helpline 0800 650 659

Parkinson’s New Zealand www.parkinsons.org.nz

For all enquires: Continence NZ: Continence Helpline: Call 0800 650 659 : Email: info@continence.org.nz

This document has been developed by and remains the property of, the Continence Foundation of Australia

© Continence Foundation of Australia 2015