Constipation as a Symptom of Parkinson’s Disease

The medical world, as of today, still questions the cure and the cause of having Parkinson’s disease (PD). However, several treatments, surgeries, and therapies are present to aid PD patients. Earlier studies have proved that the said illness occurs due to the nerve cells dying in the brain, mainly in the area of the brain called the substantia nigra. With the neurons dying, the brain produces dopamine. It is a chemical responsible for sending signals to the brain that controls movement and coordination. As the dopamine levels continue to decrease, it would cause an individual to lose the control of his/her movements.

Symptoms vary from one person to another and they may experience a tremor of the hands, legs, and face. Moreover, the slowness of movement (bradykinesia), the stiffness of the limbs, or impaired balance and coordination are also possible symptoms. However, over the past decade, studies show that dopamine is also present in other parts of the body including the non-motor parts. This notion is due to the discovery that the Lewy Bodies (clumps of protein alpha-synuclein) are present in the brainstem and olfactory bulb. This indicates that the said disease may affect a person’s sense of smell and sleep regulation.

In addition to this, the intestines have also been discovered to have dopamine. This means that gastrointestinal problems may be a sign of having Parkinson’s disease, which includes bowel movement.

Unknown Pathogen in the Gut: A Hypothesis

Prof. Heiko Braak, M.D., an award-winning doctor for his studies and research for Parkinson’s disease, has a hypothesis that an unknown pathogen in the gut could be the cause of having PD. He added that the disease is following a step-by-step procedure in acting upon the body. It is said to start from the olfactory tract down to the vagal nerve, and then towards the central nervous system. His hypothesis also states that the spinal cord is not a potential route responsible for spreading the said disease to the brain because it will only be affected after the central nervous system. However, studies show that only 51-83% of the PD patients are following the pattern of Prof. Braak’s hypothesis.

Gastrointestinal problems do occur in PD patients; one of these is constipation. It is treated with time, patience, and dietary changes. Constipation is treated by controlling your body to restore normal bowel movement. Though often prescribed, studies show that it is unadvisable to take enemas or laxatives because it may damage the lining and bowel function.

Symptoms of constipation in Parkinson’s disease may include the following:

• Dry bowel movements and executing passing motions would be difficult
• Bowel motions in a week is less than three (in average)
• Feeling the need to strain in the toilet
• Feeling that the bowel isn’t empty after passing motions

Parkinson’s disease alone has an undiscovered cause. Constipation in line with the disease can have many reasons including (1) lack of dopamine which impairs the control of movement within the body including the intestines, (2) uncoordinated bowel motions due to bowel muscles being weak, (3) eating problems, (4) drinking problems, (5) sedentary lifestyle (lack of exercise) which is common to patients with PD due to the loss of muscle control, and (6) medications that may result in slower bowel movements or decrease appetite.

Constipation implications

Chronic constipation has its own implications including diarrhea, urinary inconsistency, urinary tract infections, the feeling of being drowsy, unenergetic or sluggish, nausea, or abdominal pain. Diagnosing if the current constipation in a patient is a result of Parkinson’s disease may be detected by medical history, a detailed description of symptoms, and physical examination. It is best to consult a doctor regarding this matter.

In summary, it is suggested to implement dietary changes that would include more water and fiber rather than highly processed food. Moderate exercise is also advised together with a habit of using the toilet. Avoid the use of unnecessary medicines which may include constipation-causing ingredients such as calcium and aluminum. The intake of laxatives, bulk formers, and stool lubricators are also advised upon the doctor’s prescription.

The National Parkinson Foundation has released a procedure in treating this side effect that comes along with PD. The following are needed to be strictly complied and at the same time being guided by a doctor:

• Correct diet and fluid intake: Meals should be eaten at the same time of each day. Your diet must include fruits (including its skin where the fiber is present), vegetables, whole grain meals, and cereals.

• Eat at least two pieces of fruit and five servings of vegetables per day: Drink 6 of 8 glasses of fluid daily. Drinks that have caffeine and alcohol do not count as it can worsen constipation and may also cause dehydration. It is also recommended to drink warm fluids after waking up and with breakfast as it can start bowel activity. Spread the drinks throughout the day.

• Regular time should be implemented for bowel movements: Doctors recommend it to be an hour and a half after a meal.

• Bulk formers: Bulk formers may be bran, Metamucil, and Fibercon. These can be bought even without prescription. It should be consumed daily by adding 1 to 2 teaspoons of bran or Metamucil to breakfast or dinner. On the other hand, as a starting dose, Taking 2 tablets of Fibercon per day is advised. Correct fluid intake should be done in taking these bulk formers. Don’t skip as it can worsen constipation. A quick increase of the dose of bulk formers may lead to gas formations or stomach fullness which is incorrect. These may take effect after 2 to 3 months to correct constipation.

• Stool softeners: Like bulk formers, it can be bought without a prescription. Once the stool gets very hard, this would help. Dosage is advised to be started as once daily.

• Laxatives and suppositories: While establishing a bowel program, avoid the use of strong laxatives and suppositories that may also be habit-forming. Only mild examples of this item are recommended for intake as it can further harm the bowel. It is not advised to use these as a replacement for diet and bulk formers. Suppositories would aid a patient into emptying the bowel by using rectal stimulation.

• Enemas: The use of enemas is only recommended when nothing else works and for special cases only because bowel can be dependent in these.

Conclusion

As advised, which may be difficult for PD patients, exercise is still advised to be part of the treatment. An exercise program monitored by a physiotherapist would contribute a lot. The goal should be 30 minutes of exercise per day. This would also include a few minutes of warming up and cooling down.

Toilet habits should also be implemented strongly. Going to the toilet should not be suppressed as it can lead to constipation. Body posture can also greatly help smoother bowel movement by placing the patient’s elbows on his/her knees and the feet on a footstool. Also, holding your breath or straining should be avoided.

An individual should be alerted and should contact a doctor when constipation suddenly develops, bowel motions have traces of blood and is painful, have unexplained weight loss, and remains constipated for three weeks even with the best efforts. Help will be provided by doctors or neurologists that would suggest a program that fits the patient’s condition and lifestyle.