Constipation

Constipation

Constipation occurs when bowel movements, or "stools," become less frequent or more difficult to pass. Some define constipation as less than three bowel movements per week, but what constitutes constipation can vary because our usual bathroom patterns differ. Some people go every day, while others may go only three or four times per week.

Constipation can significantly impact quality of life, causing bloating, discomfort and nausea. It is one of the most persistent symptoms of Parkinson's disease (PD), arising often years before the motor symptoms and affecting people throughout their disease course. Constipation also can slow absorption and lower the effectiveness of Parkinson's medications, such as levodopa. For these reasons, it is a major priority for Parkinson's researchers.

Causes

In Parkinson's, constipation can be part of the disease process. PD can affect the autonomic nervous system, a network of nerves that directs bodily functions we don't consciously control, such as blood pressure and digestion. When digestive tract movement slows in PD, constipation can happen. Recent research also has linked changes in gut bacteria (the microbiome) with Parkinson's disease; these disruptions may contribute to constipation.

Constipation also can be a side effect of some Parkinson's drugs. It's a common problem, for example, with Artane (trihexyphenidyl), which sometimes is used to ease tremor.

Other prescription and over-the-counter medications, including narcotic painkillers, antacids that contain calcium (Tums) or aluminum (Mylanta), or iron supplements, can contribute to constipation, too. Too little physical activity, water or fiber also can play a role.

Treatments

The first steps in treating constipation are diet and lifestyle adjustments:

• Drink at least six 8-ounce glasses of water per day.
  Water increases flow through the digestive tract. You may need more water, especially in hot weather, but start with at least six full glasses per day. Keep in mind that caffeine and alcohol can cause dehydration, which will worsen constipation. And consider drinking warm liquid in the mornings, as this sometimes can stimulate a bowel movement.
• Add more fiber to your diet.
  Fiber helps drive waste through the intestine. Gradually increase the amount of fiber in your diet with vegetables, berries, fruits with skin (such as pears and apples) and whole grains.
• Eat smaller meals throughout the day.
  Some people notice more small meals rather than fewer larger meals helps with constipation as it allows more time for digestion.
• Exercise regularly.
  Abdominal muscle movement helps activate the digestive system. Steady, moderately strenuous exercise, such as walking, swimming or light weightlifting, may help ease constipation.

When diet and exercise are not enough, your doctor may recommend over-the-counter or prescription medications, including stool softeners, laxatives or enemas.

• Stool softeners, such as Colace (docusate), can be used if stools are hard. These can be taken on a daily basis for short periods.
• Laxatives work in different ways. Some, such as Miralax (polyethylene glycol), pull water into the colon to ease constipation. These are fairly gentle and very popular. "Stimulant" laxatives, such as Dulcolax (bisacodyl) or Senokot (senna), promote muscle contractions in the digestive tract. These are not recommended for daily use as they can be more harsh on the system.
• Enemas are sometimes used for significant constipation, but these should be used cautiously and only under the advice of your health care provider.

Today, there are no prescription drugs specifically for Parkinson's constipation. However, the U.S. Food and Drug Administration (FDA) has approved drugs for "chronic idiopathic constipation" — constipation due to an unknown medical cause or medication. These drugs — Linzess (linaclotide), Amitiza (lubiprostone) and Trulance (plecanatide) — may be considered after diet changes, exercise and the above over-the-counter therapies have failed.

As with all Parkinson's symptoms, discuss the treatment of constipation with your doctor and work together to find a regimen that fits your needs.

Ongoing Research

The Michael J. Fox Foundation (MJFF) emphasizes research into understanding the gut-brain connection, learning about the experience and impact of constipation, and developing new treatments for this symptom:

• Understanding the gut-brain connection: Researchers are working to learn how and why constipation happens in Parkinson's and how individual's unique gut bacteria (microbiome) play a role in symptoms, disease and medication effect. They also are examining the protein alpha-synuclein in the gut to see if this could be a route for diagnosis and measurement of disease.  
• Learning about the experience of Parkinson's: To better understand the occurrence and impact of symptoms, including constipation, MJFF is gathering data from people with and without Parkinson's through its online clinical study Fox Insight. Register today to contribute valuable information through questionnaires and surveys.
• Developing new treatments: Several therapies, including a novel medication and non-medication strategies, currently are in clinical trial testing for constipation. Visit MJFF's study-matching tool Fox Trial Finder to learn more and sign up for ongoing trials

The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation for Parkinson's Research has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson's disease and any other medical condition be made in consultation with a physician or other qualified medical professional.