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--- On Sat, 6/13/09, Jim Slattery <[log in to unmask]> wrote:


From: Jim Slattery <[log in to unmask]>
Subject: Constipation and PD
To: [log in to unmask]
Received: Saturday, June 13, 2009, 10:28 PM


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I am not a doctor of medicine; the following is not medical advice
but only the personal opinion of the writer. Any contemplated
change in treatment or medication MUST be referred to your
treating medical practitioner - Dr James F. Slattery PhD Soc Sc
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Parkinson's disease and constipation
Parkinson's disease (PD) is a progressive, degenerative neurological condition that affects the person's ability to control their body movements. Symptoms result from the degeneration of nerve cells in a part of the brain, which causes a deficiency in the availability of dopamine, a neurotransmitter necessary for smooth, muscular activity.
Constipation is a common complication of PD but it can be managed with medical treatment, extra fibre in the diet and lifestyle changes.
Symptoms
The symptoms of constipation include:
·       Bowel motions that are dry and difficult to pass
·       Less than three motions a week on average
·       Feeling the need to strain on the toilet
·       The bowel doesn't feel empty, even after a motion
A range of causes
The ways in which PD can increase the risk of constipation include:
·       Insufficient dopamine - lack of neurotransmitter dopamine impairs muscle movement throughout the body. Bowel muscles can become slow and rigid.
·       Uncoordinated bowel - the bowel muscles may be weak and unable to contract or they may clench instead of relaxing when trying to pass a motion.
·       Eating problems - dietary fibre is indigestible, so it adds bulk to the bowel motions and prevents constipation. However, if chewing and swallowing are difficult, a person with PD is less likely to eat fibrous foods.
·       Drinking problems - water is needed to plump the dietary fibre in bowel motions. Swallowing difficulties may discourage the person with PD from drinking enough fluids.
·       Sedentary lifestyle - lack of exercise slows the passage of food through the intestines. PD reduces muscle control, so lack of exercise is common.
·       Medications - many different drugs such as the common pain relief medication, codeine, can cause constipation. Medications used in the treatment of PD, especially anticholinergic drugs such asbenzatropine (Cogentin), can slow bowel movements, or dampen appetite.
Complications of chronic constipation
·       Lethargy
·       Nausea
·       Abdominal pain
·       Twisted bowel
·       Obstructed bowel
·       Bowel incontinence (leakage or diarrhoea)
·       Urinary incontinence (caused by pressure against the bladder)
·       Urinary tract infections.
Diagnosis
Diagnosis of constipation may include:
·       Medical history
·       Detailed description of symptoms
·       Physical examination.
Treatment
Your doctor may suggest various treatments to help combat constipation, including:
·       Dietary changes including consuming more fibre and water
·       Moderate exercise
·       Good toilet habits
·       Avoiding unnecessary medicines that contain substances known to cause constipation such as calcium and aluminium
·       Laxatives
·       An enema - this may be part of the initial treatment
·       Treatment for any medical problem that may be contributing to the constipation, such as haemorrhoids.
Self-help suggestions - dietary fibre
Be guided by your doctor, but general suggestions include:
·       Choose easy-to-eat fibrous foods such as soft fruits. Consider mashing or pureeing fruits to make them easier to eat. Make sure to include the skin, where most of the fibre is found.
·       Eat homemade vegetable soups.
·       Sprinkle a tablespoon of bran on your breakfast cereal or add the bran to baked products such as cakes. NOTE: Bran should be avoided if you have swallowing problems.
·       Fibre supplements may be helpful. However, you must drink enough fluids for the supplements to work properly. NOTE: Avoid fibre supplements if you have swallowing problems.
·       Don't increase dietary fibre too quickly or you'll risk bloating and abdominal cramps. If discomfort occurs, cut back your fibre intake, increase your fluid intake, apply a hot water bottle to the abdomen, and see your doctor.
Self-help suggestions - fluid intake
Be guided by your doctor, but general suggestions include:
·       Try to drink six to eight glasses of fluid every day. Water is the best drink.
·       Avoid drinks that cause dehydration such as tea, coffee, and alcohol.
·       Spread your drinks throughout the day.
·       Cut back on milk drinks, as milk can cause constipation in some people.
Self-help suggestions - exercise
Be guided by your doctor, but general suggestions include:
·       Consult closely with your doctor, physiotherapist or health care professional when devising your exercise program.
·       Aim for at least 15 minutes of exercise every day.
·       Spend a few minutes warming up and cooling down. This could include marching in place or stretching.
·       Start with the easiest exercises first. Slowly introduce the more difficult exercises as your fitness increases.
·       Only exercise when other people are at home who can help if necessary.
Self-help suggestions - toilet habits
Be guided by your doctor, but general suggestions include:
·       Go to the toilet as soon as you feel the urge to pass a bowel motion. Avoid hanging on.
·       Use correct body posture on the toilet - it can help you pass a bowel motion. Place your elbows on your knees and put your feet on a footstool.
·       Avoid holding your breath and don't strain when you are on the toilet. Allow yourself plenty of time.
·       Use a warm washcloth pressed against your anus or gentle massage with one or two fingers to help to relax the muscles.
·       Talk to your doctor about medicines to help soften your motions. It is important that the doctor realise that the patient suffers from PD, and the ramifications of that disorder for the treatment of  constipation. For example, it can be dangerous to prescribe a "moving" type of medication by itself, if the person's anal sphincter is shut tightly in spasm.
Seek immediate medical attention
See your doctor if:
·       Constipation develops suddenly
·       You have bloody bowel motions
·       Passing a bowel motion causes pain
·       You have unexplained weight loss
·       Constipation is still there after three weeks despite your best efforts.
Where to get help
·       Your doctor
·       Your neurologist
·       Your local continence clinic or service
Things to remember
·       Constipation is a common complication of PD.
·       Constipation can be managed with appropriate medical treatment, extra fibre in the diet and lifestyle changes.
·       See your doctor if the constipation does not resolve within three weeks, despite your best efforts. 
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