AS requested, I'm fwdg this here as well as to the main PD list, since some
of us CGs may not be readingthat list currently. Camilla
----------------------------Original message----------------------------
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Date: Tue, 19 Nov 1996 03:08:02 -0500
To: [log in to unmask], [log in to unmask]
Subject: Constipation advice

Hi, I am a neurologist, and a patient sent me a "Protocol for Prevention of
Constipation in Parkinson's disease" which included your email addresses.
 Since I do not check up on any of the PD bulletin boards, I thought you
could pass the attached advice on Constipation on to the various PD BBs you
participate in.  The basis of this document is an excellent summary article,
part of a Symposium on Geriatrics; "Constipation and Fecal Incontinence in
the Elderly Population", Y. Romero et al, Mayo Clinic Proceedings 71:p.81-92,
January 1996.  I hope it becomes a helpful pamphlet for anyone with
constipation.  Sincerely, R.D. Fross, M.D., Kaiser-Permanente Health Care
Program, Hayward, California

Constipation management and prevention:

What is Constipation?
 1) only one or two bowel movements per week
 2) often having hard stools
 3) often straining while trying to have a BM
 4) feeling not completely empty of stool when done

Who gets Constipation?
 People with:  1) chronic disease
    2) reduced mobility
    3) poor dietary habits
    4) reduced fluid intake
    5) a variety of constipating medications

How does a doctor evaluate Constipation?
 Certain disease states need to be ruled out:
  anemia
  diabetes
  chemical imbalances (high calcium, low potassium)
  kidney failure
  thyroid failure
  colon disease (diverticulosis, cancer, polyps)
  rectal/anal muscle disorders
 A physical examination and blood tests are useful.

If simple Constipation is found, how is it managed?
 1) Discontinue unnecessary medications which may contribute to constipation;
substitute less constipating ones.
 2) Use the body's natural reflexes, by attempting to have a BM about 30
minutes after eating a meal.
 3) Do not sit and strain too long.  Fatiguing the rectal muscles may impair
evacuation.
 4) INCREASE INTAKE OF FLUIDS (ideally 6 to 8 glasses per day) - including
water, juice, tea, coffee, soda, etc.  Maintain a high fluid intake
indefinitely.
 5) INCREASE FIBER INTAKE - at least 10 grams of fiber per day, either
dietary or supplemental.
 6) AVOID BEING SEDENTARY; Be as active as possible; exercise daily if
possible.




If that doesn't work, how can Bowel Movements be stimulated?
 Cathartics (bowel stimulants) take many forms.  This list recommends the
safe cathartics for simple constipation, in order of FIRST-SAFEST/EASIEST,
LAST-STRONGEST/MOST SIDE EFFECTS:
 1) Fiber supplementation (to hold onto stool moisture, softness)(MUST ALSO
HAVE HIGH FLUID INTAKE or the fiber will worsen the problem by remaining DRY
in the colon)
  Dietary: Fiber-rich fruit (prunes, etc)
    Bran (1 cup per day)
  Supplements: Natural - Psyllium (Metamucil, Perdiem)
       (1 tsp. up to three times daily)
     Synthetic - Methylcellulose (Citrucel)
       (1 tsp. up to three times daily)
      -Calcium polycarbophil (FiberCon)
       (2 to 4 tablets daily)
 2) Physical activity 30 minutes after meals, or at least Scheduled Toileting
30 minutes after meals.
 3) Non-absorbable disaccharides (hyperosmolar agents) (to draw fluids into
the colon to soften the stool)
  - Sorbitol solution (1 to 2 tablespoons once or twice a day)
  - Lactulose syrup (1 to 2 tablespoons once or twice a day)
 4) Glycerin suppositories (rectal irritant to promote evacuation)(once a
day)
 5) Magnesium-containing laxatives (saline cathartics) (to draw fluids into
the intestine, and to stimulate intestinal contractions)
  - Milk of Magnesia (1 to 2 tablespoons once or twice a day)
  - Haley's M-O (same dose, has mineral oil as well for lubrication)
 6) Tap water enema (preferrable to irritative Fleet (phosphate) enema) (to
flush stool out of the rectum, and perhaps unblock the flow)
 7) Mineral oil enemas (to lubricate and flush out the rectum)
 8) Stimulant laxatives (taken by mouth) (to stimulate propulsive colon
activity, and draw fluid into the colon to soften the stool)
  DO NOT USE DAILY; NO MORE THAN 3 TIMES A WEEK
  - Bisacodyl (Dulcolax) - up to three times a week, no more
  - Anthraquinones (senna, cascara)
   Senokot (2 tablets daily up to 4 tablets twice daily)
   Perdiem plain (1 to 2 tsp. per day)
   Peri-Colace (1 to 2 tablets daily)
  - Phenolphthalein (ExLax, Correctol, Feen-a-Mint) (1 to 2 per day)

What about Stool Softeners?
 Stool softeners DO NOT IMPROVE CONSTIPATION.
 Do not bother with Docusate or Colace to treat constipation alone.  It may
be used in combination with other methods, but will not achieve relief of
constipation by itself.