At 14:00 1998/11/22 -0600, you wrote:
>The Parkinson Foundation of Canada
>has an on-line pamphlet on this subject at;
>   <http://www.parkinson.ca/confrm.html>
>
>The site downloads slowly, alas -
>almost as though it too were constipated.

lucky me, i had no difficulty accessing the site

i also thought the info was quite valuable and have reproduced it below
for those of us without wwweb access
and also to add it to our archives
where there is a treasure-trove
of info posted over the
past five years

our pd list archive web-site  [maintained by simon coles]
is part of the pwp web-ring  [maintained by jerry finch]
as is my very own web-site  [maintained by his ether-twin bubba finch]
ergo
the pwp web-ring is our ideal one-stop-surfing-site
so hop on!

janet

-----------------------------------
Managing Constipation in Parkinsons
http://www.parkinson.ca/confrm.html

Introduction:
The goal of this pamphlet is to help you understand what makes constipation a problem in Parkinsons, and what you can do to develop a plan of prevention.

In Parkinsons, the constipation is most often due to a combination of the following factors:
- Your intestines move more slowly than normal because of your Parkinsons.
- Your drug therapy
- Your inability to exercise enough
- Not drinking enough fluids. If you have Parkinsons, you must be particularly careful about constipation in hot weather when you may become dehydrated.
- Difficulty expelling a stool because it is hard, dry and painful to pass. The longer the stool remains in the gut, the more water is reabsorbed into the tissues and the dryer it gets.
- Difficulty expelling a normal stool because you feel weak. This difficulty may arise if you are under-medicated or your drugs are wearing off at the time you feel the need to have a bowel movement.

Try the following in the order given. Do not hesitate to call your physician if your constipation is prolonged as it can lead to problems that can be very serious and need urgent medical attention: in Parkinsons, the bowel can twist and cause an obstruction.

Physical Activity:
To promote regularity, be as active as you can. A physical therapist can advise you on exercises that suit you. The Parkinson Foundation of Canada also has an exercise pamphlet. It is possible to exercise even if you are confined to your home.

Regularity:
The following may help you establish regular bowel habits:
- Eat meals and snacks at regular times.
- Establish a regular time for emptying your bowels.
- A hot drink can stimulate bowel activity.
- Go to the bathroom regularly after breakfast as food stimulates the bowel to empty.
- Always respond to the urge to empty your bowel.
- Make sure you are comfortable on the toilet, with your feet flat on the ground or on a stool.
- Take your time.
- If you need to modify your toilet or the area around it (hand rails, raised toilet seat etc.) Talk to your physician, home care nurse, or occupational therapist.

Level One:
Modify your diet by increasing your intake of fibre-rich foods:
- Whole grain bread, crackers, muffins.
- Serve breakfast cereals with at least 4 grams of fibre per serving.
- Use dried beans, peas, lentils in soups, salads and casseroles.
- Add 1-2 tablespoons bran to hot cereal, yogurt, stewed fruits and milkshakes.
- Eat plenty of raw or soft-cooked fruits and vegetables, including the skin whenever possible.
- Add dried fruits to cereals, salads, desserts.
- Try the following fruit-lax recipe: Soak 1 lb. mixed dried fruits cranberry juice overnight. Chop in blender, store in refrigerator and have one/half - one whole cup every morning with cereal or yogurt.

Sample high fibre menu:
Breakfast:
- half banana
- 3/4 cup high fibre cereal & milk
- 1 slice whole wheat toast
- butter/marmalade
- 1 glass water/juice, coffee, tea
Lunch:
- 1 cup split pea soup
- 1 slice rye bread with tuna, mayonnaise, tomato & cucumber
- 1 orange
- 1 glass milk/water/juice
Dinner:
- baked chicken breast
- baked potato with skin
- cooked carrots & green beans
- fruit salad with yogurt
- 1 glass water or juice
Snacks:
- Take with medications or at bedtime
- Could include whole grain muffin or scone with a glass of milk, or 2 oz. cheese with whole wheat crackers plus a glass of juice, water or milk.

Increase your fluid intake:
- Drink 6-8 eight ounce glasses of water, milk or juice a day, most of it by 4 pm to avoid sleep upset.
- If necessary, measure out a pitcher each morning and put a reminder on the refrigerator door.

Level Two:
- If after two days you are still constipated, add 1-2 tablespoons of Psyllium (Metamucil) 2-3 times a day with a cup of water. Taking Psyllium or Metamucil three times a day with plenty of water is preferable to taking it all in one dose.
- You must also be able to maintain an adequate fluid intake (6-8 glasses of water a day) and take regular exercise if you want the bran or bulking agents to work well for you.
- lf you have difficulty swallowing, and/or choking episodes, you should avoid bran (including bran muffins), Metamucil, Prodiem and other bulking agents.
- If using the advice in level 1 or 2 relieves your constipation, continue indefinitely. Levels 3-5 are NOT intended for continuous use.

Level Three:
- If you are still constipated after two days, add: Sennosides 12-24 mg. at bedtime or Bisacodyl 10 mg at bedtime or Cascara 5 ml (1 tsp) or 2 Senakot tablets.

Level Four:
- If you are still constipated after 1-2 days, add: Lactulose 15 ml twice daily or Glycerin suppositories: Use 1-2, lubricate tip with KY jelly and insert gently while sitting on the toilet.

Level Five:
- If you are still constipated after 1-2 days, give a Fleet enema. If this fails, then you should contact your physician or the local health unit.

Giving an Enema:
The patient lies on a towel, on the left side, knees bent, as close to the edge of the bed as possible. The buttocks can be raised (for gravity) on a plastic covered pillow (a trash bag will do). The enema should be warmed, the rectal tube lubricated (KY jelly) and inserted gently and slowly as far as possible. Give the enema slowly and then withdraw the tube. Cover the patient and offer a heating pad or hot water bottle for the abdomen. Encourage the patient to retain the enema for as long as possible, and then assist him/her to the commode or toilet. A successful enema will often yield more than one bowel movement over several hours and so it should be given early in the day to avoid disturbing sleep.

Gas and Bloating:
Increasing the fibre content of your diet too quickly and by too much can cause painful gas, bloating and cramps. There are several anti-gas products available from your pharmacy. Hot peppermint water (made with peppermint oil) plus a hot water or heating pad on the stomach can be comforting.

Retention and Overflow:
This is a situation where small amounts of watery stool seep around a bolus of constipated stool. This needs attention, most often with an enema, because the blockage is usually higher than can be reached with suppositories.

IMPORTANT:
Everyone concerned with Parkinsons needs to be alert for the possibility of volvulus (twisting of the bowel) and obstruction (blockage). Parkinson patients are more prone to these for unknown reasons: perhaps the sluggish motility of the bowel is to blame. By the time either of these develop, the patient is often out of the hands of the neurologist and under the care of a surgeon who may not know about the risk and mortality.

This pamphlet has been prepared by Susan Calne, RN,
Clinical Coordinator, Karol Travis, RDN,
and Shellen Letwin, Ph.D. Pharm.,
University Hospital,
Health Sciences Centre,
2211 Wesbrook Mall,
Vancouver, BC
V6T 1B5
0ct/97

-----------------------------------

janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada
http://www.newcountry.nu/pd/members/janet/
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