[Note: for those with wwweb access this information is available
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search by using 'managing constipation' as the search criterion]
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Managing Constipation in Parkinsons
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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
The Parkinson Foundation of Canada
<http://www.parkinson.ca/confrm.html>
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janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada
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Camilla Flintermann, CG for Peter 82/70/55
Oxford, Ohio
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