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Camilla, Thank you very much for your info. Yen >From: Camilla Flintermann <[log in to unmask]> >Reply-To: Parkinson's Information Exchange Network ><[log in to unmask]> >To: [log in to unmask] >Subject: Managing Constipation in Parkinsons: Parkinson Foundation of > Canada >Date: Thu, 12 Oct 2000 23:00:03 -0400 > >Dear Yen--I think I sent you some references before for your father about >constipation. Perhaps you didn't get them? You may find this article >helpful...and there is MUCH information in the archives, at the URL in blue >below. This is a very common and serious proiblem. Not everything works >for everuyone, or all the time. My husband has tried many things, and at >present he also is doing well with Lactulose, >with occasional Senokot if he has no results. Please try the suggestions >here, and I hope it will help. >May I suggest again that you join the CARE list for caregivers of PWPs--you >do NOT have to be living with your father to be a caregiver for >him.....write me offlist if you have more questions. > >Camilla Flintermann, CG for Peter, 82 dxd 1989 >******** > >Date: Sat, 05 Dec 1998 15:29:42 -0500 > >From: janet paterson <[log in to unmask]> > >Subject: Managing Constipation in Parkinsons: Parkinson Foundation of >Canada > >Sender: Parkinson's Information Exchange <[log in to unmask]> > >X-Sender: [log in to unmask] > >To: Multiple recipients of list PARKINSN <[log in to unmask]> > >Reply-to: Parkinson's Information Exchange ><[log in to unmask]> > >MIME-version: 1.0 > >X-Orcpt: rfc822;[log in to unmask] > >Comments: cc: Ann Erickson <[log in to unmask]> > > > >[Note: for those with wwweb access this information is available > >in the pd list archives at: <http://james.parkinsons.org.uk/> > >search by using 'managing constipation' as the search criterion] > > > > > >--------------------------------------------------------- > >Managing Constipation in Parkinsons > >--------------------------------------------------------- > > > >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> > >--------------------------------------------------------- > > > >janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada > >[log in to unmask] > > _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com.