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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
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>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
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>