Hello
Here is some info that I was sent by Dr. Robin Fross about constipation.
Please send your comments to him, not to me!
Brian Symonds <[log in to unmask]>
Hi, I am a neurologist, and a patient sent me a "Protocol for Prevention of
Constipation in Parkinson's disease". 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.
