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I am preparing a talk for a support group meeting on constipation - so here is a resource I came across...... Bowel Management in Parkinson's Disease Used in the UBC Movement Disorders Clinic, Vancouver Susan Calne RN, Clinical Coordinator The trick with constipation is prevention not damage control. In Parkinsonism, the constipation is most often the result of your intestines moving more slowly than normal because of your Parkinsonism, the drugs you take, and your inability to take enough exercise or drink enough fluids. If you have Parkinsonism you must be particularly careful about constipation in hot weather when you may be dehydrated. 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 serious and need medical attention. Fruit Lax Recipe * 1 lb. of mixed dried fruits (your choice - they do not have to be prunes) * Put the fruit in a bowl and cover it with cranberry juice and leave to soak overnight. You could also make some Senna tea and use this to soak the fruit in (available from health food stores and in some pharmacies). * Process in a food processor or a blender, but leave it chunky. Put it in a plastic tub with a lid and keep it in the refrigerator. * Have at least half a cup for breakfast each day. * Use dried fruit as sweet snacks, but pay extra attention to dental hygiene if you start to eat a lot. Gas and Bloating Do be careful not to use too much bran or bulking agents in your diet as they can cause painful cramps, gas, and bloating. If you do want to use some, introduce it slowly - 1 teaspoon at a time on top of fruitlax or cereal. You must also be able to maintain a high fluid intake and take regular exercise if you want the bran or bulking agents to work for you. You should avoid bran (including bran muffins), Metamucil, Perdiem and other bulking agents if you have difficulty swallowing and/or choking episodes. There are several anti-gas products available from your pharmacy. Hot peppermint water made with peppermint oil is useful and a hot water bottle or heating pad on the stomach can be comforting. * Stool softener: there are several on the market. These coat the stool and make it more comfortable to pass. You should use one regularly and always if you have to take any medicine with codeine in it (ie, Tylenol #3). * Milk of Magnesia at night * Vegetable laxative - Senakot * Stool softener and laxative - Senakot S * Glycerin suppositories: use two, lubricate tip with KY jelly and insert gently while sitting on the toilet. Giving an Enema For a constipated patient with Parkinson's, the tube of a standard Fleet enema is not long enough. A longer, reusable rectal tube should be purchased. 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 for as far as possible. Give the enema slowly and withdraw the tube. Cover the patient and offer a heating pad or hot water bottle for the tummy. Encourage the patient to retain the enema for as long as possible and then assist them to the commode or toilet. A successful enema will often yield more than one bowel movement and so give them early in the day to avoid disturbing sleep. Retention and Overflow This is a situation where small amounts of watery stool seep around a bolus of constipated stool. It needs attention, most often with an enema as the blockage is usually higher than can be reached with suppositories. We all need to be alert for the possibility of volvulus and obstruction. Parkinson patients are more prone to this for unknown reasons: perhaps the sluggish motility of the bowel. By the time this develops, the patient is often out of the hands of the neurologist and under the care of a surgeon who may or may not know about the risk and mortality.