I have put off sending this post for nearly a year. But, soccertese's bad experience of constipation, makes me feel it is wrong not to post about enemas just because of the yuk factor.
Constipation has been the worst symptom of PD for me. Left untreated, but for my Parkinson's drugs, I would probably defecate only once per week. And this would come only after many hours on the toilet, and only after painful straining. Unmedicated, I would average about 6 hours on the toilet per defecation, but I have spent up to 24 hours in one stretch. A particularly bad situation can develop when the faeces are passed only partially through a sphincter without being released. This causes the valve to remain open, leading to brown liquid to drip out. At this stage, I am essentially toilet-ridden until the faeces are passed.
I have tried, with only minor success, drinking more water, but this is easier said than done (PD seems to have weakened my desire to drink); foods (e.g. prunes); over the counter remedies (e.g. senna, lactulose). I have good success with Movicol (macrogel), but this has salt in it, which I find makes it impossible to take on a regular basis.
Regular enemas are not recommended by medics. For instance, the National Parkinson Foundation write [1]:
"It is tempting to try to control bowel function with enemas or laxatives. However, these can damage the lining and function of the bowel. You should avoid them if at all possible."
In spite of that warning being in place, for the last 20 months I have given myself water enemas at the rate of about 2 per week. In this time I have averaged about 2 defecations per week, with about 80% of defecations being enema assisted.
About 10% of enemas have been unsuccessful in making me defecate. These have usually been either bad cases where I have not defecated for 4 or 5 days, or where I have rushed the enema. In these cases, I drink 2 sachets of Movicol in a pint of water every hour, and also 1 pint of hot orange juice every hour. Three hours, at most, of this regimen have always been successful for me. I also take my PD medication as normal during this time.
I append details of a DIY enema delivery system.
Reference:
[1]
http://www.parkinson.org/sites/defau...%20Disease.pdf
John
APPENDIX
1. You need a hook about 1.5m above the floor to hang the enema container from. It is best for it to be close to a bath or shower. To avoid screwing into the wall, I use a stand made from a suitable length of aluminium angled bar screwed into a small chair. This has a notch cut in to hang the vessel from.
2. My container is a 2 pint plastic milk bottle. Clean it. In the UK these are usually made from a flexible plastic (HDPE) and are easy to work with. They come with a handle forming a hole. A number of loops of different sizes are looped through the handle. The bottle is suspended upright with one of the loops placed over the hook. The length of the loop affects the pressure in the pipe and, hence, the rate of flow.
3. The enema tube needs to be about 2m long. Clean it. I use a plastic car windscreen washer pipe, 2.4m long with an internal diameter of about 3mm. A hole is drilled in the plastic bottle top to fit the outside diameter of the tube. The tube is pushed through the hole until if reaches the bottom of the bottle. The fit needs to be tight, but not perfect. The other end of the tube needs to have any sharp edges sanded.
4. The bottle is filled to the top with water. The bottle top, with the pipe through its middle, is screwed on until it is tight, and the bottle is suspended from the hook. Pressing the sides of the bottle in forces the water to rise up the pipe and out of the bottle, forming a syphon. Once the syphon is formed the pressure can be released by loosening the bottle top. The water will now continue to flow out until the bottle is almost empty.
5. Put the free end where it needs to go. I find it useful to lie on the floor on my right side. Don't expect to receive the whole 2 pints: however much water is received you are ready when you feel the urgent need to defecate.
6. Clean everything.
7. Replace the bottle and the tube frequently.