http://www.medpagetoday.com/MeetingCoverage/MDS/39901

i've read that constipation may slow gastric emptying which leads to more l-dopa getting broken down to dopa and less l-dopa getting to the brain so it's just not the discomfort that's a factor.

That's right. Absorption is not through the stomach, it is through the small intestine. It is most noticeable when the constipation ends. For hours or even a day or two, I am wondering why I feel so badly over-dosed by the drugs. It's because more of the drug is getting past the stomach and absorbed by the small intestine, and from there, to the brain.

Conversely, block up that drainpipe, with no "movement" in the small intestine, and the drugs are delayed, and get chewed up by acid in the stomach, and I have to take more drugs to get the same "bio-availability" reaching the small intestine.
It is yet one more factor that makes it devilishly hard to balance your drug intake. It's not only a question of how many pills you swallow; it is moreso a question of where they go after you swallow them - how much gets to your neuro system and how fast.
The whole Duodopa schtick is about that: installing a new pipeline to bypass the stomach entirely, and have a steady flow of drugs, and you can speed up or slow down the flow.
But AbbVie charges $60 Grand a year for the product. Would be cheaper if we could balance by bio-availability; the right dosage at the right time. Never get it right, too many factors changing hourly, but keep on trying to balance the dosage.

Next time you feel very under-dosed or over-dosed, think back: when was the last time you used the toilet plunger? Is there a co-relation in timing?

Has the municipality sent you a legal notice about blocking up the town sewage treatment plant? That's always a bad sign.

Constipation is one of the worse symptoms of PD for me, and the only one that sometime is so bad I think it could kill me.

Like Bob I find an improvement in my PD symptoms after defecation.

Back in February, 2011 there were discussions about constipation in the thread "Faecal transplant eases symptoms of Parkinson's"
http://neurotalk.psychcentral.com/sh...ghlight=faecal

I proposed (post #21) the following hypothesis:
"rather than Parkinson's causing constipation (as I'd always assumed), it is rather the case, that with the wrong bugs in the gut, Parkinson's and constipation reinforce one another: Parkinson's slows the transit time, leaving longer for toxins to build up, leading to a worsening of the Parkinson's, and so on."

I presented (post #29) the following data:
"Since my diagnosis in 2005 I've collected PD relevant data, including between 2006 and 2009 defecation data. ( I gave up collecting defecation data because I was worried about becoming anally retentive [!!!].) Things are complicated by changes in medication, both directly for constipation and for PD. So, I've chosen a period between January and August 2006 when I was on neither.

"The frequencies of the length of time in days between defecations are:
[0,1) 23
[1,2) 45
[2,3) 16
[3,4) 24
[4,5) 3
[5,6) 3

The data above is from 7 years ago. I dream of having the same results now. As I reported then, I no longer collect this data, but my estimate in percentage terms of my defecation interval times now are:
[0,1) 10
[1,2) 10
[2,3) 10
[3,4) 10
[4,5) 20
[5,6) 20
[6,7) 20

For me Movicol with prune juice is the most effective treatment to keep the faeces relatively soft. If this for some reason does not work and the faeces harden, I find drinking a litre of hot orange juice over a period of about a hour helps as a laxative.

I suppose that if it gets worse, i.e. over a week without defecation, I'll try an enema. Has anyone got any experience of this?

Finally, although I can't compete with Bob and municipal warnings, I find that blocking the toilet is a problem. If you can, you want to break up the faeces before you flush. If I flush and the faeces block up the system where I can't reach them, I flush a few times to see if this gets rid of the blockage. If there's no luck and the toilet is only draining slowly, I find the best way to unblock it is to flush the toilet then put a football ( = soccer ball in US English) in the water and force it up and down, raising and lowering the water level, eventually it should clear.

John

Welcome to the Club. There have been times when the time between BMs have been measured in weeks for me. Further, I can remember the problem as far back as the seventh grade of elementary school! I also remember that area of my body as being where I stored a lot of emotional energy - anger or rage in particular. A constant tensing of the muscles that continues to this day. Also a feeling that if I get angry enough that if that barrier ever collapses, somebody is going to be in deep ****.

I don't know what that tells me, but some possibilities include H. pylori as the culprit. Another is inflammation and its chemical entourage (can cause depression as well), hypervigilance resulting from exposure to bacterial toxins in utero keeping the tension level up there is yet another, and so on.

The one that intrigues me today is the possible role of the vagus nerve which wanders aimlessly around the viscera and plays a big role in such things. I have noticed that when I reach that "cliff hanging" stage when the meds just don't want to cooperate, that I can do a few situps as well as tightening certain strategicly embarrassing muscles and bump things to "on". Possible compression of the nerve can't be ruled out.

As of late I stopped eating bread (even ezekial sprouted grain bread) and am noticing sinemet lasting longer .....4 hours +. Also have slowly dropped a couple of pounds . Tis indeed a sacrifice to give up the rye toast in the mornings, pizza and artisan bread but carrying it around in my gut for days has tipped the scale in favor of giving it up. Brown rice pasta is better than wheat pasta imho and I have a yummy recipe for a curry quinoa salad if anyone is interested. I don't know for sure whether its the change in diet ( I'm also eating strawberries from my garden in the mornings ) that is extending the "on" time but its definitely helped reduce the tire round my belly -and i still get my ice cream....

Love quinoa!

I've suffered with constipation for several years now and blamed it all on PD. Well, my problem now appears to be fixed.

It was probably due to a statin (Simvastatin to be exact) that a heart doctor prescribed for me several years ago. Looking back at it I can now see that the constipation grew progressively worse in the months following my first dose of the statin and has gotten progressively better to the point of having almost totally disappeared now that I have stopped taking it.

If you're taking a statin I suggest you think hard and long about why you're taking it. The many bad side effects just weren't worth the grief to me.

Steve

Constipation has also been an issue for me!! There have been days if not weeks where I have not had a bm or very poor ones to say the least. After the Memorial Day weekend I had fruit every day (strawberries, grapes, watermelon, necturines) and a new salad blend from Costco...Kale something...contains broccoli, brussel sproats, among other "super foods" and still nothing....until last Wednesday. For some unknown reason I started having bms every day. Hope it continues but I need to stock up on more fruits and veggies!!

Have never found a solution...constipation has been my major problem since high school. Only lately, the old stand-bys don't work as well (if at all) Cascara Sagrada has always helped..now I usually have to take 2 days in a row to get any partial relief. Used to take 1 a week so I'd MOVE once a week.Hardly ever have bowel sounds. ...which can be heard in a normal person all the time with a stethoscope. Dad also having problems with constipation since last year. He is now 87 (now with tremor, restless legs, sleep deprivation and memory issues) It is amazing in our family how issues start younger each generation. Has anyone else found this to be true?