Managing Constipation in Parkinson’s Disease
 

interesting advice on probiotics
https://nwpf.org/stay-informed/blog/...0%99s-disease/

Constipation is the worst symptom of PD for me. It is the symptom that stops me from doing more things than all the other symptoms put together. It is common for me to go 5 days without defecating. And for me to be stuck on the toilet for over 12 hours.

I've tried all the things mentioned in the article without any significant improvement. Indeed, although eating more fibre is usually recommended, I find that eating too much creates its own problems: the sheer size of the faeces makes defecating difficult.

The only things that work for me are:
- Macrogol / Movicol;
- enema

There seems to be some interplay between the constipation and the underlying Parkinson's. As the article explains the PD slows the passage of faeces, which, in turn, slows the digestion of my meds, making my PD worse and further slowing down the passage of faeces. The faces contains pathogens which the body wants to expel, so having them stuck in the body is not a good idea.

Even if one manages constipation as a chronic condition, one still needs to deal with the time when you are blocked up, feeling an incredible need to defecate, but unable to do so.

When in this situation I drink 500ml of orange juice and 500ml of water containing two sachets of Movicol every hour. But it can take 4 hours or more of this regime and much straining to "go".

I'll be grateful to hear of other people's experiences.

John

Constipation in PD
 

This article "Constipation in neurological diseases" has some info on the subject and also some possible strategy for management and drug treatment in constipated patients.

"The pathophysiology of constipation in PD seems to be multifactorial. Lewy bodies have been found in both parasympathetic nuclei and nerves, including the vagal nucleus and myenteric plexus from upper oesophagus to rectum,26, 27 indicating a genuine autonomic failure with a pathoanatomical basis. This is consistent with neuropathological studies, in which histological changes were found in the corresponding areas28, 29 with Lewy bodies in both CNS as well as degeneration and depletion of dopaminergic neurones of the myenteric and submucosal plexus27, 30, 31"

http://jnnp.bmj.com/content/74/1/13.full

it is interesting to note that James Parkinson recognized gastrointestinal features in his original monograph published in 1817.

response to johnt, nutrition advice for pd'ers, 7:1 diet
 

wish i had some magic bullet for you johnt, after 12 years from diagnosis i don't have much of a problem. i eat very little dairy, no cheese - only reason is if i buy yogurt or cheese have no will power and eat too much, no bread, pasta occasionally - same reason - eat a lot of brown rice with veggies, oatmeal, apples, no meat, a little chicken, no potatoes but i do eat sweet potatoes, snack on prunes every day, very boring diet. drink black tea in the morning, coffee later in the day for a caffeine boost.

as an aside, here's a discussion on how the ratio of carbohydrates to protein can overcome the negative affect of protein in advanced patients taking l-dopa and general nutrition. wish i could just take an agonist.

http://loriliebermanandassociates.com/parkinsons-7-1

http://wurtmanlab.mit.edu/static/pdf/816.pdf

http://www3.parkinson.org/site/DocSe....pdf?docID=192

Very useful discussion. Constipation can be a horrible symptom. Worse if you have surgery, due to painkillers, anesthesia, lack of moving. But 8 years after diagnosis, I usually do okay & usually have BM daily tho not always easy. I am mostly vegetarian, but do eat fish few times a week, no meat or chicken, drink kefir & Yakult probiotic, try to avoid too much milk & cheese, make sure to get enough good fats, use coconut oil often, take fish oil, raisin bran & blueberries almost every morning, get exercise every day, snack on prunes throughout the day (maybe 5-7 total), and probably some other stuff I've forgotten. Usually works for me. May be close to Soccertese's 7:1 diet, but I haven't calculated it yet.

go, go,go
 

Have you noticed that your swallowing responses are impaired? In order for you to keep the little do-gies a movin', the intestines smooth muscle must move constantly in a "peristaltic wave". This gets the movement going, and swallowing is what initiates a wave of muscular activity all the way down the line. Less frequent swallowing, less bowel movement. A diet of fruit and whole grains should also help. And relax, the words "**** retentive" are based on a truth.

Have you tried lots of vitamin C? It works great as long as you use non buffered type. I use 1000 mg vitamin C with hydroquercetin from Life Extension Foundation. I do 4 grams a day, spread throughout the day.

Of course vitamin C (and quercetin) are very powerful antioxidants so they are good for much more than constipation.

Drink lots of water too, but I bet you knew that.

Also if you're concerned about smooth muscle movement take some L-arginine. I do some of that too.

l-arginine might interfere with l-dopa absorption. you have to be careful about the protein/aminio acids you ingest if on l-dopa.
http://www.ncbi.nlm.nih.gov/pubmed/25073474

In addition, l-arginine can lower blood pressure significantly. As many PWP already are hypotensive, this could be very dangerous. I would not use it without the advice and following of your doctor.

This may be a relevant time to remind everyone of what is posted at the bottom of all pages here:

At what point in the medication process does the med leave the digestive system and begin its medical function? In thinking about John's 5 day no go problem, does the medicine just pile up on top of the fecal matter that is not moving through the system, thereby providing less and less benefit to the patient? I recently went for five days myself with increasing pain, my belly as taut as a soccer ball and less and less energy. I finally took 1/2 of an outdated Fleet pill in the morning and another half later in the day. The next morning it took 20 minutes to expel the mass. Sorry to be so graphic, but there appeared to be a correlation between my inability to pass feces and my ability to get the benefit of C/L. I was still riding my bike 20 miles per day so exercise didn't seem to make a difference. Any interpretations?

Nan, graphic is good. We need to understand as well as possible. I've been there, but never for 5 days. If I get really uncomfortable for more than a day or so, I take stool softeners and/or insert a suppository and really step up diet & exercise (stretching, walking, posture), drink liquids & some coffee, avoid sitting, cheese, milk, etc. You're right: exercise alone doesn't cut it; it's the total package. But sometimes no matter what...

This doesn't say exactly where meds are absorbed but does have some relevant information , and info on supplements and Vitamins relating to PD.
https://books.google.com/books?id=lV...sorbed&f=false


My dad takes Miralax/generic daily...

explanation why meds less effective
 

Levodopa is not absorbed from the stomach, but the stomach plays an important role in controlling how levodopa reaches its absorptive sites in the small bowel. Some medicines, including dopamine agonists and anticholinergics, can also delay gastric emptying, as can severe stomach acidity, although over-treatment of this problem can also prevent dissolution of levodopa tablets, leading to incomplete absorption.

Moreover, gastric emptying can be delayed by Parkinson’s itself or by constipation caused by the colon-gastric reflex. Levodopa tablets may remain in the stomach for a long time, leading to delayed absorption in the small intestine and a delayed response to the treatment.

An enzyme called dopa-decarboxylase that is present in the stomach lining can convert levodopa trapped in the stomach into dopamine, making it unavailable to the central nervous system. Furthermore, dopamine formed in the stomach may stimulate gastric dopamine receptors, leading to stomach relaxation and reduced gastric motility, and this can worsen the problem.

Liquid levodopa may improve motor fluctuations by ensuring better absorption. Levodopa methyl ester and dispersible formulations are absorbed more quickly than standard preparations, especially when taken after meals. Subcutaneous infusion of the dopamine agonist apomorphine is effective in controlling motor fluctuations by bypassing the gastrointestinal tract.

People with Parkinson’s should try to eat small meals and take medicines when fasting. Dopaminergic D2 receptor antagonists, such as domperidone, improve gastric emptying in Parkinson’s. Similar effects can be induced by the 5-HT4 receptor agonists mosapride, presumably by increasing local release of the neurotransmitter acetylcholine.

http://www.epda.eu.com/en/parkinsons...owel-problems/

prior post concerning natural anti constipation fruit paste
 

I had horrible constipation - and I do mean scary - for years in part from many years of many meds. Best solution for me was daily servings of aloe vera mixed with fruit juice and chia seeds. I use a piece of fresh aloe vera about the size of my forearm, a mango, and the seeds. Cured me of constipation problems and aloe vera has many nutritional benefits besides.

I also tried aloe vera which worked great. The past few months I have taken Thiamine regularly and no longer have any problems!