Hey, anyone dealt with this issue?
 

As we all know there are many side effects of our meds. The least of these being GI symptoms. My problems are what I call "partial bowel obstructions". It begins with a small bowel movement-loose. Followed by constipation then alot of diarrhea. This happens maybe 1-2x a month, otherwise I stay pretty regular but more to the side of constipated till the diarrhea hits. All of this is compounded by the fact that it seems that I get little warning-it feels like I've gotta go NOW and then wham. This makes it less than pleasant to go out for the day. I usually ruin at least 2 pair of underwear a month, leading me to use these depends garments. I have tried to deal with this as an IBS issue but I still get little warning. Docs have suggested more vegs, water for regularity, etc. and I know I need to do better but it's very frustrating.

Don't get trapped
 

Jim,

I haven't heard of any lower GI side effects of meds. I do know that anticholinergics like Amantadine cause or exacerbated constipation. I am fairly atypical in this area, as in I'd say I'm a little slow but not full blown.

Are these extreme fluctuations happening near med dosages? If not, maybe time to check in with your regular doc, It is easy to think everything is PD related but not always the case. It could be something else that is easily treatable.

Laura

agree
 

There seems to be a pattern so i'd keep notes with dates to show him. IT should help him/her a lot.
Constiiipation is a major problem ; i must eat certain things and wait. I can go to a conference and not go the whole time.

yep, we're having a cheerful time discussing elimination but at least it isn't the weekend......lol

Is it a medication issue?
 

Entacapone also known as Comtan or Comtess, and Stalevo are known to cause diarrhoea (It is in the side-effects leaflets). When this happens it is recommended to discontinue the medication as the problem is unlikely to resolve. If you are on one of these medications it might be a good idea to consult your neuro. I was advised of this when I was started on entacapone.

Hoping you find a good solution to your problem

Lindy

Scoop on Poop
 

Not trying to be funny - just getting your attention. This is an excellent but seldom discussed topic.
Constipation is a "side effect"' of having Parkinson's. We don't move as much, which really slows down the digestive tract. Also, many of us take anti-depressants, many of which cause constipation as a side effect.

I won't name them all, but most PD meds lend to diarrhea or constipation..

I know you mentioned diarrhea, but that can be a result of having constipation (Keep reading - it gets more confusing!) Many PD patients get "impacted" - sort of plugged up. This causes leakage or diarrhea around the impaction.

Impaction of the bowel can be lethal! In fact, it is one of the leading causes of PD death . Below are some excerpts from side effect listings of some commonly used PD drugs.

Straight from the rxlist.com website:
NOTE! The side effects listed does not mean you will definitely have them; this is just a list of potential side effects. you may look up these side effects or interactions yourself at the above website.

Side effects of:

Sinemet or carbidopa/levodopa: Gastrointestinal: dark saliva, gastrointestinal bleeding, development of duodenal ulcer, anorexia, vomiting, diarrhea, constipation, dyspepsia, dry mouth, taste alterations.

Requip/Mirapex: in order of decreasing incidence: nausea, dizziness, somnolence, headache, vomiting, syncope, fatigue, dyspepsia, viral infection, constipation, pain, increased sweating, asthenia, dependent/leg edema, orthostatic symptoms, abdominal pain, pharyngitis, confusion, hallucinations, urinary tract infections, and abnormal vision.
Comtan/
In clinical trials, diarrhea developed in 60 of 603 (10.0%) and 16 of 400 (4.0%) of patients treated with 200 mg Comtan and placebo, respectively. In patients treated with Comtan, diarrhea was generally mild to moderate in severity (8.6%) but was regarded as severe in 1.3%. . . . . Diarrhea generally resolved after discontinuation of Comtan. . Typically, diarrhea presents within 4 - 12 weeks after entacapone is started, but it may appear as early as the first week and as late as many months after the initiation of treatment. Diarrhea may be associated with weight loss, dehydration, and hypokalemia.

Post-marketing experience has shown that diarrhea may be a sign of drug-induced microscopic colitis, primarily lymphocytic colitis. . . .

If prolonged diarrhea is suspected to be related to Comtan, the drug should be discontinued and appropriate medical therapy considered. If the cause of prolonged diarrhea remains unclear or continues after stopping entacapone, then further diagnostic investigations including colonoscopy and biopsies should be considered.
These possible side effects also apply to Stalevo.

Artane: Potential side effects associated with the use of any atropine-like drugs, including Artane, include cognitive dysfunctions, including confusion and memory impairment; constipation, drowsiness, urinary hesitancy or retention, tachycardia, dilation of the pupil, increased intraocular pressure, choreiform movements, weakness, vomiting, and headache.

WHAT TO DO: The following is prescribed for PWP:

Exercise - just walk, twist your torso, stretches, anything - but don't be stagnant - movoe as much as you can.

Eat roughage (celer y, fiber, leafy veggies,, fruits like plums, apples, oranges.

Drink water every time you think about it.

Keeping your colon "clean" also helps prevent toxicity of the drugs we ara required to take.

What a crappy topic!
 

This is one of the more embarrassing PD symptoms. Nothing like being out in public and having a sudden uncontrollable "attack."

But what Jim described doesn't sound like microscopic colitis. My husband (who doesn't have PD) suffers from microscopic, lymphocytic colitis and it is not characterized by periods of constipation. It is all diarrhea - all the time. His was diagnosed after a colonoscopy and biopsies. Meds are VERY expensive, but we have found that probiotics (acidophilus, etc.) help. He needs a high dose in pill form.

On the PD side of things, I have a similar problem to Jim and (on my doctor's recommendation) have found that a low dose every day of FiberCon or generic fiber laxative helps. It absorbs the excess fluid, creates bulk, and helps with regularity. I take one before bed and one in the afternoon, if I think of it. No need to take the full dose recommended on the bottle, but it's important to take a low dose every day. If I forget, I'm in trouble.

All of Peg's recommendations are good!

J:-)

Many drugs can cause the symptoms you describe. For me the use of Tylenol 3 as well as Coumadin does the damage. When the stool becomes impacted it is natural for the water to accumulate behind it and cause diarrhea. But it is the first instance of constipation that can do the harm. I tried all that the doctors told me till one told me it was attaining more movement that was my problem and many others suffered the same way.

He said I should take a stool softener at least once a week and more if becoming that way again, because food can sometimes be a source of the problem for me.

Well I did, and the problem is gone and has been for over 7 months now. The softener keeps both problems in the condition they need to be. With the first bout of Chemotherapy it was a big problem, lol sorry. Starting third round on the 7 of January I will be in much better shape for the problems it incurs for me.

Try it for a week or so and you can't hurt yourself if you don't use more than 3 per week. If you need more than see your Doctor for sure.

I really hope this helps you as it has me.

Thelma

gotta go
 

Jim I understand this problem, I have had 'urgency' for so long - years before diagnosis and treatment. I wonder if the two issues-

gotta go now, and
alternate constipation then diarrhea

are two separate but interconnected problems.

I also have urgency of micturition so I have thought this could be a lack of muscle tone issue. Unfortunately starting medication has not improved things. Thanks for posting on this topic.

A few months before my dx I developed frantic urgency of micturition and my Doctor prescribed "Detrusitol (tolterodine tartrate)prolonged release capsules, hard" and they knocked the problem right on the head. Worth a try.

go,go,go
 

Yes we lose control of the peripheral nervous system as time goes on. I take narcotics for pain, so that's double trouble, and am only somewhat regular if i eat 6 pieces of toast and drink warm liquids. EVERY day. have tried everything, Sennocot, Stool softeners, bisacodyl products, just make my lower gut sore, but only a good mixture of both water soluble and "long" fibers in the diet, and lots of water help in my case. And KEEP MOVING, exercise is one of those things we parkies want to natually avoid. and force yourself to swallow more (chew gum), we tend not to. this gets peristaltic waves going through the length of the gut, and forces material to move along little doggies! cs

Thanks Paddy - I have been prescribed oxybutynin hydroxide - another anticholinergic but as I'm in the middle of adding L Dopa to my current agonist regime I have given them a good trial. Maybe its also because I'm wary of anti cholinergics having seen the effect of Cogentine (benzotropine) on a friend's memory.

Suggestions for acute diarrhea, constipation, colitis
 

For people able to tolerate a small amount of gluten, barley water can work miracles to soothe acute constipation (C) and/or diarrhea (D). And for anyone suffering from bowel spasticity in conjunction with either C or D, topical magnesium oil may relieve the spasticity better than an oral mag supplement.

Caution: People with gluten intolerance and/or celiac probably shouldn’t try barley water. People with diabetes should allow for the carbs in barley water when planning their food intake. (I can’t tell you how many grams of carb are in barley water, I apologize.) And people with impaired renal function shouldn’t try magnesium oil or any other magnesium supplement without talking to a doctor first.

In the past, my husband, who has PD, had bouts of alternating C and D. The main and ongoing symptom was C, which we understand was due to PD. We would try a laxative or senna, and it would halt the C but would send him into D. We would resolve the D with an antidiarrheal, and the C would start again. However, his bowel remained spastic, and he would continue to run to the bathroom as often as every 10 minutes but would pass nothing. He was exhausted with this cycle. We opted to try barley water and topical magnesium oil, and they resolved both problems completely. The barley water worked within a few hours; the magnesium oil worked to stop the spasticity of the bowel within 10 minutes. Yes, that’s not a typo, 10 minutes! By the time he was able to be seen by a doctor several days later, the doctor said, "I'm not seeing ANY problem here."

Barley water recipe: Soak some whole-grain barley in water overnight and throw the water away in the morning. Put the soaked grains in a saucepan and add plenty of fresh water (it's called "barley water" because it has a high water content). Exact amounts aren't important, but I cook about 1/2 cup of barley grains (measured when dry) with 6-8 cups of water. Bring to a boil, turn the heat down to the lowest setting and cover it. It’s important to cook it slowly and gently, not to vigorously boil it. Simmer covered for 45 minutes and remove from heat. Allow it to cool, covered, for another 45 minutes; it will thicken during this time. Stir well and refrigerate. Gently re-warm it one serving at a time. Serve in a bowl lightly salted. We like to add fresh lemon juice and olive oil; it makes a tasty soup. Give up to 3 times a day for up to 2 days or until it runs out.

Magnesium oil recipe: Mix a cup of Zechstein magnesium chloride crystals and a cup of water until dissolved and place the liquid in a spray bottle. After a shower, spray a few squirts of mag oil into your hand and massage it into your skin. Apply wherever you can easily reach – arms, legs, torso. We use about 20 squirts total, but the exact amount isn’t important. Beware of getting the liquid on your clothing, because it will leave a bleach spot (that’s the chloride in it). After massaging it in and letting it dry, then get dressed. If you find that your skin is too sensitive to use the mag oil full strength, you can dilute it with up to an equal amount of water.

Other helpful measures: After this last bout of colitis, we started drinking a half-glass of kefir for probiotic support each day, and each morning drinking a cup of hot herbal tea to which the juice of 1/4 fresh lemon has been added. The tea was the suggestion of a herbalist. For us it doesn't matter which herbal tea is used; we like lemon balm or sage or rosemary. Plain hot water with lemon juice works equally well but isn't as interesting (in our opinion). This strategy relieved my husband's long-standing C. If we forget our tea with lemon for a couple of days in a row ... the C returns.

Having some success with C drinking a cup of herbal tea in the morning as well and taking a probiotic with it.....Acidophilus with Lactis, 1 billion.....

I've had constipation issues for years before starting Parkinson's Medications.

I get best results by eating shredded wheat (no sugar) and yogurt for breakfast daily. Lots of water (do not let yourself become dehydrated!). Aim for "clear/light yellow" pee. If not drink more water. Caveat, with Comtan It is always darker. :(

Colace & Senekot are my "go to" meds if I haven't had a bowel movement in two days.

Dehydrated.... pull skin on the back of your hand. As you release is will flow back into your hand. If a "tent remains" you are dehydrated. Do not let yourself get dehydrated, use extreme caution with summer heat.