Water enema for Parkinson's constipation?
 

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.

Hi John,
I don't want to come across as preachy but there are a few measures that can be done for constipation.
I've found the following helped me a lot in overcoming this problem.
I was a registered nurse before my change to a parkinsonian and so have seen my fair share of bums!
Flavour a jug of water with some lemon and or lime to make it more palatable and make sure you drink it all by say lunchtime.
Then do same in afternoon. I try and change to something like green or peppermint tea in between.
Increase your fibre intake.
Grainy type bread, more veggies, fruit.
I find apples are particularly helpful. Lots of different fresh fruit and nuts to snack on helps.
You're at a high risk of a prolapse with all that effort plus taking fluids orally is much more fun than rectally!
Good luck!

Other options ---
natural help for chronic constipation - Google Search

some other things to try
 

Hi johnt, here's some youtube videos that show yoga, massage, etc. to help prevent/relieve constipation. I tried doing the exercises that I could along with simultaneously taking a laxative so can't say for sure the exercises did the job or the laxative but I did have a BM an hour or 2 after doing the exercises. Good luck. Of course do this stuff at your own risk and don't overdo the massages.
I assume amazon has books on constipation which recommend specific stretching/massages.
Fwiw, I think just laying on my back and just pulling my legs back and every which way helped the most. There are a zillion videos


Yoga for Constipation - YouTube
Massage for Constipation - YouTube
Yoga That Helps You Poop with Sarah Badorine - YouTube
Constipation Pooping Positions - YouTube

The bowel movement beet test: How to measure your digestive ‘transit time’ - National | Globalnews.ca

http://movementdisorders.ufhealth.or...-constipation/

https://www.squattypotty.com/shop/ca...toilet-stools/

I added magnesium 400mg to my diet and the constipation went away for good.

can you recommend a formulation or brand?

No. I just use whatever is at Walmart.

exercise if possible
 

Another thing that can really help with constipation is exercise, particularly walking, which helps move things along as you walk plus the gravity factor pulling things downward. I realize not everyone is that mobile, but it does help.

Also on magnesium: if you start to get diarrhea you may be taking too much-although some might view that as a welcome change to constipation:)

Advanced Pooping Techniques
 

A couple of years ago a thought occurred to me regarding the connection between blowing your nose and pooping.

We learn at a fairly young age that it is wise to "clench" when we blow our nose, to prevent a possible accident at the other end. Well, I thought, maybe when we are trying to poop, we could assist things by doing the exact opposite. So the next time I was trying to poop, I tried blowing my nose at the exact same time as I was pushing, and it worked.

Anyway, it works for me and I use it all the time now.

NB: The push and the blow have to be at the exact same time.

more about constipation
 

Immediately after I began taking selegiline in 2010 my bowels clammed up on me. At first I took natural laxatives but I got a suggestion from another PWP that eating 6 dried figs a day could help. I find that it does. My constipation is only correlated with selegiline so I suppose things may vary if one's constipation correlates with PD progression instead of a drug like selegiline which is known to cause constipation. Also, dietitians have warned of the possibility of too much sugar intake as dried fruit is usually sweetened, so one may want to wash the figs or use something else.

I've told the story about nine days without a bowel movement. PCP said "ER now to make sure you don't have a blockage".

Lots of water.

Lots of fruit. Apples and Blueberries are high on my list.

I eat shredded wheat & yogurt for breakfast. Note the cereal is a local store. No added sugar is the big thing.

I've had dieticians tell me I should not need the cereal with enough fruits and vegetables. Irony is as long as have it for breakfast, I'm doing fairly well.

Worst part, not poops. Food doesn't move along. Sinemet doesn't make it into the small intestine to be absorbed. No meds, no movement. From Dr Okun I learned a tip of chewing Sinemet while drink Orange Juice (natural stuff, not the super sweet sugar stuff).

Post DBS my bowels seem to be working better. Next business trip is next month, so we will see how that goes.

Hot liquids
 

The combination of a half glass of kefir daily, and a morning cup of hot herbal tea with the juice of half a fresh lemon added, helped my husband to resolve his constipation. A teaspoon of fennel seeds makes an effective laxative tea, especially if you slightly crush the seeds with a mortar and pestle before making the tea. If you eat a daily salad -- raw veggies with an oil and vinegar or oil and lemon juice dressing that you make yourself -- it helps things along greatly as well.

Best of luck with that!

Tri-Magnesium
 

The doc I was seeing for the Hinz protocol recommended 2 tri-magnesium 300 mg capsules daily and that seems to work well.

The following work for me

Grapes
Magnesium
High dose bit c 500-1000mg.
I don't have a real problem, going every two days but with effort but 'bloating' is terrible, most days I look like Iv swallowed a basketball, Which has made me consider it could be fluid ie something nasty however in a more rational frame of mind it's, without spelling it out, it's certainly gas due to poor gut motility.

John, I'm the same... some days I have to force myself to drink as I rarely feel the need though I'm clearly dehydrated !

On a different note Iv been absent from the forum on DR's advice. My ocd suddenly went crazy and manifested in medical matters. My bedroom is now a consulting room, Im probably anaemic from all the tests Iv done on myself and was looking how much used ambulance would be !!

constipation
 

Good morning - I have a good day when I have a bowel movement, because otherwise my PD medications just don't work [levo-carb] and my day is ruined with symptoms. Notice that just about ALL PD medications cause or exacerbate constipation too. Well, I've been reading that TENS/muscle stimulation machines can be used to help this condition. I just bought the machine, but haven't tried it for that yet - has anyone else? Apparently research done by physiotherapy departments, among others, indicate that it does work. There is no point in filling up our intestines with all sorts of fruit, seeds, natural or synthetic 'roughage' or anything else, as it might just make the situation worse (impaction), since it is lack of 'electricity' in the neurons controlling peristalsis that are the problem. I think we have something like neurogenic bowel that para and quadriplegics have [but not as complete} I do know that my neurologist, neuro nurse, family doctor and all other 'health professionals' are useless and know less than we do, but neurologists love prescribing drugs that make side effects lists longer, so I'd be careful with their drugs. I'll keep you posted.

With all the science out there indicating a link between a disturbed intestinal microbiome and Parkinson's disease and constipation, I would think probiotic would prove useful. In fact, probiotics work well for me. I use a quarter teaspoon of a powdered probiotic daily and this is all I need.

constipation/probiotics
 

Probiotics used to work very well for me, and reliably so, especially a fermented one called "BioKplus". Unfortunately, after I tapered off Citalopram (an antidepressant/antihistiamine) I developed severe food intolerances, including the probiotic. (query mast cell disorder) There are so many twists and turns in the way this disease is "treated" that we cant count on anything to work all the time. I have found the neurologists to be pretty useless.

As I noted in my original post in this thread, medics have most often been unsupportive of the use of enemas to relieve constipation. The latest NICE guidance shows a change:

"The case for adopting Peristeen for transanal irrigation in people with bowel dysfunction is supported by the evidence. Peristeen can reduce the severity of constipation and incontinence, improve quality of life and promote dignity and independence."

NICE is the "National Institute for Health and Care Excellence"

Peristeen is a pump driven enema system. I don't see that it would give me any advantage over the gravity fed DIY system that I described in my original post. My system is, moreover, far less expensive.

Although the NICE guidance is for Peristeen explicitly, I think that the guidance will apply to water enemas in general.

("Transanal irrigation" is being used as a synonym for "enema".)

Reference:

[1] NICE Guidance
Peristeen transanal irrigation system for managing bowel dysfunction
Medical technologies guidance [MTG36] Published date: February 2018
Peristeen transanal irrigation system for managing bowel dysfunction | Guidance and guidelines | NICE

John

John, for the past 10 years, I've used a "Toto Washlet", which is a kind of bidet attachment for one's toilet. The jet is strong enough to provide me with help when some poop won't come all the way out.

At the risk of sounding a bit gross, it is possible to obtain the same effect with a shower wand in the shower (on the most "intense" setting). Gross it may sound, but it works.

I mention these things in case they may be of use to you and the community.

Dan

Can we include the mental and emotional component of digestion?
 

Eliminate constipation, IBS, sluggish digestion, bloating with yoga, Ayurveda & Agni Sara - YouTube

Magnesium has been beneficial to me but I have had to experiment with dosage and form .. Recently have been pleasantly suprised to feel some brain fog clear with magnesium threonate-which I have taken before w/o clear (pun not intended) result (but then brain fog wasn't so much an issue at that time). Magnesium citrate (I used "Natural Vitality Calm Magnesium Powder") hasn't disturbed stomach acid but through time seems to penetrate less (while, through time, needing to take more) into my bowel which magnesium hydroxide does do (faciliates larger more well formed stools) but I am careful with because my stomach signals with a bit of pain . Also I have found it useful to combine Mg wiith herbs. Magnesium has also assissted with sleep - a bedrock for brain regeneration.

Since rigidity has been one of my main and longstanding symptoms yoga has been very helpful to counter gently .

John, thank you for sharing your story. I am struck by how patient you are . I feel that there is a gold mine to be realized (in time) from the lead of my resistance -somehow....deep down I sense there is some victimization,embarrassment or shame at the root. Has anyone tried coffee enemas?

With Kind Regards--
MD

Finally, after about 10 years of almost constant constipation, I haven't experienced any for at least 3 months. I've got no idea if this will work for anyone else, but this works for me:
- every night, I take a sachet of macrogel (movicol) mixed into a cup of milk kefir or yogurt;
- every morning I take my first levodopa of the day, and at a variable time after eat breakfast;
- every second day I give myself an enema, perhaps 30 minutes after eating breakfast;
- wait perhaps 5 minutes, give a slight strain, and out it comes.

I chose kefir to get rid of the taste of macrogel, which was stopping me from taking it. But, it has been mentioned in its own right by Bergamotte in an earlier post in this thread as a way to reduce constipation.

John

Seems like alot of effort to solve a common problem that most PDers have. I simply take 400 mg of magnesium daily and problem disappeared! Hope this helps!

John,

I am so happy to hear you found something that works so well after all that you have been through- what a relief !

Kind regards,
MD