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.