While certain symptomatic medications for PD can lead to constipation
in some people, the more likely cause is abnormal function of a part of the
brain that regulates smooth muscle activity in the intestines. One of the hallmarks of PD is slowness of
voluntary movement, also known as “bradykinesia”. In a sense, a similar slowness can be thought
of affecting the muscles of the digestive tract. The stool takes longer to travel along the intestine,
more fluid is drawn out of the stool, and a harder, denser formation results. This is more difficult for the person to
pass.
Chronic constipation can be a very trying issue, but there are many
things that a person can do to alleviate it.
Get Enough Fluid
Consuming enough fluid is crucial to combating constipation. The recommendation is to drink at least 6 to
8 glasses (~48 – 64 ounces) of fluids per day, regardless of whether it is
water, tea, coffee, juice, etc. Note
that the fluid requirements increase in hot weather. Also be aware that some people may be upset
by certain fluids e.g. too much coffee makes some people jittery, while too
much milk may make some people constipated and give others diarrhea.
Healthy Diet
Eat a well-balanced diet with plenty of fiber. Fiber is found only in plant foods. Foods
highest in insoluble fiber are whole grains including: whole grain bread (which
must contain at least 3 grams of fiber per serving as shown on the nutritional
content label), cooked dried beans, and fruits and vegetables with edible
skins. Fruits with edible seeds— such as strawberries—have the most fiber.
Wheat bran is an excellent source of insoluble fiber. People who experience constipation should aim for 25 to 35 grams of fiber daily. If you’re not used to eating whole-grain foods, or apples and potatoes with the skin, it is best to increase the fiber content gradually. Bloating and gas may occur as the system tries to adjust to larger levels of fiber. Products like Beano can prevent extra gas formation and may therefore help when the fiber content in the diet is increased.
Bulk Formers and Hyperosmolar
Laxatives
Some people have found that the daily dose of a bulk former can keep
constipation at bay. Bulk-formers
(Metamucil, Citrucel) are not digested but absorb liquid in the intestines,
forming a soft, bulky stool. The bowel’s normal evacuation process is then
stimulated by the presence of the bulky mass.
Healthcare providers may recommend a hyperosmolar laxative (Miralax,
Sorbitol) for patients with chronic constipation. Hyperosmolar laxatives act as hydrating
agents that draw fluids into the intestine. Higher water content in the
intestine results in softer stools. It
is important to drink a lot of water for the laxative to be effective, and to
reduce gas and cramping. Please consult
your primary care physician before starting any regular use of a hyperosmolar laxative.
Exercise
Regular exercise is not only good for your heart, breathing, and mood,
it also helps the intestinal tract to push stools along. Exercise stimulates the contraction of
intestinal muscles, and efficient intestinal muscles move stools out quicker.
Massage and Honoring the Urge
Manual belly massage from the bottom of the ribcage to the top of the
pubic bone, performed 2-3 times daily, is said by some to send mechanical
signals to stimulate the bowel.
Train yourself to honor the urge to have a bowel movement and be
accepting of the notion that it won’t always occur first thing in the morning
or only at home. The natural position
for evacuating the bowel is squatting, so things like raised toilet seat
devices may hinder successful movement. Placing
your feet up on a small bench while sitting on the toilet can aid your body’s
natural functions.
If all of these things do not adequately relieve constipation, consider
adding regular prune juice to your diet.
You can also mix what is known in hospitals as the Prune Juice
Cocktail.
Mix together:
1/2 cup applesauce
2 tablespoons wheat
bran (“miller’s bran”)
4-6 oz prune juice
Refrigerate.
Take a tablespoonful per day at first, gradually increasing until you
find the amount that works best. Most people find this mixture quite palatable.
If all of these remedies do not prove helpful, it is important that you
speak with your primary care provider and ask what else can be done. If you do not respond well to the options
detailed above, your doctor may suggest Senna, a vegetable-based natural
laxative. It is important to avoid using
laxatives or suppositories, unless directed by a physician. While laxatives may provide temporary relief,
allowing your body’s natural system of waste disposal to operate is a wiser
course than relying on a stimulant.
Laxatives, over time, may damage the lining of the colon.
