Constipation is a complication of Parkinson’s disease. It can be managed with medical treatment, diet and lifestyle changes.

Parkinson’s disease is a progressive, degenerative neurological condition affecting the person’s ability to control their body movements. Symptoms result from the degeneration of nerve cells in the middle area of the brain that make and store dopamine (a brain chemical necessary for smooth, controlled movements) thus lower dopamine production.

The symptoms of constipation include:

•    Difficulty in passing motions

•    Less than 3 bowel motions a week

•    Feeling the need to strain on the toilet

•    Feeling that the bowel isn’t empty after defecation

Why does Parkinson disease cause constipation?

• Lack of dopamine (a neurotransmitter) in the brain – impairs control of muscle movement throughout the body including bowel muscles.

•   Uncoordinated bowel motions – the bowel muscles may be weaken and unable to contract.

•  Eating problems – dietary fiber is indigestible and prevents constipation. People who have Parkinson’s disease sometimes find it difficult to chew or swallow so they may avoid eating fibrous foods.

•  Drinking problem – swallowing difficulties may discourage a person with Parkinson’s disease from drinking enough fluids.

•    Sedentary lifestyle – lack of exercise slows the passage of food through intestines. Parkinson’s disease reduces muscle control, so lack of exercise is common.

• Medications – many different medications can cause constipation. Parkinson’s disease medications may slow bowel movements or cause a decrease in appetite.

Various treatments to help to relieve constipation include: 

1. Dietary changes, including more fiber and drink more water. Choose wholegrain foods such as cereals, brown rice, lentils and beans, fruit and vegetables rather than refined or highly processed foods.
2. Moderate exercise.
3. Good toilet habits.
4. Avoid medicines that contain substances, such as calcium, known to cause constipation.
5. Laxatives.
6. Treatment for any other medical problem that may be the underlying cause of constipation, such as haemorrhoids.

Dietary fiber for constipation in Parkinson’s disease

• Soft fruits. Mashed and pureed fruits are easier to eat. Make sure to include the skin, where most of the fiber is found.

•  Vegetable soups

• Oat bran or psyllium husks on your breakfast cereal or baked products such as cakes. However, avoid bran if you have swallowing problems.

Fluids for constipation in Parkinson’s disease

•    Six to eight glasses (up to two litres) of fluid every day, especially water, is best.

•    Limit drinks that cause dehydration such as alcohol, tea and coffee.

Spread your drinks throughout the day.

Exercise for constipation in Parkinson’s disease

• Aim for at least 30 minutes of exercise every day. Walking and dancing are recommended for people with Parkinson’s disease.

•    Remember warming up and cooling down including stretching.

•    Only exercise when other people are at home who can help if necessary.

Toilet habits

•    Go to the toilet as soon as you feel the urge to go. Waiting too long can lead to constipation.

•    Use correct body posture on the toilet. Place your elbows on your knees and put your feet on a footstool.

•   Allow yourself plenty of time. Avoid holding your breath and don’t strain when you are on the toilet.

•    Use a warm washcloth pressed against your anus or gently massage with one or two fingers to help to relax the muscles.

Where to get help

•    Your doctor.

•    Your neurologist.

•    Seek complementary treatment such as acupuncture.

People with constipation will be benefited from acupuncture treatment, new research suggests. After eight weeks of electroacupuncture, acupuncture involving electrical stimulation, study participants experienced significant symptom and quality-of-life improvements, the study found. Electroacupuncture uses thin needles inserted beneath the skin that are attached to a device that sends electric pulses into the body. The medical approach is to treat constipation by stimulating the sacral nerves and increases small intestine and colon movements.

Yenny Vandalita, MD.

GP&Medical Acupuncturist