Managing Constipation in Elderly Patients with Parkinson's Disease

Constipation in the elderly?

Hello Dr.
Lin,
My father has Parkinson's disease and is currently on medication for management.
However, one of the side effects of the medication is constipation.
He often goes a week without a bowel movement.
Last month, he experienced abdominal pain and went to the hospital for an enema, and also underwent a colonoscopy.
The results showed no abnormalities.
He is currently taking medication prescribed by a gastroenterologist, but there seems to be no improvement.
Are there any other methods to alleviate this condition, or are there any further tests that need to be conducted? Currently, he feels the urge to have a bowel movement but is unable to do so, and we are concerned about the potential consequences of fecal impaction.
I would appreciate it if you could take the time to respond.
Thank you.

Kevin, 30~39 year old female. Ask Date: 2006/11/06

Dr. Lin Minghui reply Gastroenterology and Hepatology

1.
A colonoscopy has been performed, ruling out the possibility of colorectal tumors and polyps.
2.
Patients with Parkinson's disease experience a reduction in neurons in the colonic plexus, leading to slow colonic motility.
Additionally, the intrinsic extrapyramidal movement disorder affects the relaxation of the rectal pelvic muscles, resulting in delayed fecal expulsion and constipation.
3.
It is recommended to increase fluid intake, enhance dietary fiber consumption, engage in moderate exercise to boost activity levels, and practice proper bowel training.
Breakfast should be consumed, and when there is an urge to defecate, one should go to the restroom.
Establishing a regular bowel movement schedule, typically after breakfast, is beneficial.
Engaging in intestinal exercises such as abdominal massage, contracting abdominal muscles, and enhancing defecation ability is also advised.
Insoluble fiber, such as psyllium husk, can be taken to stimulate intestinal peristalsis, but fecal impaction should be addressed before increasing fiber intake.
4.
Additional tests such as colonic transit time studies, anorectal manometry, and defecography are rarely used in clinical practice and are reserved for cases with unknown etiology that are difficult to treat.

Reply Date: 2006/11/06

More Info

Managing constipation in elderly patients with Parkinson's disease can be particularly challenging due to the interplay of the disease itself, the medications used for treatment, and the general physiological changes that occur with aging. Constipation is a common issue among Parkinson's patients, often exacerbated by the side effects of dopaminergic medications such as Levodopa, which can slow down gastrointestinal motility.

Understanding the Causes
1. Parkinson's Disease Effects: Parkinson's disease affects the autonomic nervous system, which can lead to decreased gastrointestinal motility. This means that food and waste move more slowly through the digestive tract, leading to constipation.

2. Medication Side Effects: Many medications used to treat Parkinson's, including anticholinergics and certain dopaminergic agents, can cause constipation as a side effect. This is due to their impact on the nervous system and muscle contractions in the gut.

3. Dietary Factors: Older adults often have dietary habits that may not provide sufficient fiber or hydration, both of which are crucial for maintaining regular bowel movements.

4. Physical Activity: Reduced mobility, which is common in Parkinson's patients, can also contribute to constipation. Regular physical activity helps stimulate bowel function.

Management Strategies
1. Dietary Modifications:
- Increase Fiber Intake: Encourage a diet rich in fruits, vegetables, whole grains, and legumes. Fiber adds bulk to the stool and can help promote regular bowel movements.

- Hydration: Ensure adequate fluid intake. Dehydration can worsen constipation, so encourage drinking plenty of water throughout the day.

2. Physical Activity:
- Encourage gentle exercises, such as walking or stretching, as tolerated. Even small amounts of movement can help stimulate bowel function.

3. Medications:
- If the current medications prescribed by the gastroenterologist are not effective, consider discussing the addition of over-the-counter laxatives or stool softeners with the healthcare provider. Options include:
- Osmotic Laxatives: Such as polyethylene glycol (MiraLAX) or lactulose, which help draw water into the bowel.

- Stimulant Laxatives: Such as bisacodyl or senna, which stimulate bowel contractions.

- Always consult with the healthcare provider before starting any new medications to ensure they are safe and appropriate given the patient's overall health status and current medications.

4. Routine and Timing:
- Establish a regular bowel routine. Encourage the patient to try to use the bathroom at the same time each day, which can help train the body to have regular bowel movements.

5. Behavioral Techniques:
- Encourage the use of a footstool while sitting on the toilet to help position the body in a way that may facilitate easier bowel movements.

6. Monitoring and Follow-Up:
- Keep a record of bowel habits, including frequency, consistency, and any associated symptoms. This information can be valuable for healthcare providers in adjusting treatment plans.

When to Seek Further Evaluation
If these strategies do not lead to improvement, or if the patient experiences severe abdominal pain, bloating, or any signs of bowel obstruction (such as vomiting or inability to pass gas), it is crucial to seek medical attention promptly. Further evaluations, such as imaging studies or additional gastrointestinal assessments, may be necessary to rule out any underlying issues.

Conclusion
Managing constipation in elderly patients with Parkinson's disease requires a multifaceted approach that includes dietary changes, physical activity, medication adjustments, and regular monitoring. Collaboration with healthcare providers, including neurologists and gastroenterologists, is essential to tailor a management plan that addresses the unique needs of the patient while minimizing discomfort and potential complications.

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