Akathisia and Constipation: The Odd Couple

Sometimes, the call of nature is a daily dash to the bathroom. At least it used to be for me. I had a regular routine — until Parkinson’s disease came along.

Now, I don’t sense “having to go” in the same way. Days will go by without a visit to the white throne. Things get backed up worse than the LA freeway at rush hour, which gets quite uncomfortable.

I’m talking about constipation.

For those with a more sensitive nature, you can stop reading here. But I encourage you to continue, as I’ll explain how the symptoms of akathisia and constipation might be partners.

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Sometimes, when not sensing the bowels moving, the rest of my body experiences the dance of akathisia, or muscle urgency. The urgency to move is such that I get out of bed and walk around at 4 a.m. to alleviate the muscles’ demand for action.

At this point, I don’t realize that some nerves are telling me to head to the bathroom. It doesn’t feel like my gut nerves are speaking out, telling me to go. But upon settling on the porcelain ship, it becomes apparent that the bathroom was the ultimate destination after all. Interestingly, the urge to move my external body goes away after completion of the bathroom task.

Constipation has long been associated with Parkinson’s and is one of the most frequent nonmotor symptoms. One study noted that up to 80% of Parkinson’s patients suffer from constipation. The phenomenon I find curious is the occasional pairing of akathisia and constipation.

A 1987 study in the journal Neurology, “Akathisia in idiopathic Parkinson’s disease,” noted that 26% of Parkinson’s patients could not explain the inability to remain still, a state of true akathisia. This disputes the common belief that akathisia simply represents the need to move for relief of discomfort imposed by rigidity or lack of movement.

It is also an injustice to label the experience as restlessness with the not-so-subtle “it’s all in your head, pull yourself out of it” comments. Other than drug-induced akathisia, this doesn’t explain the need to move when constipation is at play.

In my case, the constipation might be due to inhibition of body signals that normally indicate a bowel movement is imminent. At the same time, there are some excitation neural signals happening so that I experience akathisia. This combination is significant as an example of the pairing of excited signals (akathisia) with inhibited signals (constipation). This malfunctioning crossover inhibition pairing (MCIP) happens with enough regularity to be both repeatable and observable.

Recent research is starting to explore excitation/inhibition (E/I) mechanisms. The disruption of E/I has been implicated in many neurological diseases, including Parkinson’s. Think of the E/I mechanism as having two dials. One turns up the level for paying attention (E). The other turns down the input (I). These two affect all brain activity.

The wake-sleep cycle is an example of this. Researchers have identified the role of homeostatic and circadian processes in the wake-sleep cycle in primary neurological disorders such as Parkinson’s and Alzheimer’s diseases. Pain or facing danger can cause MCIP, an excited focus on the danger accompanied by brain blindness to anything else in the environment.

I have numerous malfunctions in my neural networks where excitation and inhibition are faulty, like when my early sleep cycle initiates akathisia and with my broken biological clock. As my Parkinson’s progresses, constipation/akathisia MCIP has moved up the rankings in my troublesome symptom list.

Given all of this, I propose that:

1. My constipation is the result of inhibitory neural pathways that are well known in Parkinson’s.
2. Akathisia is also a well-known event in Parkinson’s and may be a result of excitable neurons acting out at inappropriate and unguarded moments.
3. The human brain simultaneously sends out inhibition and excitation signals. This can best be demonstrated during fight-or-flight responses, when parts of the brain are both excited and inhibited. Inhibition with constipation and excitation with akathisia may be acting in tandem due to faulty regulatory system processes. These rely on the E/I mechanism to regulate and return to homeostasis.
4. With Parkinson’s, the E/I mechanism is broken and sometimes sends exaggerated excitation and inhibition signals simultaneously, which manifests as MCIP. The result is an odd pairing of observable phenomena — in my case, constipation paired with akathisia.

Given the individualized nature of this illness, it is likely that there will be a wide variety of these odd MCIP pairings. What have you observed as unusual, paired phenomena? Please share in the comments below.

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Parkinson’s disease.