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Constipation Treatments
Constipation seems to be a very common problem for Parkies, apparently due to the lack of proper bowel muscle operation (dopamine affects every muscle) and/or due to a side effect of one or more medicines.
So, what can you do to remedy this chronic condition? The solution has to be long term and not harmful, so a regular double dose of those extreme blow-out laxative products isn’t a good answer. Here is what I have done and/or am doing now. Be sure to consult your neurologist before implementing any of these regimens. From mildest to most dramatic, they are
1. Drink more water and juice and fluids. Parkies are known for being slightl dehydrated, and water is needed to process the former food.
2. Eat more fiber and drink high-fiberf juice. Prunes and prune juice are obvious choices, but apples, bananas, avocados, peanuts and other natural foods are great sources. Eat fiber bars. Some of them have up to 9 grams of fiber per bar. Be warned, however, many of the bars are spiked with chicory root, which tends to cause bloating and gas. Eat one of those bars for breakfast and you might clear out your whole office before noon. Wheat bran is also recommended by food folks, and psyllium is too. I like prunes (which have now been rehabilitated by calling them “dried plums”) and peanuts and avocados, and apples. Don’t overdo it, though. Too much fiber can cause–wait for it–constipation. The recommended amounts of fiber that I see on reputable web sites is 38 grams per day for men under 50, 30 grams per day for men over 50. For women under 50, 25 grams per day; for women over 50, 21 grams per day.
2. Take 1 to 2 stool softener pills per day. The stool softener is docusate sodium and comes in 100 mg gel caps. The directions on most bottles say you can take up to 3 pills (300 mg total) per day. I take one pill per day, at my 6 am medicine feast.
3. Magnesium is also recommended for Parkies with constipation, because it also helps treat magnesium deficiency, which can cause restless legs and fidgeting. There are several forms available: Magnesium gluconate, and magnesium citrate can supply a laxative effect. Recommended dose per day is 400 mg.
4. The Nuclear Option: Consult your neurologist of doctor before resorting to the nuclear option. Here’s what I’ve learned from experience. (I guess having Parkinson’s means never having to say you’re embarrassed.) I buy those 4.5 ounce saline enema bottles from the dollar store or anywhere, and POUR OUT THE CONTENTS. Then I fill the little bottle with warm tap water, put some hand soap on the nozzle to lube it, and go for it. In about five minutes I usually have the desired results. On rare occasions, when one bottle is insufficient, I refill the bottle and bomb my bum twice. Beware, with the second load of water, results are almost always immediate. I have used this treatment for at least a year and have had no untoward effects. And I’m not injecting drugs, only tap water. When my constipation has driven me to feel sad, bloated, out of sorts, sluggish, lazy, and tired, I pursue the nuclear option and half an hour later I feel rejuvenated (as much as a Parky can feel rejuvenated). -
52 Replies
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The only thing that has worked for me fairly consistently is taking Miralax every day (with my doc’s approval). From what I’ve read, this is a common solution for PWP (and a good way to avoid the nuclear option). 🙂 I also take magnesium citrate before bed and also try to drink plenty of water and clear fluids during the day. It’s not perfect, but this combo has worked better for me than others I’ve tried. Prune juice, fiber-rich foods, fiber supplements, etc. have been both inconsistent and unreliable.
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Hi,
Thank you for this topic. I also have a big problem with constipation. I always drink extra water, eat lots of fiber, take magnesium 150 high absorption 2 times a day, senokot stool softner, restoraLax (suggested by my neuro) and glycerine suppositories when necessary. However, I can and I do have bowel movements with this regime. The issue I have is that I spend a great amount of time in the bathroom whether I go or don’t go. Strain or don’t strain. I spend an amazing amount of time in the bathroom either way. I find I wake up between 3-5 am most every morning because of bowel pressure. My average time in the bathroom is 45 minutes but at times I wait over an hour. The rest of my day is similar. I’m sorry to be so graphic but I havn’t read anything very specific on this topic. Most of us just say constipated but like all of PD symptoms each of us can experience something odd or different. I don’t know if anyone can relate to what I mean and if others have this kind of bowel issue. My massage therapist has suggested stomach massage that she says can be very helpful. I will be trying it soon and will come back to this post if I find it helpful. -
My personal record in the constipation department was 2 weeks with no action. Miralax, Dulcolax tablets, Magnesium Citrate…nothing worked. I eat plenty of fiber. I exercise. I thought I was getting adequate fluids because my urine was usually very pale/clear. Then one day I realized that a large proportion of fluid intake was caffeinated. Caffeine can pull the water from your gut and put it into your urine instead. Voila! That makes nice dilute urine and stools like cement! I got a “Water” app on my phone and started tracking my water intake. Not as impressive as I’d thought. I set my target for 72oz per day and within 2 weeks my bowel function improved markedly. My MDS told me she wanted me to have 3 movements a week, and now most weeks I am there! I know this is not the perfect solution for everyone, because PD slows down the movement of your gut itself. However, for many PwPs that are new to this game, actually tracking your water intake and improving it may surprise you.
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For about 3 months I had mild, intermittent abdominal pain and no appetite for an evening meal. Eventually the abdominal pain increased to the point that I went to an ED and, after an abdominal CT, was diagnosed with constipation. I had been taking oxybutynin (oxy) to calm my urinary bladder to decrease nocturia and apparently the oxy was contributing to constipation by reducing bowel peristalsis. I stopped the oxy and started taking 1.5 doses of Miralax and three 500 mg Citrucel tablets each day. (I use the generic versions of each.) I keep a BM diary to track the approximate amount of stool that I am passing each day. (Usually I just estimate, but I do have a strainer and scale that I use occasionally to check my estimates.) If I pass less than 10 oz of stool per day for 3 days (or if I have symptoms like abdominal pain or loss of appetite) then I take one extra dose of Miralax, one extra Citrucel tablet and 17 mg of sennakot before bed for one or two days. I have been using this regimen for about 9 months. Seems to work for me.
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My hubby has also suffered with constipation issues. He has finally found a regiment that works for him, so I’ll share it in hopes it helps others. First, water is of utmost importance. We live in Florida, so staying hydrated is a must. Adding in the constipation issue just adds to the mix. Next, a piece of fruit with each meal, at least, per day. Add a cup of Smooth Move tea each evening. Two 30 minute walks each day, for more reasons than just the constipation. A half cup of unsalted, mixed nuts each day. A Docusate (stool softener) each day, as prescribed by his neurologist. It took a couple years to find the right amount of food/meds to make for regular, fairly quick, and painless bowel movements. Previous to that, it took up to a whole 24 hour day to pass “the plug” that then allowed enormous amounts of stool to follow. We hope that this may help someone that is still struggling with constipation.
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I didn’t realize that constipation could be linked to PD. Thank you for sharing your experiences. Do you think that hydration is the best strategy?
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Hi Folks,
I admit to daily Miralax. Otherwise, don’t want to talk about it!!
Robert C
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PS
Or hemorrhoids!! Don’t want to talk about that either!!
Why can’t they just send us the pamphlet with the not so nice things about PD, and, while they are at it, about this getting older thing too, and just get it over with!!
Oh, and the easy solutions to all of them too, of course.
Robert C.
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Hi, Mary Beth. Constipation is often one of the first symptoms that people with PD have. https://parkinsonsnewstoday.com/2018/02/08/10-early-signs-of-parkinsons-disease/
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Thanks for the reference, Jo. My Dad also has ulcerative colitis and he lost his colon many years ago. So, I know that his digestive process is difficult but it doesn’t quite function the same way as it used to.
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Mary Beth,
Hydration is a great place to start, because it has to be a part of ANY constipation treatment regime. Traditionally, good bowel function is made up of fiber, fluids and exercise. It’s sort of like a three-legged stool: do without one of these and the whole thing falls over. For some PwPs, having a properly balanced 3-legged stool is all it takes. For others, various other things must be added – and the right routine is as varied as each individual PwP. But first start with the easy stuff. Water is cheap. Exercise is good for many aspects of PD. Fiber can be deliciously added to a diet plan. Cheap, easy, doesn’t interfere with any of the meds. Add more ruffles if the basics alone don’t do the trick.
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Thanks for the tips, Gail! It sounds like you’ve done your research.
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Why not keep the saline?
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Just curious, I started my wife (PD 1year) on Mannitol because of the PD benefits I read on these forums however after 1 week she became constipated and developed belly aches??? She blamed Mannitol for this and stopped taking it?? The constipation went away?? Has anyone taking Mannitol experienced increased constipation or is it just coincidence that PD is causing it and not Mannitol with my wife??
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Funny, when I take mannitol, it causes diarrhea.
My regimen is hydration, oatmeal with date syrup for lunch, Magnesium 500 mg at night.
My backups include miralax, colase, Dulcolax chews, senna or suppositories (rarely used)
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I also routinely use the nuclear option, but generally use the saline ingredients. However, I have also been diagnosed with pelvic floor dyssynergia which causes the muscles in the pelvic floor to not relax thus inhibiting stool passage thru the rectum. As such traditional treatments for constipation such as fiber, laxatives, water and stool softeners are mostly ineffective. These promote stool movement to the rectum, but do not enhance muscle relaxation. As such they can actually make the situation worse. I’ve had Botox injections to help relax the sphincter muscles which helps, but not one hundred percent.
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Re mannitol — I’d be surprised if it caused constipation. Mannitol is a poorly absorbed sugar, which means that much of what you swallow remains in the intestine. It then pulls water into the intestine, resulting in softer stool. I.e., it’s an “osmotic laxative”, if you take enough of it. For me, I find that a tablespoon has that effect.
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Thanks Dave for the reply on mannitol. I was pretty sure the constipation for my wife Karen was more a PD issue than a mannitol issue, however the first bout with constipation coincidently began within the first week of her taking mannitol, so I could not convince her that it was from PD? I will have to wait until she experiences another issue with constipation without mannitol so that I can get her back on mannitol
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After being hospitalized for with an Illeys and spen 5 days in the hospital until U could pass the stool and have an MRI to rule out other things, tumor, etc. I has yet been diagnosed with PD but connected with a nutritionist who suggested bitters or to drink 2 small 4 to 6 ounces of warm water and 1/3 to 1/2 of lemon at least once a day and I stretch before I get up as well as message my belly with rotatiting circles. My nutritionist said when you rely on stool softeners or Miralax type meds and your intestines will become dependent rather than letting nature take its course. I suggest a nutritional consult as most insurances cover up to 6 visits a year.
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With an “Ileus”
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I am hoping that my response will be helpful to anyone with PD experiencing GI symptoms. My mom, diagnosed with PD in 2017, had a number of GI issues (including constipation) since 2010. Her GI issues were comprised of constipation; bloating; indigestion; gas; burping; growling noise; abdominal pain & cramps; loss of appetite; nausea and etc. About 2-3 hours after getting food in her stomach, she experienced extreme abdominal pain. She has seen numerous gastroenterologists throughout the years, and none of them have been effective. These GI doctors ordered extensive studies and tests, indicating normal results. She tried Benefiber, stool softer, prebiotics, and post-biotics ; yet none has been helpful. She was also too sensitive to laxatives that even small dose resulted in extreme diarrhea for multiple days. As you can imagine, she lost weight dramatically, and it was agonizing for me to see my mom suffering this way.
Most recently, she hasn’t been able to tolerate solid food for over 5 weeks. Even with liquid diet, she had severe diarrhea, followed by sudden urgency of bowel movement for 2-3X/day. She was losing more weight and was very low in energy and strength. About a week ago, I was able to locate PDGI clinic at UCLA, where one physician scientist specializes in gastrointestinal complications of Parkinson’s Disease. He spent almost 2 hours with my mom, obtaining detailed history and completing physical examination (including rectal exam). After getting x-ray of the abdomen, which revealed constipation with distension and full of gas, the doctor prescribed Suprep and Motegrity. Once my mom followed this treatment plan, ALL of her GI issues disappeared likea miracle! She is no longer suffering any of her past GI symptoms, including constipation and extreme pain & cramps. Now, she is able to eat normal portions of solid food. Below is the link to the PDGI clinic and this doctor’s presentation at UCLA Symposium:
https://www.uclahealth.org/gastro/motility/parkinsons
https://www.youtube.com/watch?v=cGKt3IT6y8E
I am crossing my fingers (and toes) that this will be helpful to any one of you or your loved ones! Well wishes!!!
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I use 2 stool softeners and suppositories. PD complicated by a congenital long bowel. Per my GI md.
PS – Do no care for Parkie name.
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Constipation is said to be one of the most common symptoms of PD. It fits with the theory that PD starts in the gut. When I get desperate, I either insert an index finger in the rectum and move it around OR I take a saline enema with one of those little plastic bottles (10 count of them at CVS). Small shot of it works like a charm. Be sure to leave the saline in long enough; it’s a small relief just knowing that you can do something about the problem.
On the lighter side, . . .
Said the doctor to the confused patient who was eating the suppositories, “What are you doing with th0se things, eating them?!)
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I take 1/2 cap of Mirelax daily & adjust the dosage as needed. If I back off I’m almost instantly constipated & visa versa if I take more It’s to much. My latest approach has been to take 1/2 cap Mirelax & eat 1 slice of extra sharp cheddar cheese a day. I have a BM 2-3x daily.on the 1/2 cap daily & when I have an X-ray to see if I have kidney stones they always say they couldn’t see much because I was constipated. So I’ve decided that I would take stuff to clean me out 2 days prior.
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Hi,
Thank you for this topic. I also have a big problem with constipation. I always drink extra water, eat lots of fiber, take magnesium 150 high absorption 2 times a day, senokot stool softner, restoraLax (suggested by my neuro) and glycerine suppositories when necessary. However, I can and I do have bowel movements with this regime. -
I’m surprised that the article and the responses so far make no mention of exercise, except to note that PD affects all muscles.
But it’s important to note that the muscles that are called to duty when needed at the end of a BM are mainly multiple core muscles used for multiple things. And fit core muscles respond to the same exercises that are part of an overall core routine.
So as in much PD care, look to Pilates or another discipline instead just another pill bottle, and what may show up is a natural path to “getting a move on.”
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