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Dr. Okun

Post of the Week: Addressing Constipation in Parkinson's Disease

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Provided by Janis Miyasaki from the NPF Center of Excellence in Toronto.

 

 

Constipation in Parkinson Disease

 

I learned in practice never to ask patients, “do you have a problem with constipation?” Most People With Parkinson’s don’t have a problem with constipation – they’ve been living with it for years. Now, I ask, “how often do you have a bowel movement?” Most people – even with Parkinson disease – can have a bowel movement every day. Constipation is present in more than 60% of patients and may occur even before motor symptoms like tremor and stiffness start.

 

Constipation is a problem because stomach emptying is also slow. As a result, your pills don’t get delivered to the part of the bowels where they can be absorbed. Your pills may be less effective. You will feel bloated and uncomfortable. Your appetite may reduce. There is evidence that constipation increases your risk for bowel cancer. In extreme cases, bowel obstruction may occur. This means that your bowels can not move because all of the stool (poop) in your gut. This is a problem because the blood supply to the gut is also blocked and your bowels can have a “stroke”. Then you will need to have surgery and possibly an ostomy bag (the gut is attached to your abdominal wall and a bag collects your stool and must be emptied at least daily).

 

Prevention is the key! Exercise, proper diet and enough water to help your bowels work are essential (generally eight glasses of water a day or more if you are sweating – this is more than your body needs to keep hydrated, but enough to keep your stool soft). Changing the diet to include more whole grains, avoiding white bread, pasta and rice will also help.

 

Your body wants to have a bowel movement in the morning. Help it by taking hot oatmeal in the morning with a hot strong cup of coffee. You can add dried figs or dates.

 

Avoid Metamucil or other forms of psyllium since in the slow gut, this tends to become hard and make constipation worse in Parkinson disease.

 

Polyethylene glycol 1350 or Miralex (available in drug stores over the counter) is also effective in Parkinson disease. The dose used in a study was 7.3 grams of macrogol dissolved in 1 cup of water twice a day.

 

If this doesn’t work, ask your Primary Care Physician, neurologist or movement disorders specialist for prescribed medications.

 

Ramjit AL, Sediq L, Leibner J, Wu ss, Dai Y, Okun MS< Rodriguez RL, Malaty IA, Fernandez HH. The relationship between anosmia, constipation and orthostasis and Parkinson’s disease duration: results of a pilot study. Int J Neurosci 2010 Jan;120(1):67-70.

 

Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, Miyasaki J, Iverson DJ, Weiner WJ. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74(11):924-31.

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This is from Citrucil.com

 

"What is the difference between the psyllium fiber in Metamucil and the SmartFiber in Citrucel with SmartFiber?

 

Fiber is the non-digestible portion of plant foods that plays a critical role in digestion. There are two different categories that all fiber products fall into: 1) soluble or insoluble, and 2) fermentable or non-fermentable.

 

Soluble fiber dissolves in water, whereas insoluble fiber does not. The fiber in Citrucel with SmartFiber is 100% soluble; the psyllium fiber in Metamucil is not 100% soluble.

 

Citrucel with SmartFiber contains only 100% non-fermentable fiber, so none of it ferments to cause excess gas like the fermentable fiber in Metamucil. This is based on laboratory tests. Results may vary in humans."

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thank you Dr Okun..........

 

so "Avoid Metamucil or other forms of psyllium since in the slow gut, this tends to become hard and make constipation worse in Parkinson disease "

 

can I assume I'm ok with Citrucel? Been taking it for several months, not really sure if it is helping or hurting.

'

'

'

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My GI specialist told me the safest and most effective treatment for constipation was milk of magnesium tablets - magnesium hydroxide. I now take two tablets at bedtime and one first thing in the morning. I have had to take up to 16 tablets a day before I went on sinemet.

 

The drug info websites say not to take it if you have renal problems and to avoid taking them with meals as a low pH helps nutrient absorption and it is also an acid neutralizer. Other than these do you have any other caveats relating to magnesium hydroxide for those of us with PD?

 

Konsyl psyllium brand was only helpful if I had not eaten sufficient fibre and even then only 1/4 teaspoon. Metamucil has sugar in it which certainly can't be helpful. Foods I've found most helpful are summer squashes, peaches, water melon, hot salsa and any other source of capsaicin and all the legumes. Things that did not help were figs, prunes, bran, oatmeal.

 

I now make quadruple strength small amount of coffee to try to promote stomach emptying as well as bowel activity and wonder if you could perhaps also address this problem which I'm sure is the upper half of the constipation problem. I've read that 70mg of erythromycin works quite well. Any other suggestions on this quite serious problem of failure of stomach to empty???

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I actually don;t recommend one thing over another but rather to tailor what works in moderation.

 

For gastric emptying problems---first diagnose with a gastric emptying study---then I usually try erythromycin or a mycin antibiotic, or domperidone.

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Provided by Janis Miyasaki from the NPF Center of Excellence in Toronto.

 

 

Constipation in Parkinson Disease

 

I learned in practice never to ask patients, “do you have a problem with constipation?” Most People With Parkinson’s don’t have a problem with constipation – they’ve been living with it for years. Now, I ask, “how often do you have a bowel movement?” Most people – even with Parkinson disease – can have a bowel movement every day. Constipation is present in more than 60% of patients and may occur even before motor symptoms like tremor and stiffness start.

 

Constipation is a problem because stomach emptying is also slow. As a result, your pills don’t get delivered to the part of the bowels where they can be absorbed. Your pills may be less effective. You will feel bloated and uncomfortable. Your appetite may reduce. There is evidence that constipation increases your risk for bowel cancer. In extreme cases, bowel obstruction may occur. This means that your bowels can not move because all of the stool (poop) in your gut. This is a problem because the blood supply to the gut is also blocked and your bowels can have a “stroke”. Then you will need to have surgery and possibly an ostomy bag (the gut is attached to your abdominal wall and a bag collects your stool and must be emptied at least daily).

 

Prevention is the key! Exercise, proper diet and enough water to help your bowels work are essential (generally eight glasses of water a day or more if you are sweating – this is more than your body needs to keep hydrated, but enough to keep your stool soft). Changing the diet to include more whole grains, avoiding white bread, pasta and rice will also help.

 

Your body wants to have a bowel movement in the morning. Help it by taking hot oatmeal in the morning with a hot strong cup of coffee. You can add dried figs or dates.

 

Avoid Metamucil or other forms of psyllium since in the slow gut, this tends to become hard and make constipation worse in Parkinson disease.

 

Polyethylene glycol 1350 or Miralex (available in drug stores over the counter) is also effective in Parkinson disease. The dose used in a study was 7.3 grams of macrogol dissolved in 1 cup of water twice a day.

 

If this doesn’t work, ask your Primary Care Physician, neurologist or movement disorders specialist for prescribed medications.

 

Ramjit AL, Sediq L, Leibner J, Wu ss, Dai Y, Okun MS< Rodriguez RL, Malaty IA, Fernandez HH. The relationship between anosmia, constipation and orthostasis and Parkinson’s disease duration: results of a pilot study. Int J Neurosci 2010 Jan;120(1):67-70.

 

Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, Miyasaki J, Iverson DJ, Weiner WJ. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74(11):924-31.

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In regards to constipation, why are whole grains considered helpful but psyllium isn't? By the way, I have found "Smooth Move" herbal tea very effective, but try not to use it more often than about once every two weeks. Also, we hear ad infinitum to drink eight glasses of water a day---but that is extremely hard. Does anybody really do that? And shouldn't it be adjusted for weight. I weight about 130---how much should I drink?

 

ubilam

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Interesting questions. I will post for you. I do not have the answers. I am also not sure about adjusting for weight but it makes sense. Many of my patients do drink 6-8 glasses of plain water a day and it is very helpful.

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can Ensure protein drink contribute to constipation? All my life non-dairy creamers bind me up, I don't know if Ensure is in this class

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Most of my patients say no, however some say yes. What we generally recommend is a trial on and off for a few days to be sure. The nutrition is critical so be sure you replace.

 

Also you may want to direct this question to our ask the PD dietician forum.

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I was wondering how much Miralax is too much? Would the cap full (as directed) in a glass of water twice daily be too much to use on a regular basis?

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These are tricky questions as sometimes you can accidentally overdose on these things---your doctor should make the decision based on your medical history, your medicines, and your general state.

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The general issue to discuss with your doctor is dehydration (feeling weak or getting dizzy when you stand up too fast), heart rhythm problems, and electrolyte problems in the blood.

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Provided by Janis Miyasaki from the NPF Center of Excellence in Toronto.

 

 

Constipation in Parkinson Disease

 

I learned in practice never to ask patients, “do you have a problem with constipation?” Most People With Parkinson’s don’t have a problem with constipation – they’ve been living with it for years. Now, I ask, “how often do you have a bowel movement?” Most people – even with Parkinson disease – can have a bowel movement every day. Constipation is present in more than 60% of patients and may occur even before motor symptoms like tremor and stiffness start.

 

Constipation is a problem because stomach emptying is also slow. As a result, your pills don’t get delivered to the part of the bowels where they can be absorbed. Your pills may be less effective. You will feel bloated and uncomfortable. Your appetite may reduce. There is evidence that constipation increases your risk for bowel cancer. In extreme cases, bowel obstruction may occur. This means that your bowels can not move because all of the stool (poop) in your gut. This is a problem because the blood supply to the gut is also blocked and your bowels can have a “stroke”. Then you will need to have surgery and possibly an ostomy bag (the gut is attached to your abdominal wall and a bag collects your stool and must be emptied at least daily).

 

Prevention is the key! Exercise, proper diet and enough water to help your bowels work are essential (generally eight glasses of water a day or more if you are sweating – this is more than your body needs to keep hydrated, but enough to keep your stool soft). Changing the diet to include more whole grains, avoiding white bread, pasta and rice will also help.

 

Your body wants to have a bowel movement in the morning. Help it by taking hot oatmeal in the morning with a hot strong cup of coffee. You can add dried figs or dates.

 

Avoid Metamucil or other forms of psyllium since in the slow gut, this tends to become hard and make constipation worse in Parkinson disease.

 

Polyethylene glycol 1350 or Miralex (available in drug stores over the counter) is also effective in Parkinson disease. The dose used in a study was 7.3 grams of macrogol dissolved in 1 cup of water twice a day.

 

If this doesn’t work, ask your Primary Care Physician, neurologist or movement disorders specialist for prescribed medications.

 

Ramjit AL, Sediq L, Leibner J, Wu ss, Dai Y, Okun MS< Rodriguez RL, Malaty IA, Fernandez HH. The relationship between anosmia, constipation and orthostasis and Parkinson’s disease duration: results of a pilot study. Int J Neurosci 2010 Jan;120(1):67-70.

 

Zesiewicz TA, Sullivan KL, Arnulf I, Chaudhuri KR, Morgan JC, Gronseth GS, Miyasaki J, Iverson DJ, Weiner WJ. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74(11):924-31.

 

I suffered a lot from constipation (PD patient forf 8 years - now 62 years old. My doctor suggested Movicol and it worked miracles for me. No longer battling for hours to empty bowels and hard, big stools. Hope it helpd others.

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