What is the cause & treatment of Constipation in Parkinson’s disease?

What causes Constipation in Parkinson’s disease?

Parkinson’s disease affects nerves going to the intestines. As a result, the intestines, just like the rest of the body, move slowly in Parkinson’s disease. This is the major reason why almost all patients of Parkinson’s disease also have constipation. Patients with Parkinson’s disease may also find it difficult to relax the anal sphincter (the outlet valve) sufficiently so that stools can be passed.

Other factors increase constipation, and it is straightforward to treat these other factors:

  • Patients with Parkinson’s disease may not get up frequently to drink water. As a result, they might become dehydrated, and their stools may become hard.
  • Physical immobility by itself, and lying in bed all the time can delay the downwards passage of food.
    readingbed
    Physical inactivity can cause constipation.
  • Patients prefer to eat softer things in Parkinson’s disease because these are easy to swallow. Frequently, these softer things (e.g. rice) do not provide enough fibre. Fiber in our food absorbs water and makes stools soft, making them easy to pass.
  • When the urge comes, patients with Parkinson’s disease may not be able to get up to pass stool. This may cause stools to become hard and impacted (stuck).
  • Some medications such as opioids (e.g. tramadol, given for pain), antidepressants (e.g. Amitriptyline), antihypertensives (diltiazem, furosemide, chlorothiazide etc) may worsen constipation.

What should you eat if you have Parkinson’s disease & constipation?

Ideally, you should eat a high-fibre diet. Particularly, you should eat a diet rich in insoluble fibre which is found in raw vegetables and fruits.

It is essential to be careful about the kind of vegetables and fruits you should eat.

Try to eat vegetables and fruits that are easy to swallow. For example, having 1-2 bananas every day would be a great idea! Fruits and vegetables that are difficult to chew and swallow (e.g. apples and pears) may get stuck in your throat if you try to swallow them whole. Therefore, you can mash them nearly into a pulp, or even better pulverize them in a mixer before you eat them.

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Bananas are easy to swallow, especially after they are mashed.

If you have diabetes, try to avoid fruits with high sugar content (e.g. grapes and mangoes). Vegetables such as spinach, mushrooms or well-cooked cauliflower, broccoli and other soft, easy to swallow vegetables would be excellent choices.

If you have a lot of trouble incorporating fibre into your diet, think about buying a smoothie machine or maybe you can even use your regular mixer. If it is strong enough, it pulverizes any fruit or vegetable into a fine smoothie that is very tasty! “Ninja” is one such good brand for blenders. You can increase the taste further by adding reasonable quantities of sugar, chocolate powder, honey and other condiments.

smothie
Smoothies or pastes of fruits (and even vegetables) are very tasty and easy to swallow! Just use your mixer!

If you have trouble swallowing, remember to make the smoothie on the thicker side, almost like custard. This can be achieved by putting a banana or two in each smoothie. Make sure there are no large chunks of fruits/vegetables. You can take it in a bowl and eat it with a spoon. Thick smoothies eaten with a spoon are easier to swallow than very thin smoothies.

Is it important to drink enough water?

Absolutely!!!

Water is essential to keep the stools soft. It is absorbed by the fibre in the diet. This swollen up fibre increases the bulk of stool. This bulk makes it easier for intestines to push it forwards and ultimately out of the body.

waterbottle
Keep a bottle of water close to your bed, so that you can drink water whenever you want to.

Patients with Parkinson’s disease often don’t drink enough water because of two problems:

  • They find it difficult to get water when they are thirsty.
  • They find it difficult to go to the bathroom when they have to pass urine.

Some of my patients were used to drinking only 2-3 glasses of water when they visited me! Of course they were very constipated!

Consider drinking at least 7-8 glasses of water daily. If you want, you may drink less water towards the end of the day so that you don’t have to get up in the middle of the night to pass urine. If you do have a lot of trouble getting up in the night, you may need adjustment of your medications so that they keep working throughout the night.

Do two things:

  • Keep a bottle of water near your bed / the place where you sit.
  • Make sure you drink at least 7-8 glasses of water daily.

What are some useful home remedies?

Other than eating a healthy, high-fiber diet and drinking enough water you may try the following home-remedies for constipation:

  • Walk at least 30 minutes daily.
  • When resting, sit upright in a chair. Do not spend the day lying down in bed.
  • Substances called “Probiotics” may help in maintaining a regular bowel schedule. Don’t buy expensive medications for this purpose! Yoghurt or “Dahi” is a rich source of probiotics. You can try eating half to one bowl of yoghurt/Dahi daily.
    yogurt
    Probiotics present in yogurt may help to have regular bowel movements. There is no reason to buy expensive brands, in fact home made yogurt probably is the best kind.
  • Prunes provide some laxative effect. They can be difficult to swallow, so make sure you smash them or cut them up into tiny pieces before you eat a few pieces daily.
  • Maintain a regular bowel schedule. Try to use the bathroom at the same time every day. When you get an urge to pass stool, do not wait. Try to use the bathroom as soon as it is possible.

Which medications should you avoid for Constipation in Parkinson’s disease?

You should NEVER take any medications without the prescription and advice of a Doctor. Taking medications without a prescription is illegal and may be life-threatening.

  • Levosulpuride (e.g. PAN-L tablets)
  • Metoclopramide (e.g. Perinorm)
  • High doses of domperidone (e.g. PAN-D tablets)
Medications 1
Medications given for constipation can worsen Parkinson’s disease.

It is possible that, because of the nausea and bloating that sometimes happens with Parkinson’s disease, you may be given medications to help your bowels move. Unfortunately, many of these medications (list provided) can result in worsening of Parkinson’s disease. Therefore, make sure that your doctor knows you have Parkinson’s disease before taking any new medications.

Which medications are safe for Constipation in Parkinson’s disease?

Laxatives that increase the bulk of the stool (e.g. Isabgol) are the safest medications for constipation in Parkinson’s disease. If these are not helpful, then some mild medications that increase the movements of the gut (e.g. bisacodyl) can be prescribed by your doctor.

psyllium husk 4359307 1920
Isabgol powder (made from the husks of the psylium plant) makes your stools softer and easier to pass, by absorbing water and making your stools slightly more bulky.

When all else fails, an enema can be helpful. A warm-water enema may help in making stools soft. Rarely, a stimulant enema may be given to make the gut move and expel the stool. Remember that enemas, just like all medications, should be given ONLY after talking to a doctor.

enema
Once you become used to it, an enema can be given at home.

In rare cases, the stools may need to be manually removed by a surgeon. However, if you maintain a regular diet and schedule this is not required.

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, SV Road, LIC Colony, Vile Parle

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  • Avatar Paras Prabhu ★★★★★ a month ago
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    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
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    Dr Kharkar gives you all the time you need to hear you out in complete detail. He probes in depth to ensure he has managed to gain all data points to find … More the best way forward medically for you. He is an authority on the subject. After 4 years of suffering I have found my go to doctor
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    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
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    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
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    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you
  • Avatar Anil Chinchulkar ★★★★★ 4 months ago
    We have visited the hospital and meet the Dr. S. Kharkar. And my personal experience is very much better and exilent. My father is very well recover as … More we thought. Thanks to Nanavati Hospital and Dr. S. Kharkar.
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    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
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    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
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    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
  • Avatar Bianca D'silva ★★★★★ 9 months ago
    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
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    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
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  • Avatar Krishna kumari Radhakrishnan ★★★★★ 11 months ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
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    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ 10 months ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ a year ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
  • Avatar Govind Patel ★★★★★ 11 months ago
    Doctor explained very Good nice person give length time to check body
  • Avatar Sharmila Kumawat ★★★★★ a year ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

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India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai