www.parkinson.org Julie H.
Carter, R.N., M.S., A.N.P.
Many people with PD have constipation. Usually
it can be corrected with time, patience and dietary changes. Constipation is
not failure to have a daily bowel movement. It is normal for some people to
have a bowel movement every 3-4 days. The key is to know what is normal for
you. Constipation is bowel movements that become more infrequent and are dry
and difficult to pass.
The key to relief is patience
and consistency. Constipation takes time to develop as it takes time to restore
normal bowel function. Bowel training usually takes 2 to 3 months. Often you
will see no change for the first week or two. Do not be discouraged; this is
normal.
It is tempting to try to
control bowel function with enemas or laxatives. However, these can damage the
lining and function of the bowel. You should avoid them if at all possible.
Some medicines, both prescription and non-prescription, cause constipation as a
side effect. Have your health care provider evaluate all of your drugs.
Following is a series of
steps to restore normal bowel function. Begin with STEP 1 for two weeks. If
there is no significant improvement after two weeks, add to your STEP 1
routine, the items in STEP 2 and if needed, STEP 3. STEPS 4 and 5 are to be
used as a temporary last resort.
Eat meals at the same times
each day.
Include fruits, vegetables,
whole grain breads and cereals in daily meals.
Drink 6 to 8 glasses (8oz
each) of fluid daily. (This does not include caffeine or alcohol, which act as
diuretics and can aggravate constipation.)
Drink warm liquids on rising
and with breakfast. (Warm liquid and food starts bowel activity.)
Establish a relaxed, regular
time of the day for bowel movements. (About 1/2 hour after a meal is best as
there is normally greater bowel activity at this time.)
S_t_e_p_ _2_ _– _B_u_l_k_
_F_o_r_m_e_r_s_ _
Bulk formers can be purchased
without a prescription. Examples are bran, metamucil and fibercon. They are not
habit-forming.
Use bulk formers daily.
Add 1 to 2 teaspoons to bran
or metamucil to your morning or evening meal each day. For fibercon, use 2
tablets per day as a starting dose.
Drink 6-8 cups of liquid
daily with bulk formers. If you do not, your constipation may actually worsen.
DO NOT increase the amount of
bulk former too quickly. Gas formation or stomach fullness may result.
BE PATIENT. Bulk formers may
take 2 to 3 months to correct constipation.
S_t_e_p_
_3_ _– _S_t_o_o_l_ _S_o_f_t_e_n_e_r_s_ _
While
working on a bowel routine, you may need to use a softener if your stools are
very hard. Stool softeners, like bulk formers, are not habit-forming and may be
purchased without a prescription. Examples are Colace and Surfax.
_Use stool
softener daily.
_Begin with
one a day. Increase to one each morning and evening if needed.
S_t_e_p_ _4_ _–
_L_a_x_a_t_i_v_e_s_ _a_n_d_ _S_u_p_p_o_s_i_t_o_r_i_e_s_ _
Laxatives should be used with caution. They activate the bowel by
chemical irritation. Long-term use may actually harm the bowel. Some laxatives
are especially harsh, including Ex-lax, Ducolax, Feenamint, Correctal and
Castor Oil. DO NOT use these while trying to establish a bowel program.
Relatively mild laxatives may be used while establishing a bowel
program, but they are NOT a replacement for diet and bulk formers. Use them
sparingly while you continue with your program. Mild laxatives that may be used
are: Milk of Magnesia (2 tablespoons at night), Doxidan (1 tablet at night),
Pericolace (1 tablet at night) or Senokot-S (2 tablets at night).
Suppositories provide rectal stimulation to empty the bowel. Stool must
be present in the rectum for suppositories to be effective. Suppositories must
make contact with the inside wall of the rectum to work. You may need to use
suppositories while establishing a bowel program. If needed, use Glycerin daily
or every other day. DO NOT use Ducolax, as it is habit-forming and irritates
the bowel.
Step 5 - Enemas
The bowel can easily become dependent on enemas. We recommend that you
use enemas only when nothing else works.
REMEMBER: CONSISTENCY AND
PATIENCE ARE THE KEYS TO MANAGEMENT
OF CONSTIPATION.
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