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Over the years we have noticed that Parkinson’s disease patients commonly present with constipation. We always recommend as much daily vigorous exercise as is possible, and drinking 6-8 glasses of water a day. If that doesn’t work, we have over the last ten years handed people this formula, which has been a secret that has been refined by Janet Romrell, P.A.-C in our practice.
Constipation is an alteration in stool frequency, consistency, and/or passage of stool. The normal pattern of bowel movements can and will vary by 1 to 3 days. A stool-voiding pattern of every day or every other day is encouraged.
Change in diet or activity
Lowered activity – Exercise and increased activity will assist in establishing regular bowel patterns.
Diet – Be sure to include fiber-rich foods: bran, whole-grain breads – oat, rye, fruits, vegetables (leave peel on), whole-grain cereals, oatmeal, pasta, nuts, popcorn and brown rice.
Medications – narcotics, sedatives, antacids, antispasmodics, iron supplements
Not drinking enough fluids – Drink at least 6 to 8, 8 ounce glasses of fluids per day. This is all inclusive (everything you drink like water, tea, coffee, juice, colas, etc.), but water is best, and we encourage you to drink primarily water. Bladder patients should reduce fluid intake after the evening meal.
Note that the daily recommended fiber intake: 20 – 30 grams
A Natural Recipe
Miller’s (unprocessed wheat) Bran* 1 cup
Applesauce ½ cup
Prune Juice ½ cup
Mix these ingredients together and refrigerate. Replace the mixture each week. Take 1 – 2 Tablespoons daily for one week for desired results. If needed, you may increase dose by 1 Tablespoon each week. Stool frequency and gas may increase the first few weeks but will usually adjust after one month.
*Miller’s Bran is unprocessed wheat bran. This may be purchased at most large grocery stores and is found with either the hot cereals or flours and baking goods. The most commonly found brand name is Hodgson Mill and it comes in a brown 14 oz. box. Miller’s Bran may also be purchased in bulk at health food stores.
You can also sprinkle bran on food to supplement your fiber intake.
Bowel Clean Out
The bowel clean out should be done before starting on the bowel program that is outlined for you by your physician. This should be done on a day when you will be at home all day to minimize the risk of accidentally soiling your clothes. The bowel clean out is a two-part procedure:
In the morning take 2 oz. of Milk of Magnesia and follow that with a hot drink. This could be hot coffee, hot tea or even hot broth. This helps to stimulate the bowel and enhance the effects of the Milk of Magnesia.
That evening, after dinner, give yourself a Fleet enema. This helps to make sure the rectum is empty. You should be able to rest the night without worry or discomfort.
This procedure may be repeated the next day if needed.
Bulk producing: Metamucil, Fibercom or Citrucel. Mix 1-2 Tablespoons in juice or water and take by mouth 1 to 2 times daily. This adds consistency or bulk to the stool and facilitates water retention in stool – must take adequate fluids by mouth to avoid causing constipation.
Note:some practitioners do not recommend these but other practitioners find it useful. See the quote below.
Stool Softeners: Colace. Softens stool by facilitating the admixture of fat and water (detergent activity). Do not use with mineral oil. Take 1 tablet by mouth 1 to 2 times daily.
Combinations: Pericolace. Mild stool softener and laxative combined. Take by mouth 1 to 2 times daily.
Irritant/Stimulant: Products containing Senna. Laxative with direct action on the intestinal mucosa and the nervous plexus of the bowel.
Suppositories: Glycerin, Dulcolax. Inserted rectally every other day or when needed. Stimulates the rectum and assists with evacuation.
Dr. Janis Miyasaki at the University of Toronto, recently shared her experiences in treating constipation in PD patients over many years, and I have found her approach particularly helpful (here is a blurb from her):
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.
A Florida Blog by Michael S. Okun, M.D.
UF Center for Movement Disorders & Neurorestoration, Gainesville FL