Constipation, if left untreated, can lead to several problems.

The good news is that there are easy lifestyle changes that you can make to prevent and manage constipation and its impacts on your quality of life.

What is constipation?

Constipation is a common problem for many people with Parkinson’s. At first glance, constipation may seem more of a nuisance than a real concern. Constipation adds to the burden of having Parkinson’s and has a negative effect on the person’s quality of life.

The myth that you must use your bowels every day is simply not true. Everyone is slightly different, but most health care professionals say constipation is when you have less than three bowel movements a week. The normal bowel motion is soft formed and easy to pass and you should feel like you have completely emptied your bowel. If you are straining to empty your bowels or your bowel motion is hard and dry, you may be constipated and you need to take action.

You may feel the need to strain on the toilet or feel like you haven’t completely emptied your bowels, even after going. Constipation may make you feel bloated and nauseous even though you may not have eaten much.

Why is constipation a problem?

Parkinson’s affects the muscles of the bowel and causes a slower movement of waste through your GI system (aka transit time). This slow movement of the digestive tract causes more water to be reabsorbed and stools harden.

Anal muscles may also contract instead of relax making it difficult to empty the bowel. Not emptying the bowels may affect how well your medication works (e.g., levodopa is absorbed from the small intestine before it can cross the blood-brain barrier).

Changes in chewing and swallowing may also affect your eating and drinking habits.

Constipation, if left untreated, can lead to several problems. You may feel unwell, lethargic and nauseated. This may worsen the constipation if you do not feel like eating and drinking adequately. Severe constipation can mimic diarrhoea with loose bowel motions which is caused by the hard motion irritating the bowel wall. The loose bowel motion can result in bowel incontinence (involuntary leakage from the bowel).

Constipation can also disturb your bladder causing you to wee more frequently and more urgently, and may even result in you being incontinent (involuntary leakage of urine). Constipation may make it more difficult for you to empty your bladder and this may result in urinary tract infections. If left untreated, constipation can lead to bowel obstruction in the worst cases, which left untreated could be fatal.

Constipation in Parkinson’s

Constipation often appears early in Parkinson’s and tends to persist throughout the condition. It causes bloating, nausea, and discomfort, and it can reduce the effectiveness of Parkinson’s medications by interfering with how the body absorbs them.

Some people may not realise they’re constipated, especially if they’ve always had infrequent bowel movements, such as going only once a week.

Gut symptoms can begin years before motor symptoms like tremor or stiffness. These symptoms often continue as Parkinson’s progresses.

Parkinson’s can lead to constipation in several ways:

  1. It affects the muscles of the bowel, slowing down how food and waste move through the digestive system.
  2. Some Parkinson’s medications slow bowel activity as a side effect.
  3. Chewing and swallowing difficulties can reduce how much food and fluid you consume.
  4. Reduced mobility and less physical activity can decrease bowel stimulation.

Parkinson’s slows and stiffens the bowel muscles. When mobility decreases, the bowel receives less stimulation, and waste (faeces) moves too slowly. This lack of movement in the gut can lead to constipation.

Medicines used to treat Parkinson’s may also be a factor in constipation either by directly affecting the bowel, slowing it down, or by affecting appetite. Chewing and swallowing difficulties can affect eating enough fibre on a daily basis. Fibre is found in fruit, vegetables and grains and is important in keeping the bowel action formed and soft. Drinking sufficient fluid is essential in preventing constipation. You may find this difficult if your swallowing is affected. Talk to your treating doctor if you are experiencing chewing and swallowing difficulties. You may benefit from a referral to a Speech Pathologist or Dietitian.

How do I know if I am constipated?

A stool is made up of digested food, proteins, bacteria, salts, and other things produced and released by your intestines. After you go to the toilet, what you see is the result of the food you’ve eaten, how much fluid you drank, your combination of medications and other lifestyle factors. So, what your poo looks like can be a really important thing to tell your care team.

The Bristol Stool Chart, Bristol Poo Chart or Bristol Stool Form Scale is a medical aid designed to classify faeces into seven groups. This chart is used by your care team and it is a great tool for anyone wanting to monitor and improve their bowel movements. The types of stool you see on the chart depends on the time poo spends in the colon. You can use the Chart to check what your poos are telling you, it shows seven different categories:

  1. Rabbit droppings: Separate hard lumps, like nuts (hard to pass)
  2. Bunch of grapes: Sausage-shaped, but lumpy
  3. Corn on the cob: Like a sausage or snake with cracks on its surface
  4. Sausage: Like a sausage or snake, smooth and soft
  5. Chicken nuggets: Soft blobs with clear-cut edges (easy to pass)
  6. Porridge: Fluffy pieces with ragged edges, a mushy stool
  7. Gravy: Watery, no solid pieces (entirely liquid)

Every person will have different bowel habits, but the important thing is that stools are soft and easy to pass.

Steps to prevent constipation

Hydration tips

  • Your thirst mechanism may be impaired due to PD symptoms so set a timer or use other cues to remember to drink.
  • Drink at least 1.5 to 2 litres (6 to 8 glasses) of fluid daily unless advised otherwise by the doctor. The best drink is water.
  • Limit caffeine, alcohol, and sugary drinks as they can cause bladder irritation.

Diet tips

  • Eat a balanced diet. As a guide, getting the recommended 30 grams of fibre per day if you are male or 25g if female. Be careful not to bulk bowels up with fibre too much if your GI tract is really slow.
  • In people with Parkinson‘s, increasing your fibre intake may actually bulk up your poos and cause further constipation.
    • If advised, choose a breakfast cereal high in fibre (e.g., All Bran, Weetbix).
    • Gradually add wholegrains into your diet (e.g. use wholegrain or wholemeal bread and wraps, swap to brown rice instead of white, instead of white flour choose flour high in fibre).
  • Aim to eat 5 serves of vegetables and 2 serves of fruit a day. Smoothies are a great way to sneak them all in.
  • Add nuts and seeds into your diet. Put them into salads, on your yogurt and cereal or have small handfuls as a snack.
  • Add lentils and other legumes into casseroles, bolognaise and soups.
  • Eat smaller meals throughout the day to allow more time for digestion.

Toilet tips

  • Develop good toileting habits. Going as soon as you get the urge is the most effective time to completely empty the bowel (e.g. most people get the urge first thing in the morning or following a meal when eating something has stimulated movement in the bowel).
  • Be aware of the correct sitting position on the toilet. Sit on the toilet, elbows on knees, lean forward and support your feet with a footstool. Relax and bulge out your tummy, relax the back passage and let go. Do not hold your breath.

Exercise tips

  • Getting moving will help you get moving… exercise is great for constipation.
  • A post-prandial walk (10 to 15 minutes of walking after a meal) can help get things started. Gentle movement increases abdominal contractions, helps food move through the digestive tract more efficiently, and can improve blood flow to the intestines, all contributing to easier passage of stool.
  • Exercise also plays an important role in the prevention and management of constipation. Aim to exercise more than 30 minutes per day and if possible, vary the types of exercise you do.

Medication

When hydration, diet and exercise are not enough, laxatives may be recommended by your health professional. Laxatives are medicines which help you pass a bowel action. They can make the bowel action softer and easier to expel or they may increase the motility of the bowel. Remember that fibre may just keep bulking up the slowed bowel, making constipation worse, so only take as advised.

Laxatives are not regarded as the first step in the management of constipation, but they may be necessary if the steps outlined above have little or no result. The ideal laxative for a person will depend on which of the factors are causing the problem. Talk to your Nurse, GP or neurologist before taking any laxatives.

Your Care

Remember, the management of constipation for people living with Parkinson‘s is a forever problem. A dietitian can help advise of the best foods to eat for your situation.

The first step to improving your bowel control is to have a full continence assessment carried out by a health professional.

If your constipation is severe or acute help should be sought from your GP, a Continence Nurse, or a Parkinson’s Nurse specialist.

For more information, contact the Continence Health Australia’s National Continence Helpline at 1800 33 00 66. The Continence Health Australia is a peak body for awareness, education, and advocacy for those with continence and their carers. www.continence.org.au

For more information:
www.invisibledisabilities.com.au
www.continence.org.au
www.bladderbowel.gov.au
www.toiletmap.gov.au

This Infosheet was kindly reviewed by the Australian Neuroscience Nurses Association and Continence Health Australia.

Neuroscience Nurses Association logo

The Australasian Neuroscience Nurses’ Association (ANNA), is the peak body for neuroscience nurses. Their mission is for the advancement of neuroscience nursing through education, networking and support to enable optimal care. ANNA achieves this through the provision of opportunities to network, access to resources, promotion and support of the neuroscience speciality.

Continence Health Australia exists to serve all Australians by promoting bladder, bowel and pelvic floor health.

References

Bristol Stool Chart. Continence Foundation of Australia webpage

Adams-Carr, K. L., Bestwick, J. P., Shribman, S., Lees, A., Schrag, A., & Noyce, A. J. (2016). Constipation preceding Parkinson’s disease: A systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry, 87(7), 710-718. https://doi.org/10.1136/jnnp-2015-311680

Heaton, K W & Lewis, S J 1997, ‘Stool form scale as a useful guide to intestinal transit time’. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 – 924. Retrieved on 2/3/2007.

Yao, L., Liang, W., Chen, J., Wang, Q., & Huang, X. (2023). Constipation in Parkinson’s Disease: A Systematic Review and Meta-Analysis. European Neurology, 86(1), 34-44. https://doi.org/10.1159/000527513

Happy middle aged man with neat white beard and glasses looking at a laptop

Donations

Your donation helps us to achieve our core business, to improve the lives of people affected by Parkinson’s in Australia through national advocacy, raising awareness and connecting people living with Parkinson’s, their families and carers, researchers and health professionals in the Parkinson’s community.