GI Issues

Constipation  

Constipation is one of the most common non-motor symptoms of Parkinson's. Constipation can significantly impair quality of life, may impact the effectiveness of levodopa therapy which may worsen both motor and non-motor symptoms, and can cause health complications if not managed properly. 

 Signs and symptoms of constipation include:  

 Infrequent bowel movements: less than 3 spontaneous soft bowel movements per week. 

• Stools that are hard, dry, or lumpy, and difficult or painful to pass. 
• Straining to pass a bowel movement or a prolonged time to pass a bowel movement. 
• The sensation afterwards that the bowel has not fully emptied. 
• Stomach pain, bloating, or cramping.   
• Nausea 
• Decreased appetite 
• Flatulence (passing of gas) 
• Tiredness  

 Dietary and lifestyle modifications are usually suggested as the first step in treatment of constipation. Dietary modifications may include:  

• Drinking enough fluid.   
• Eating an adequate amount of fibre. Foods rich in fibre include vegetables, fruits, legumes, lentils, wholegrains, nuts, and seeds.  
• Consuming food sources of prebiotics and probiotics.    

 If dietary modifications do not help control your symptoms of constipation, talk to your GP about medicines. 

Gastroparesis (slow stomach emptying)  

Gastroparesis slows the movement of food from your stomach to your small intestine and is a common non-motor feature of Parkinson's. Symptoms of gastroparesis may include: 

• Nausea and vomiting 
• Bloating  
• Epigastric pain 
• Feeling excessively full after meals 
• Not being able to finish a normal sized meal 

Gastroparesis can impair your quality of life, nutritional status and may impact the effectiveness of levodopa therapy which may worsen both motor and non-motor symptoms of Parkinson's.   

Recommendations for managing gastroparesis may include both dietary modifications and medication options. Diet modifications rely on measures that optimise stomach emptying and may include:  

• Eating small, frequent meals 
• Consuming a small-particle-size diet and chewing food well  
• Modifying your fibre and fat intake 
• Avoiding carbonated drinks and alcohol  

If dietary modifications do not help control your symptoms of gastroparesis, talk to your GP about medicines. 

Nausea 

People living with Parkinson's can experience nausea (with or without vomiting). Nausea may be due to gastroparesis or constipation, a side effect from taking certain medications, or may be due to the progression of Parkinson's.  

Recommendations for managing nausea may include both dietary modifications and medication options. Dietary modifications may include: 

• Rinsing your mouth before eating.  
• Relaxing during meals. Trying to make mealtimes enjoyable. 
• Eating and drinking slowly and chewing food well. 
• Avoiding an empty stomach. An empty stomach will increase nausea. 
• Eating small, frequent meals. 
• Having regular sips of fluids throughout the day.    
• Avoiding or minimising intake of foods that may worsen nausea such as caffeine, fatty foods, or spicy foods.  
• Eating your largest meal of the day when you feel best. This is often breakfast. 
• Choosing cold foods or foods at room temperature as the smell of cooked foods may trigger or worsen nausea.  
• Resting after meals but avoiding lying flat for at least 30 minutes after eating. 

If nausea occurs as a side effect of taking levodopa, you may benefit from taking levodopa with food until your body adjusts to it. If this is not effective, talk to your GP.  

If dietary modifications do not help control your symptoms of nausea, talk to your GP or pharmacist about medicines. 

Gastro-oesophageal reflux disease (GORD) 

People living with Parkinson's can experience gastro-oesophageal reflux disease (GORD). GORD occurs when stomach acid leaks into your oesophagus, causing symptoms such as:  

• Heartburn, regurgitation, or chest pain  
• Nausea or vomiting, bloating, burping or indigestion 
• Difficulty swallowing  
• A cough that happens at night, wheezing, and hoarseness 
• A feeling of a lump in your throat 

Recommendations for managing GORD may include both dietary modifications and medication options.  

Dietary modifications may include: 

• Eating smaller, more frequent meals throughout the day as this can help reduce the pressure on the lower oesophageal sphincter. 
• Avoiding or minimising intake of certain foods that may trigger or worsen symptoms such as fatty or spicy foods, peppermint, chocolate, citrus fruits, tomato products, alcohol, caffeine, and carbonated drinks.  
• Staying upright during and after a meal.  
• Avoiding lying down within 2 hours of consuming a meal.  
• Managing and preventing constipation.  

If dietary modifications do not help control your symptoms of GORD, talk to your GP about medicines. 

Difficulty swallowing (dysphagia) 

Another common GI issue people living with Parkinson's can experience is difficulty swallowing (dysphagia). This can occur at any stage of Parkinson's, and is described as difficulty moving food, liquid, saliva, or medication from your mouth to your stomach.  

If swallowing difficulties are not managed properly, life-threatening medical problems such as pneumonia, choking, poor nutrition, and dehydration can occur. Early detection and individualised treatment of swallowing difficulties is crucial to prevent complications and improve your quality of life. 

 A Speech Pathologist can assess your swallowing ability and safety and may suggest a texture modified diet and/or thickened fluids for safe swallowing. If a texture modified diet and/or thickened fluids has been suggested, an Accredited Practising Dietitian (APD) can provide education on suitable foods and fluids to consume and ensure your diet is nutritionally adequate.  

 If you think you might have a swallowing problem, talk to your GP and organise an assessment of your swallow with a Speech Pathologist.  

Dry mouth 

People living with Parkinson's can experience dry mouth. Dry mouth can be uncomfortable and may increase the risk of tooth decay. Dry mouth can also worsen swallowing difficulties and can cause reduced food intake and weight loss.  

Recommendations for managing dry mouth may include dietary and lifestyle modifications and medication options. Dietary and lifestyle modifications may include: 

• Ensuring you are well hydrated. Sipping on water frequently throughout the day.  
• Consuming soft and moist foods and adding sauces to meals to add extra moisture.  
• Chewing sugar-free gum to help saliva flow. Note: avoid this if you have jaw pain or jaw problems. 
• Avoiding or minimising intake foods and fluids that may irritate your mouth and cause pain, such as citrus, tomato products, spicy or salty foods, or alcohol.  
• Using products that act as a replacement for saliva in your mouth. This can include gels, mouthwashes, mouth sprays, and toothpastes.   
• Sucking on lozenges designed for dry mouth. 
• Maintaining good oral hygiene and visiting your dentist regularly, as tooth decay can develop faster when your mouth is dry. 

If dietary and lifestyle modifications do not help control your symptoms of dry mouth, talk to your GP about medicines. 

Drooling  

People living with Parkinson's can experience drooling. Drooling – also known as sialorrhea – is the excessive buildup of saliva in the mouth, often leading to unintentional spillage. Both medications and other treatments may help reduce drooling. 

• Consult a Speech pathologist who can suggest behavioural and swallowing therapy to help manage drooling.  
• For mild symptoms, drooling may be managed by chewing sugar-free gum to promote more frequent swallowing. Note: avoid this if you have jaw pain or jaw problems.  
• Talk to your GP or pharmacist about medicine options.  

Seeking further assistance  

GI issues are a common feature of Parkinson's that can affect overall health and wellbeing. Prioritising the management of these issues is essential to improve your quality of life. GI issues range in complexity and severity. Some GI issues can be managed with dietary modifications while others may require more extensive clinical management. 

• Speak to your GP about GI issues. Since GI issues can indicate other underlying health conditions, it is important to rule out alternative diagnoses. If appropriate, your GP may refer you to a Gastroenterologist for further investigation.  
• Speak to a Speech Pathologist if you think you might have a swallowing problem as early detection and individualised treatment is crucial to help prevent complications. 
• Speak with an Accredited Practising Dietitian (APD) for personalised advice on your specific GI issues. To find an APD near you, visit Dietitians Australia website. 

How do I access supports?

It's advisable to explore all available pathways to find the support that best suits your individual needs. Look to:

• getting a GP referral to someone with Parkinson's experience
• your state-based Parkinson's organisation for advice
• Ask Izzy https://askizzy.org.au/ to search for local services to access
• private health to see what is covered in relation to consultations and expenses
• DVA, NDIS or My Aged Care plan supports.