Management of Constipation in Patients With Parkinson Disease

Abstract

Constipation management in Parkinson disease can be challenging. Physiologically, there is a slowed colonic transit time, hypokinesia of abdominal muscular due to rigidity, and central pathology as well as a functional outlet obstruction. This is because of paradoxical external anal sphincter contraction when there should be relaxation for defecation. The paradoxical contraction is likened to a focal dystonia similar to other dystonias occurring in the rest of the body. A recent study showed the effect of decreasing anal dystonia with added levadopa in de novo patients. However, more studies are needed to replicate the effect. Often, the treatment for chronic constipation is based on provider and patient experience, with more studies needed in this area as well. Complicating factors include patient age, polypharmacy, multiple comorbids, dietary factors, and limited mobility.

Management of constipation in patients with Parkinson’s disease

“…However, clinical experience suggests simple lifestyle modifications including increased fiber and fluid intake being reasonable and beneficial prior but also supplementary to pharmacological treatment. 9 , 49 – 51 In conformity with these opinions, this approach may be discussed with patients according to principles of shared decision-making.…”

Constipation Management in Parkinson Disease

“…In addition to screening tools, a detailed nursing assessment is essential when observing for possible causes before exploring treatment options. Included in this assessment are questions about defecation patterns including frequency and time of day, physical maneuvers to allow for expulsion, diet and fluid intake, medical history focusing on GI diseases or surgeries involving the GI or genitourinary systems, and pharmaceutical interventions previously taken (herbal, over-the-counter, or prescription) 11. Along with a verbal history, nurses must assess the patient physically by inspecting the abdomen, auscultating for bowel tones, percussing for dullness, and palpating for masses 11.…”

“…8 Constipation is one of the most studied prodromal symptoms of PD, because it can precede motor symptoms up to 20 years. [9][10][11] The risk of constipation in PD increases with aging, a longer disease duration, more severe motor symptoms, polypharmacy, a higher number of comorbidities, and loss of physical mobility. 4,11,12 The cause of constipation in PD patients is multifaceted.…”

“…It manifests as hard stools, abdominal pain and bloating, and straining during defecation 8. Constipation is one of the most studied prodromal symptoms of PD, because it can precede motor symptoms up to 20 years 9–11. The risk of constipation in PD increases with aging, a longer disease duration, more severe motor symptoms, polypharmacy, a higher number of comorbidities, and loss of physical mobility 4,11,12…”

“…[9][10][11] The risk of constipation in PD increases with aging, a longer disease duration, more severe motor symptoms, polypharmacy, a higher number of comorbidities, and loss of physical mobility. 4,11,12 The cause of constipation in PD patients is multifaceted. Dysfunctional autonomic nervous system can delay smooth muscle activity, resulting in constipation from slowed colonic transit time and abnormal motor control of the anal sphincter, leading to contraction of the external sphincter instead of relaxation.…”