Parkinson’s Disease (PD) is a progressive neurodegenerative disorder primarily characterized by motor symptoms such as tremors, rigidity, and bradykinesia.
However, non-motor symptoms, including constipation, are increasingly recognized as significant aspects of the disease that can affect patients’ quality of life.
Constipation is generally defined as having fewer than three bowel movements per week, accompanied by symptoms such as straining during defecation, hard stools, and a sensation of incomplete evacuation.
Prevalence of Constipation in Parkinson’s
Research indicates that constipation affects a substantial proportion of individuals with PD. Estimates suggest that between 40% to 80% of PD patients experience constipation at some point during their illness.
Notably, constipation can occur even before the onset of classic motor symptoms, highlighting its potential role as an early indicator of the disease.
According to a study published in the National Library of Medicine, researchers found a significant association between constipation, preceding Parkinson’s motor symptoms onset by as much as 20 years, and increased risk of developing the disease.
Constipation: An Early Parkinson’s Symptom?
Evidence suggests that constipation may precede motor symptoms by several years or even decades. A systematic review indicated that approximately 24.5% of PD patients had reported constipation prior to the onset of motor symptoms.
This is consistent with findings from various cohort studies which have documented the presence of gastrointestinal symptoms in the prodromal phase of PD.
The connection between constipation and PD is further supported by the observation that patients with more severe constipation tend to have more advanced stages of the disease.
Mechanisms Behind Constipation in Parkinson’s
The pathophysiology of constipation in PD is multifaceted, involving:
- Autonomic Nervous System Dysfunction: The autonomic nervous system regulates gastrointestinal motility, and its dysfunction in PD can lead to slowed intestinal transit and constipation.
- Gut-Brain Axis: Emerging research highlights the gut-brain axis’s role in neurodegenerative diseases. Dysbiosis, or an imbalance in gut microbiota, may contribute to gastrointestinal dysmotility and constipation.
- Dopamine Deficiency: Dopamine is essential for gut motility. As dopaminergic neurons degenerate in PD, patients may experience increased constipation due to reduced dopamine levels affecting bowel function.
Probiotics for Constipation in Parkinson’s
Probiotics, particularly the strain Lactobacillus plantarum PS128, have garnered attention for their potential benefits in managing constipation associated with PD.
The beneficial effects of PS128 are thought to stem from its ability to modulate gut microbiota composition and enhance gut-brain signaling:
- Gut Microbiota Regulation: Probiotics like PS128 can restore balance to the gut microbiome, alleviate inflammation, and improve intestinal barrier function, which may be compromised in PD patients.
- Neurotransmitter Interaction: PS128 has been shown to influence neurotransmitter levels related to gut motility and brain function, potentially enhancing both gastrointestinal health and neurological outcomes
Click here to purchase probiotics (PS128) for the gut-brain-axis!
Integrating Probiotics into Parkinson’s Treatment
Given the evidence supporting the efficacy of PS128 in alleviating constipation and improving motor function, those who are caring for their Parkinson’s parents should consider integrating probiotics into the treatment plan for their parents.
This may just involve:
- Understanding your parent’s bowel habits
- Understanding the relationship between constipation and PD
- Preparing ahead of time and supplementing with probiotics
- Encouraging dietary changes (increased fiber intake)
- Encouraging physical activity, which is crucial for PD management
Integrating Chinese Medicine Into Parkinson’s Treatment
For those of you who don’t know, Chinese herbs and acupuncture are another way to treat neurodegenerative conditions like Parkinson’s Disease.
Acupuncture has garnered support from numerous clinical studies demonstrating its effectiveness in alleviating motor symptoms like myotonia in PD patients. As evidenced in the case report above, we know that acupuncture addresses motor symptoms like stiffness and tremors, as well as non-motor symptoms like constipation.
Additionally, Chinese herbs are getting more attention in research studies for Parkinson’s. While there are herbs that do help with constipation, there are also herbs that directly target the brain and the central nervous system.
Chinese Medicine for Parkinson’s in Singapore
Hi, I’m Dr Chan, and I’ve been practising Chinese Medicine for almost 2 decades already. I enjoy working with a range of conditions including digestive disorders, bloating and urinary conditions. All said, I have a particular interest in working with stroke and Parkinson’s disease patients.
These are the two neurodegenerative diseases that more and more people above 50 are suffering from. These conditions are chronic and debilitate you gradually. I know how physically and emotionally exhausting these conditions are, and it brings me joy to be able to help using acupuncture and TCM herbs for Parkinson’s.
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FAQs
1. What stage of Parkinson’s is constipation?
Constipation can significantly impact quality of life, causing bloating, discomfort and nausea. It is one of the most persistent symptoms of Parkinson’s disease (PD), arising often years before the motor symptoms and affecting people throughout their disease course.
2. What helps constipation from Parkinson’s?
Choose easy-to-eat fibrous foods such as soft fruits. Consider mashing or pureeing fruits to make them easier to eat. Make sure to include the skin, where most of the fibre is found. Eat at least two pieces of fruit and five serves of vegetables every day.
Alternatively, you could try taking probiotics to nourish the gut-brain-axis.
3. Do Parkinson’s patients lose control of their bowels?
Besides constipation, if you have Parkinson’s, you might find it difficult to get to the toilet in time. You may also find it hard to squeeze the sphincter muscles in your bottom. This can cause leakage before you can reach the toilet.
4. Why am I constipated even though I eat fiber and drink water?
While probiotics like Lactobacillus plantarum PS128, increased fiber intake, and adequate hydration are essential components of managing constipation in Parkinson’s Disease, they may not be sufficient on their own due to various underlying factors related to the disease itself or individual patient characteristics.
A comprehensive approach that includes dietary modifications, regular physical activity, proper hydration strategies, medication review, and possibly additional treatments should be considered for patients who continue to experience constipation despite these measures.
Continued research into the specific mechanisms of gastrointestinal dysfunction in PD will further enhance our understanding and management strategies for this challenging symptom.
5. Why does Parkinson’s affect your bowels?
Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body. You may be asked to keep a chart for several days of how often you use the toilet and how much you drink.
6. What type of medication to take for constipation in Parkinson’s?
In Singapore, various medications are available to manage constipation in patients with PD.
Common over-the-counter options include stool softeners and laxatives such as docusate (Peri-Colace®), senna (Senokot®), and glycerin suppositories. If these do not provide relief, healthcare providers may prescribe medications like lubiprostone (Amitiza), which increases stool water content, and linaclotide (Linzess), which enhances bowel movement frequency.
Additionally, newer treatments like ENT-01, which has shown promise in clinical trials for significantly improving constipation in PD patients, are being explored.
