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Parkinson's Disease

Constipation - is it muscular for PD patients

02/20/2001

Question:

This question addresses the problem of CONSTIPATION with PD. I endure a severe case of constipation all of the time. I manage it (unsatisfactorily) by eating lots of fiber and taking stool softeners in the morning and milk of magnesia at night. I have collected enough data to be convinced that PD produces its own special brand of constipation. In my case it appears that the problem is not as simple as slowed peristalsis or poor stool consistency. I believe that PD prevents the proper transmission of the neurological messages that tell the rectal sphincter muscles to open. Therefore, no matter how viscous my stool and no matter how hard I push, there is a prolonged unyielding resistance to passing stool. My questions are 1) Has anyone out there distinguished this problem with voiding (sphincter muscle unresponsiveness) from the usual causes of constipation, and 2) has anyone done any research on how to persuade these muscles to relax and to stay relaxed long enough to allow some stool to pass?

Thank you for responding to my message.

Answer:

PD also can cause dysfunction of the autonomic nervous system which results in constipation as well as other symptoms such as incontinence and difficulties with blood pressure regulation.

Management of the constipation includes using stool softeners and laxatives, appropriate modification of diet, and stopping medications such as anticholinergics and amantadine if possible.

There is no good drug available for this problem. Propulsid was of some benefit but was taken off the market due to cardiac side effects.

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Response by:

Arif Dalvi, MD
Assistant Professor
College of Medicine
University of Cincinnati