Common problem in PD: Constipation

"My biggest problem right now is constipation. Sometimes I don’t have a bowel movement for a whole week, and it is never easy. What do you recommend?”


This is one of the most frequent questions I am asked in my PD clinic and as editor of PD UPDATE, the PRF newsletter. Constipation is a very common problem among patients with PD. Most people as they age notice decreased frequency of bowel movements and greater difficulty with defecation. but in PD, the decreased motility of the gastrointestinal system can be very pronounced. Some medications with anti-cholinergic actions (such as trihexyphenydyl or Artane, benztropine or Cogentin) may produce or worsen constipation. Most other medications used in PD improve movement of the body but apparently have no beneficial effects on movement of the gut. In some forms of parkinsonism in which autonomic nervous system function is deficient (as in Shy Drager syndrome), patients require a lot of help in order to empty their bowels. In addition, difficulties with swallowing, urination and control of blood pressure often complicate the lives of patients with this form of parkinsonism. For most PD patients with mild to moderate constipation, a change in diet (grains, fresh vegetables and fruits) and plenty of water is recommended. Regular exercise, including walking is also useful for promoting bowel motility. For more troublesome cases of constipation the occasional use of laxatives may be indicated. Before patients begin self-medicating with many laxatives and enemas, it is worth consulting a gastroenterologist (specialist on the gastrointestinal system).

J. Sanchez-Ramos, PhD, MD