This subject comes up a lot, so I figured it would be useful to post our collective wisdom in one place as a reference. As usual – what works for one may not work for another. So members of our club are invited to also post your remedies in the comments.
The causes of Parkinson's constipation
There is more than one cause. First, muscle activity of the G.I. tract tends to become weakened – this can include difficulty swallowing, gastroparesis, and in the matter at hand, sluggishness.
The G.I. tract also tends to get dried out, from one end to the other. This can include low saliva, food or pills getting stuck in the esophagus, and inadequate moisture and lubrication for expelling the waste.
Solutions
I found that high-dose thiamine restored my normal G.I. tract peristalsis within a week or two. I have also observed that too much thiamine can result in discomfort - excess peristalsis when none is appropriate. So it took a bit of experimentation to get the dosage right. Personally, 500 milligrams of thiamine HCl is right for me, but this number is different for everybody. The protocol for high-dose thiamine is set forth here: highdosethiamine.org/
To restore moisture content I use 5 to 10 grams of vitamin C, mixed in drink, over the course of the day. I am sensitive to acid, so I use calcium ascorbate. This is about 10 percent calcium by weight. The stool softener known as docusate sodium can also work for this purpose.
I have recently noticed that consumption of MCT Oil has a lubricant effect. I use it in place of butter. I have not been scientific about measuring my consumption, but my guess is I consume about a tablespoon or two daily.
Having made these changes I can report I have not experienced constipation for some time and my bathroom duties are quick and efficient.
What works for you?
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park_bear
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I'm a pelvic floor physical therapist and have treated constipation in Parkinson's a few times and they are the most difficult to treat. One thing that helps (though needs to be used in conjunction with other methods) is putting a heating pad on your belly and performing the ILU massage to stimulate colon motility right after. here is a link: covidphysicaltherapy.org/vi.... Activity is also very important. If we do not move / walk adequate digestion is difficult. If you have a caregiver and cant do the massage on your own, caregivers can do this.
The squatty potty is also helpful because it straightens your rectum and there is less of a need to strain. I know straining is sometimes unavoidable, but overtime it does weaken the sphincters and makes them uncoordinated (causing more elimination problems)
Just a note about senna and other "stimulant" laxatives: the body can become quickly dependent on them, so they should be used sparingly. I have had many patients come in who basically are addicted to them and the colon essentially has become more sluggish and waits for that stimulant in order to eliminate. The stimulation of these laxatives also cause the sphincters to become dysynergistic over time. Osmolaxatives are more gentler and soften stools which makes them easier to move down the tract. Personally overdoing the osmolaxatives is better than using the stim laxatives.
Two things that have helped (not cured) parkinsons patients is IBGard (found in pharmacies) and eating two green kiwis a day. The enzyme in the kiwi improves colon motility,
Lastly, if you are having pain when defecating, your poop is coming out skinny or you suspect the anus itself is not opening to get the poop out, it is different than standard constipation and one needs to correct the outlet dysfunction before addressing the other parts of the digestive system.
Thanks for your extensive comment including adding the warning about senna. Accordingly, I deleted the reference to senna in my post.
I found that a footstool in front of the toilet works better for me than the squatty potty.
I see that the active ingredient in IBgard is peppermint oil. I tend to hold tension in my gut. On occasions when this bothers me I use this enteric-coated peppermint oil product:
amazon.com/gp/product/B0002... Also just a drop or two of peppermint oil mixed in with morning oatmeal can be helpful for that as well.
If someone is backed up for days and feeling ILL - i will tell them to go ahead and use the senna because you dont want to become impacted. but if you find you need to use them once a week more often, I would say double your dose of colace or miralax before you regularly reach for the senna.
Yes, i sometimes stick to the brand name just because i know it works and just want to recommend the "sure thing" but i will tell my patients from now on that if they are tired of spending the $ on IBgard to try the solar ray. The other thing about IBgard it says there is fiber as well, but it does not list it in the ingredient list which i find strange.
And before buying squatty potty i will tell people to play around with positioning stacks of books or small step stools to see which height and foot positioning works well for them
i think a lot of times people focus on the intestines and it can be other factors - that "tight gut" can also mean abdominal muscle stiffness in which case massage / heat can be helpful. When you are more of a chest breather the top of the colon gets stiff because the diaphragm is also stiff from lack of belly breathing and they kind of just adhere together. softening the belly manually with massage and heat and practicing diaphragmatic breathing can improve motility as well over time. Also, using a massage stick up and down the gut can help too. when i feel tension in the gut in a patient, i think - how can the colon work optimally when there is all that gas an tension occupying space?
My husband went on a keto diet for a few months (not sustainable) and he did mention MCT oil made him run to the bathroom regularly so i did think it may be helpful for other uses but it slipped my mind. will have to see if it helps my patients and my dad!
stopped taking mct. However I use Yerba.com organic psyllium. Highly recommend it. It keeps me regular and very healthy. Recommended by consumer lab.com excellent product IMHO. PARK BEAR has an excellent thread on constipation. About a year ago or so. I’ll try to locate and send a link. I do use flaxseed (organic) as well from Amazon increasing fiber definitely helps. Lastly, squatty potty Amazon also helps Park Bear just responded Check it out Rita Thanks PB!!
For me Yerba psyllium definitely makes me regular, daily without laxative effects every once in a while I use a laxative but not often hope this helps
I take 1/2 C/L 25/100 at 0700. I eat and take meds at 0800- . Because I’m on C/L 50/200 ER it’s ok for me to eat when I take meds. However no protein. Mostly berries and oatmeal. I take my psyllium at 0930. Need at least 1 1/2 hours after meds. I sometimes take a 2nd psyllium at 430. Lots of fiber, flax, berries, etc. helps for me considerably.
I have one dulcolax with lunch. Then generally I'll have a BM the next morning. But not always. Sometimes there's no sensation of a full colon. In chinese medicine the large intestine meridian is connected to the nose and sinuses. I found late morning or early afternoon I get congested. That's my cue to try for that BM. And in most cases it works. Sometimes I have to push on the transverse flexure on the left side below the belly button (Umbilicus) Typically there's one HARD stool that takes effort to remove. That's followed by soft, formed stool 4 inches long. That's followed by liquid mess known as fecus, digestive end-products waiting for fluid to be removed. Sometimes I'll snack on prunes during the day. If so the whole process happens faster.
More thoughts... the PWP can roughly be split into two groups - the newly diagnosed who are seeking answers and guidance, and the veterans who have the answers and can give the guidence.
And the former group is much larger.
So all veterans who want to get off the hamster wheel can decide to create their own single place (with the link found on the pinned post), and if the content is good, people will find it, and read it...
Thanks for sharing. You provide so many helpful ideas and information. God bless you! Ileocecal valve rubbed clockwise AM and PM helps along with hydration and abdomen massage.
Prune juice, or just eat a couple of RIPE pears, or mineral oil (which is usually edible, will say on label...low tech tried and true...in fact one mineral oil I saw at Walmart was in the pharmacy section, said mineral oil, and listed constipation as a reason for taking...mentioned dose too).
I'm partial to the combination of high dose vitamin C and magnesium citrate to get things moving and obtain the health benefits that both have to offer. Regular walking is helpful also, for those who are able.
Lots of great info above, good thread Park Bear, as you say what works for one person doesn’t always help another but it might do.I have been researching about resistant starch and how including these foods can help your gut health. This is an interesting article about it.
We have added recommended foods to our diets and mostly it has really helped my husband.
Breakfast oatmeal and oat germ, with mixed fresh berries, dried apricots, green bananas, flax seeds, chia seeds, cinnamon and inulin which is from the chicory plant, coconut oil.
Lunch, varies but often veg soup, salad, whole meal bread, some protein.
Snacks on grapes and oranges, and apples in the day.
Dinner small amount fish/meat lots of green veg, asparagus, bell peppers, mushrooms etc (twice cooked potato)
Supplements include Mag Citrate, B1, vit D, vit C amongst a few.
My small advice is avoid cheese. One piece of it (unless it's goat feta) just does me in for a week and a battle ensues with flax seeds and fibre, fibre, fibre, etc. Oh but I miss cheese but it's not worth the battle most of the time.
You mentioned that you still consume goat feta. In your opinion, is goat's milk less constipating than cow's milk? Trader Joe's carries goat yogurt (which I consume, thinking that it's beneficial. I still have a major problem with constipation.
Soft goat cheeses are ok for me and better than cow even soft cow cheeses. I love feta in salad and on pizza and stay away from any hard cheeses of either type. Mind you, fibre helps digestion and constipation and I’m eating more of it. Hope this helps you decide. I tried goat yogurt too but have a small amount of probiotic yogurt now and then. Plant yogurt made with oat is good and satisfies the appeal for something creamy. I should experiment with trying to make it. I can’t have gluten so it’s difficult to satisfy snacks and things.
"Food-derived opioid peptides include digestive products derived from cereal and dairy diets. If these opioid peptides breach the intestinal barrier, typically linked to permeability and constrained biosynthesis of dipeptidyl peptidase-4 (DPP4), they can attach to opioid receptors. The widespread presence of opioid receptors spanning gut, brain, and internal organs is fundamental to the diverse and systemic effects of food-derived opioids, with effects being evidential across many health conditions. However, manifestation delays following low-intensity long-term exposure create major challenges for clinical trials. Accordingly, it has been easiest to demonstrate causal relationships in digestion-based research where some impacts occur rapidly. Within this environment, the role of the microbiome is evidential but challenging to further elucidate, with microbiome effects ranging across gut-condition indicators and modulators, and potentially as systemic causal factors. Elucidation requires a systemic framework that acknowledges that public-health effects of food-derived opioids are complex with varying genetic susceptibility and confounding factors, together with system-wide interactions and feedbacks. The specific role of the microbiome within this puzzle remains a medical frontier. The easiest albeit challenging nutritional strategy to modify risk is reduced intake of foods containing embedded opioids. In future, constituent modification within specific foods to reduce embedded opioids may become feasible."[emphases added]
So effects, if any, uncertain and not limited to dairy.
Let me understand this. And I mean no disrespect at all. But in the spirit of the questions necessary to science ... You looked for the answer to whether dairy contains morphine, and you found this one study that says that research is inconclusive about whether it is detrimental? And that lead you to state "So effects, if any, uncertain and not limited to dairy."? I'm just wondering if there isn't some level of confirmation bias possible here.
I was not making a statement about detriment, though it is implied since opioids don't seem to do anyone any good in the long run. I was very simply stating that dairy products contain it. I tend to let people make their own decisions about how their bodies react to various items.
I agree with your conclusion. I like cheese because it is salty. I crave salty but avoid chips chips and junk. I doubt I eat cheese once a month but I like it. Not addicted. Not sure baby animals become addicted. But I wonder how this compound ended up in there. Hmm. Has the EU banned it, they are more progressive than the US when it comes to food. I think I’ll look into it too. Just curious.
I take magnesium citrate and vitamin C at night. I also spend a few moments in bed rubbing sesame oil on my abdomen in circular motions. Great post PB!
Thank you for starting this post, park_bear. Good information for future!!! (Hopefully it won’t be needed!). HwP drinks a glass of kombucha with a tablespoon of homemade Fire Cider in it and a small serving of fermented cabbage at breakfast and chopped salad at every meal daily. Seems to keep him regular. If we leave one item out he has problems.
He is newly diagnosed, so I don’t know if things will change over time.
For me, I get out of bed in the morning and do not sit down. I stand, do light housework, read, but no sitting. This let's gravity do it's thing. Doesn't always work but helps. I recently added a pat of natural grass-fed butter to my cornbread for breakfast, evaluating but might work for me.
I don't know what's wrong with me but I have had really bad constipation for a few years (and insomnia and sometimes urinary incontinence - just like my dad did early on with his MSA, which isn't supposed to be hereditary). I tried a lot of things to fix it including a very high fiber diet and lots of resistant starch; I track my food intake with an app called cronometer so I know how fiber much I'm getting.
Anyway - the one thing that has helped me most with constipation is teff porridge - 200-300 grams/day. I get the organic stuff from Whole Foods when available. Amazing relief. I also take miralax every night before bed, but by itself the miralax does not do much at all. I take it now mostly to make things easier on the way out, if you know what I mean.
Another thing that will work is 2 bottles of Yakult. I usually just do one bottle each evening. It seems to help with sleep and anxiety, also.
Broccoli sprout smoothies help a bit, mostly I find they help with GERD. There is at least one study on broccoli sprouts for gut motility in IBS.
I have tried it all; thiamin, magnesium citrate, vitamin c, fiber, stool softener, miralax, lots of water, and still have problems. However I haven't given up. I just started restricted starch. One study says it helps constipation. I am starting to think part of my problem may be a side effect of ropinarole. In this case none of these solutions will work. Why is the squalamine derivative taking so long to move to a stage 3 trial?
Taking at night 1/2-1 teaspoon Triphala powder (see note) along with several soaked prunes worked very well for me. Lately I substituted prunes with a fresh apple (using core, seeds and skin which supposedly contain most probiotics) and so far it's been working well too. If this remedy would fail, my next choice would be magnesium citrate which I used occasionally in the past with good results.
Note: compounds found in Triphala are metabolized by liver enzymes known as cytochrome P450 (CYP450). Taking Triphala with other drugs that utilize CYP450 may adversely increase or decrease their concentration in the blood.
I have read the reply’s and for the most part the recommendations for foods that address constipation are A-OK for the individuals that do not have the complications of Gastroparesis. The diets for constipation and Gastroparesis are contradicting. One of the big differences is low fiber for Gastroparesis and high fiber for just constipation. I am one of many PWPs that have both. Forget dairy products, and specifically for PWPS with Gastroparesis, no nuts, seeds and a host of many other foods that are most adequately described for the disease on line. I take a packet of Miralax in 8oz of water in the PM and also limit anything after 4:00PM to just liquid. Sometimes even that is not enough so on those occasions, when needed, I take Bisacodyl (stimulant) 5mg each AM) for a couple of days which does the trick. Like it has been said, we are all different in our requirements to have as best of Quality of Life as is possible. Biggest problem I have found is that the Neurologists I have seen in my local area have absolutely no idea of treating the NON MOTOR symptoms of which I have many. A complication I have, Global Neuropathy, is barely controlled with 600 mg of Lyrica. I would like to hear from PWPs that have complicated GI issues requiring contraindicated foods/supplements and RX
I have a recipe that works far better and it’s natural!
1 lb pitted prunes
4 ozs senna tea leaves (at health foods store)
1 lb raisins
1 lb figs
1 cup lemon juice
1. Prepare tea; use about 2 1/2 cups boiled water, add to tea leaves and steep for 5 minutes.
2. Strain tea and remove tea leaves.
3. Place 2 cups of tea, or amount left, in large pot.
4. Add all of the fruit to the tea.
5. Boil fruit and tea for 15 - 20 minutes, until soft.
6. Remove from heat and add lemon juice. Allow to cool.
7. Use hand mixer/blender or food processor to turn fruit and tea mix into a paste.
8. Place in glass jars or Tupperware and place in freezer (paste will not freeze but will keep forever in freezer also very long in fridge).
DOSAGE: 1 - 2 Tablespoons per day
Suggestions for use: Can be spread on toast, english muffin, bagel, bran muffin or rice cake. Good breakfast. lunch, or snack: toasted bagel or english muffin, spread with low fat cream cheese or goat cheese and topped with fruit paste. For a change of flavor mix in some raspberry or strawberry jam. The first time I made this, I cut the recipe in half, used the full recipe after that. The stuff seems to work just fine, as long as you use it regularly .... it's all natural, no chemicals, no preservatives, just a little bit of money and time invested.
Senna was the most studied intervention in the included RCTs, either as the main intervention or as the comparator. These trials were of different quality levels according to Jadad scale. Two of the RCTs were of high quality (Jadad score 4-5), whereas one RCT scored as low as 1. The efficacy and safety of senna was tested against lactulose, SPS or placebo. These trials concluded that senna was equally as effective as SPS [sodium picosulphate] or more effective than lactulose or placebo. The longest duration of treatment with senna was 5 weeks."
For my husband with Parkinsons what seems to have helped was getting treated for SIBO and taking magnesium citrate, drinking 2 or 3 more cups of liquid per day, vitamin C and he does take B1. The SIBO treatment initially involved two different antibiotics and the GI doctor had him take Align. He has quit taking Align now. He does take probiotics but it is my understanding that some probiotics can be problematic for a person with Parkinsons. The three probiotics he takes are lactobacillus rhamnosus GC, plantarum PS128, subtilis pxn21 but the constipation had pretty much resolved prior to starting these. I wish I could find the article about microbiome tests showing an accumulation of some probiotics in Parkinson's patients who took probiotic combinations that were considered problematic.
Moved to NY right before covid lockdown. Got Covid, then a tick bite…didn’t know anything about Lyme. Then became severely constipated. My theory is due to covid lockdown lowering my activity level, moving to extremely humid NY, drinking a little bit more alcohol, and ending up with impaction changed my gut microbiota from healthy to severely unhealthy (had blood and stool tests, paid for by me, which confirmed.) Bowel habits changed from daily to 3-4 days between. And difficult to accomplish to boot.
I did NOT have symptoms of Parkinsons before all this. Some months after impaction began (finally confirmed by MRI, paid for by me, due to pain under left rib cage) began severe tremors, drooling, difficulty walking, lack of expression, really bad balance, stooping, memory difficulties, trouble sleeping, etc.
Started taking probiotics, really high doses and various brands and types. Started drinking purified water, not from a bottle, no tap water due to blood test showing high mycotoxins and a moldy smell coming form faucet. Have started eating a lot of fermented vegetables, olive oil, and avocados. AND taking UN-enriched nutritional yeast along with B vitamin supplements. Some of the B’s help you. Ascorbic acid (vitamin C) and magnesium in various forms help. I also used a thumping type massager.
If you have MTHFR gene mutation, you need to be careful about the type of folate you consume and should avoid enriched flour like the plague.
This is a really important point if you do B1: B vitamins are water soluble. You sweat and they deplete. You stress and they deplete. If you take one in really high doses, apparently it will cause other B vitamins to become deficient!
(Please see the pictures from a nutrition book I read 40 years ago, “Know Your Nutrition.” This book helped me get rid of bronchitis completely after suffering for 20 years and several emergency room visits and hospital stays. 30 years bronchitis free and Covid didn’t hospitalize me.)
Lately I started taking Chinese traditional medicine herbs that have been clinically researched as they work on specific cell activity of the nervous system. I’m able to poop daily now. Neurological symptoms are much milder and improving. I can jog now. I don’t walk like a drunk anymore. I also started treating undiagnosed Lyme with rifing and herbs.
try MCT brain C8, brain octane from BulletProof.com. bcuz it does have an effect, start small and build up. try 1 tsp first then 2 tsp etc. 2 tbl/day if good for the brain also.
Thanks I'm taking 500 b1 and am constipated. Should I add 500 once a week to see if that helps? I am afraid that additional 500 a day will be too much. I have a n appointment with a new movement specialist in three weeks. I don't want to be evaluated if I am experiencing side effects. Your thoughts!
thank you for all helpful info. I appreciate all comments. Maybe I will try increasing his magnesium at night and or miralax in a.m. and p.m. to see what that does before adding any more pills, et. He hates all the pills and vitamins he already takes but think necessary. Could be the Ropriniole?
I understand regarding the pills. I add the vitamin C to my drink, and add MCT oil to food as appropriate. Constipation not a side effect of ropinirole as far as I know.
thank you for the good info. So many replies, not sure which one to try at first. Said below I might try the increase of magnesium and miralax before trying other remedies. If that doesn’t help then we will try something else.
Thanks again. Everyone on this site are so kind and so willing to help each other. God bless.
I buy a product called MagO. It's pricey, but worth it. Three capsules every night, and I usually have a BM next morning. Staying hydrated is key but I don't always do it.
5 to 10 grams of Vitamin C daily sounds like a lot to me. I've seen a number of articles that state that 2,000 mg (2 grams) is the most that an adult can safely take.
" Although too much dietary vitamin C is unlikely to be harmful, large doses of vitamin C supplements might cause:
Diarrhea
Nausea
Vomiting
Heartburn
Stomach (abdominal) cramps
Headache"
Emphasis added. This is not the kind of harm that goes on undetected and thereby causes long-term damage. If any of these occur the solution is simple - back off on your vitamin C intake.
Vitamin C in supplemental form, given at a high dose, can cause diarrhea (or reduce constipation) in part or maybe because it is digestively disruptive due to increasing oxalates.
I take 2 heaping teaspoons of a magnesium supplement called Calm made by Natural Vitality. I also drink a minimum of 2 liters of water daily. This works quite well.
It's a great post this as it's such a big problem for many pwp's. And as it shows above, so many people get benefit from totally different remedies. Senna loose leaf is absolutely a great product for my husband and other pwp's we know. We don't see a reason for it to be stopped when the Neuro also says it's totally fine in the doses we use and it works.
My husband has had senna (loose leaf tea only) with fruit tea for the past 15 years to help with constipation from the PD. It has been effective and had no side effects that we know. He eats prunes and fruit religiously every day, drinks a ton of water, and takes 1 Colace (non laxative) stool softener at night. This keeps him very regular every 2nd to 3rd day. He's a careful eater but nothing else works. I am going to get him to try at some point the Cucumber smoothie someone mentioned, but Senna (pure loose leaf) tea has been the only thing to keep him even. I know it doesn't work for everyone, just like prunes and kiwi and every other fruit doesn't seem to help him alone.. .it all just probably helps together. Luckily he has never been impacted. Colace on it's own does not help. Nulax is another product he tried year ago which is Figs & senna mixture... quite an unusual texture, but we found the tea is far better and easier. Thanks for your list, that's great for everyone.
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