Wow 😯. That’s a title eh?! Straight to your imagination I reckon. DON’T read this post whilst having your dinner.
I went to the gym this afternoon. I had very little energy and had a strong sense that my meds hadn’t really hit the spot? I reflected on this and observed that I hadn’t had a bowel movement for about 3 days. I’ve never really had constipation but after 9 years, it’s beginning to be - pardon the pun - a pain in the ass. I watched loads of videos and I came across a fascinating one by a gastroenterologist. He had various CT scans on the screen and shared a case of a PD patient who’d had constipation his whole life but had more recently started having diarrhoea. These seemed like unlikely bedfellows. He CT’ed him and he had a massive rectal impaction. The diarrhoea was travelling past and through this impaction. Strewth! 😬😳. So I thought ‘screw the prunes and senna tea’. It’s time for the big guns: I managed to find my trusty enema bag and 4 enemas later I feel so much better. In fact I feel great 😊.
Despite warnings that they’re not ideal regularly, I feel that with such compromised motility, I’m probably going to make them regular if not frequent. Food for thought by the HU community?
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You reminded me of one of my early posts here: Interventional Influence of the Intestinal Microbiome Through Dietary Intervention and Bowel Cleansing Might Improve Motor Symptoms in PDhealthunlocked.com/cure-par...
"In summary, there is growing evidence that changes in the gut microbiome and metabolome may have a direct or indirect impact of the healthy and diseased brain, as is the case for PD. Interventions that may skew the gut microbiome composition and may have a therapeutic effect on the course of the disease. Although small in size, our proof-of-concept study suggests that bowel cleansing, a well-established treatment and good tolerable intervention, in combination with a dietary intervention including SCFA have a positive effective not only on the gut microbiome but may also have a beneficial effect on the clinical course in PD. Nevertheless, as mentioned above the potential side effects including orthostatic dysregulation, electrolyte imbalance, exsiccosis, infections, abdominal pain, diarrhea, nausea and vomiting must be considered."
"Food for thought?" A lot of puns and bad jokes must happen now.
I use ozone enemas to deal with constipation. Ozone is the hemispheric gas that surrounds the planet. It can be made and pumped into bags for enemas. It cannot be stored so as soon as the bag is full one puts a rectal catheter in then attaches the bag and squeezes the ozone into the intestines. Of all the topical medications for treating constipation ozone gives me the longest relief times; Preparation-H lasts 4 hours. One ozone enema lasts 3 weeks.
what is your diet? Do you eat a lot of beans and lentils and chickpeas and not much meat or dairy? Raw cabbage is also good. Hubby has only had a problem when they upped his levodopa.
Definitely think LAJ the meds make things, worse, certainly has for my hubby as its gone along, but it's been a mix of things now that has kept him at least regular to every 2 or 3 days. We eat a good amount of lentils, beans, non red meat eating, lots of fruit, but that balanced with the colace non lax and senna leaf tea only has been great so far.
Magnesium citrate is one of the most popular types of magnesium supplements and easily absorbed by your body. It's mainly used to raise magnesium levels and treat constipation."
My mum's constipation, abdominal pains, motility and reflux issues have been tremendously helped by the introduction of a prokinetic. Constipation is no longer an issue that clouds daily life.
From going two or three times a week (increasingly with the help of a suppository), she now goes 5-7 times a week and there's zero drama, strain, or damn suppositories.
(Please note: prior to the prokinetic introduction we used one sachet of Laxido (macrogol 3350) + 500- 600mg magnesium citrate a day. Today, alongside the prokinetic, we use one sachet of Laxido + 200 mg magnesium citrate).
Parkinson's inevitably slows the entire digestive system from mouth to rear exit. Peristalsis in the oesaphagus, colon, rectum is compromised. All of the mechanical actions in the stomach are subdued. A prokinetic can help address some of those issues.
For most with PD, Prucalopride is likely the best choice. (Some options - eg Metoclopramide - are not great at all, so tread carefully) See here:
I'm not sure all PD folk should be prescribed a prokinetic, but it should absolutely be considered for those with persistent and worsening constipation, and/or with issues around bloating, abdominal pain, reflux, weight loss, premature satiety.
I am very sure the medical community does a lousy job of explaining these issues to PWP. The talk is always of constipation rather than of the entire system being impacted.
One of the problems is that the issue falls between two stools - pun entirely intended. The gastro specialist knows precious little about Parkinson's. The neurologist is no expert in gastro stuff.
A further obstacle: there are problems and significant drawbacks with most of the prokinetics that have been around for a long time. Prucalopride is much less problematic. Many are perhaps entirely unaware of its utility in this area.
My mum takes Motilitone. It's approved in S. Korea, and - like Prucalopride - appears to be more PD-friendly. The literature suggests Motilitone principally addresses abdo pains, reflux issues, satiety and not constipation, but our experience is that it has greatly improved constipation too.
Hey mate, sorry to hear you are having that issue but pleased it's not been a major issue in your day and hope that continues. But......it may be something that progresses.
My hubby as you know has been dealing with constipation for half of his PD life, so 18 years approx. He's your age. Every 3 to 4 days has become normal, until the last year or so, as we have managed to peg it back to every 2 to 3 days but he is well aware of where he is at, and has never been impacted. Once we used an enema many moons ago as were worried about impaction and another time I had to get involved (say no more), but again never impacted luckily. Meds and the PD movement slowness is the reason why it becomes that way and of course on top of that if you have a diet 'they say' low in fiber, and don't drink enough water', then it makes it worse. Problem with all of it is, everyone is different. His has definitely progressively got worse with the PD progression and the increase in meds...
My husband exercises regularly, drinks a ton of water daily, eats lots of fiber, very low red meat eater, fruit galore, bananas, prunes, apricots, etc etc but still has chronic constipation through all of it. The only thing that has helped 'him' with the balanced way of living and eating he has, is pure senna leaf tea drunk hot (NOT tea bags) 2 mugs/day in pm and late pm b4 bed (mix of fruit and senna) and Colace NON laxative (one in morn, one in eve) this Colace aerates the 'poop' so yes you poop more but it's easier to move. Years ago in NZ he used to eat 3 times a day a chunk of thick fruit based gunge is the only way I can describe it called Nulax. It was quite nice actually, full of figs etc and worked well but the texture was like biting into sticky nougat (not so easy to eat), 🫤😋and expensive. Bizarre isn't it how the fruit works, as for me, without PD, I eat 2 or 3 dried apricot or 2or3 prunes and I'm on the loo.😂
The biggest issue that probably won't go away, I presume, is the impaired muscle movement from the PD in the intestine to get the poop moving along. So.....
That's our story...... for some people it won't work, and some people don't like Senna as they have been told it's bad for the body, but our Neuro has said the way he takes and what it is not a problem, and it works. Long term laxative use is supposed to have issues with the bowel becoming lazy, but with the Colace it's also one reason we only use the stool softener not the laxative Colace. (Not so easy to get I've noticed when buying online via the U.S.) Can't get it here in Europe.
I think in the end, with reading and insight, you should do what works for you, no-one else. Hope you are feeling lighter and breezier today 😜
I developed gastroparesis, The neuro put me through the works. I had to swallow a 'Smart pill'. Then at the bottom end the diagnosis was slow transport through the colon. Nothing wrong in the stomach or small intestines. They prescribed Motegrity. Initially I needed something to aid transport but now I take one pill in the evening and have a painless BM the nest day.
There is enough literature on enemas - from… they have been used from Roman times… to cancer therapy (Gerson protocol)...
That said, I use Magnesium supplements. a combination of Magnesium Glycinate and Magnesium L-Threonate – three times a day works for me – helps with muscle cramps and sleep too. Have been using magnesium supplements for years.
Technically any magnesium supplement should work - Magnesium citrate/Magnesium oxide may work better for constipation… Of course, dosage will vary for individuals. Epsom baths may help too. Best!
One you might consider is the prebiotic/fiber, Inulin. It can help with constipation while improving the gut microbiome content by promoting healthful bacterial growth in the gut. The downside is that there will be plenty of gas until your body adjusts to the alteration to the gut microbiome. This effect is also seen initially in FMT used in PwP in studies and is generally transitory.
Certain probiotics are also noted for improving constipation and these may work even better with inulin which can act as a food for the new healthy bacteria that the probiotics bring.
To speed things up when needed, magnesium citrate will be well absorbed and will also get things moving when you feel the beginning signs of constipation.
Another simple one is a tablespoon of olive oil in the morning on an empty stomach if it meets your tastebuds approval, but not so much for me.
Alternating these may keep your digestive system in a state of confusion and unable to adapt back to a state of constipation.
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How long into your PD before you had visible tremors? Hand/foot movement?
Need Away from Home Care
levodopa or not levodopa 
