Constipation

Posted: Sat Dec 08, 2007 4:02 pm Post subject:

Constipation is generally intrinsic to PD rather than a side effect of medications. Of all PD meds, perhaps only anticholinergic drugs (such as artane) or maybe amantadine can worsen constipation. The others don't really cause it. We now realize that PD is a systemic illness that affects other parts of the body and not just the brain--the eyes, bladder, bowels, muscles, etc. There are dopamine containing cells in the bowels as well. I am attaching the constipation formula that we give our patients in case you are interested.... I. Definition Constipation is an alteration in stool frequency, consistency, and/or passage of stool. The normal pattern of bowel movements can and will vary by 1 to 3 days. A stool-voiding pattern of every day or every other day is encouraged. II. Causes A. Change in diet or activity B. Medical reasons: cancer, pregnancy, hemorrhoids, neurological disorder, muscular disorders, intestinal inflammation C. Medications: narcotics, sedatives, antacids, antispasmodics, iron supplements III. Treatment Management A. Fluids - Drink at least 6 to 8 – 8 ounce glasses of fluids per day. This is all inclusive (everything you drink like water, tea, coffee, juice, colas, etc.), but water is best, and we encourage you to drink primarily water. Bladder patients should reduce fluid intake after the evening meal. B. Activity - Exercise and increased activity will assist in establishing regular bowel patterns. C. Diet - Include fiber-rich foods: bran, whole-grain breads – oat, rye, fruits, vegetables (leave peel on), whole-grain cereals, oatmeal, pasta, nuts, popcorn, and brown rice. Daily recommended fiber intake: 20 – 30 grams Natural Recipe Miller’s (unprocessed wheat) Bran* 1 cup Applesauce ½ cup Prune Juice ¼ cup Mix these ingredients together and refrigerate. Replace the mixture each week. Take 1 – 2 Tablespoons daily for one week for desired results. If needed, you may increase dose by 1 Tablespoon each week. Stool frequency and gas may increase the first few weeks but will usually adjust after one month. *Miller’s Bran is unprocessed wheat bran. This can be purchased at most large grocery stores (Cub Foods, Kroger, Ingles, etc.) and is sold with either the hot cereals or flours and baking goods. The most commonly found brand name is Hodgson Mill and comes in a brown 14 oz. box. Miller’s Bran can also be purchased in bulk at health food stores. You can also sprinkle bran on food to supplement your fiber intake. D. Bowel Clean Out The bowel clean out should be done before starting on the bowel program that is outlined for you by your physician. This should be done on a day when you will be at home all day to minimize the risk of accidentally soiling your clothes. The bowel clean out is a two-part procedure. In the morning take 2 oz. Milk of Magnesia and follow that with a hot drink. This could be hot coffee, hot tea, or even hot broth. This helps to stimulate the bowel and enhance the effects of the Milk of Magnesia. That evening, after dinner, give yourself a Fleets enema. This helps to make sure the rectum is empty. You should be able to rest through the night without worry or discomfort. This procedure can be repeated the next day if needed. E. Medications 1. Bulk producing: Metamucil, Fibercom, or Citrucel. Mix 1 -2 Tablespoons in juice or water and take by mouth 1 to 2 times daily. - Adds consistency or bulk to the stool and facilitates water retention in stool. - Must take adequate fluids by mouth to avoid causing constipation. 2. Stool Softeners: Colace. Soften stool by facilitating the admixture of fat and water (detergent activity). Do not use with mineral oil. Take 1 tablet by mouth 1 to 2 times daily. 3. Combinations: Pericolace. Mild stool softener and laxative combined. Take 1 by mouth 1 to 2 times daily. 4. Irritant/Stimulant: Products containing Senna. Laxative with direct action on the intestinal mucosa and the nervous plexus of the bowel. 5. Suppositories: Glycerin, Dulcolax. Inserted rectally every other day or when needed. Stimulates rectum and assists with evacuation. I hope this helps! Yours,_________________Hubert H. Fernandez