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Saturday, October 13, 2018

The Dirty Secret

Today I've finally decided to discuss a dirty little secret, or not so secret as the case may be: constipation. I've been intending to write this article for some time, but it has been slow in coming. (See what I did there?)

A lot of people have this problem, but Parkinson's patients tend to be overly afflicted by it. I used to be and have a few solutions to tell you about how to deal effectively with this problem, whether or not it is due to Parkinson's.

I'm going to first discuss the basic problem, then am going to discuss the following potential solutions: The process, Diet, Supplements, Exercise, Medications, and DBS.

The Problem

One of the more common "non-motor" symptom of Parkinson's disease is constipation. I put "non-motor" in quotes, because the reality is it is a motor system even though people don't think of it in that way. Your large colon is a muscle that pushes your solid waste down and out. But, being an automatic process that we usually don't think about, we don't tend to classify it as a motor symptom. But in reality, there are motor issues at play here that Parkinson's can affect.

But it isn't merely a motor issue either. Many Parkinson's patients are missing key bacteria in their gut that help to digest food. This can result in hardened stools. Getting the gut back in shape is one key component of dealing with PD constipation.

I've also read that PD can affect the smoothness and dryness of the colon wall. This will make it harder to move stools through the colon. I recall feeling that problem as well.

The Process

Most people who have constipation push with all their might to get it out. I've since discovered that this is counterproductive. Sure, it works sometimes, but it can cause worse and worse constipation as well.

Before I knew that bit of info, I would strain to push it out. My all-time record of sitting on the toilet and trying to get it out was a little over three hours. It was grueling. I was literally crying by the time it was over with in one big explosion. That was after cramming suppositories up there and all that. I feared at the time I would end up in the emergency room because I couldn't get it to budge, no matter how hard or how many times I pushed.

The problem with pushing hard is twofold. One, it puts stress on your internal organs. That can cause its own set of problems. Problems you don't want. Two, it can pack the stool into your colon in such  a way as to exacerbate the problem.

The best process I've found is to: First, let your natural colon process take over and expel it on its own schedule. This is by far the best method and can make for the least stress on the body.

Second, if it needs a little help to get going, like when you feel the need to go, but it stops short of coming out, some moderate pushing is in order. What I've found works best is breathing deep with your stomach. That produces a natural shove and nudge of the stool. If you feel it is necessary, you can provide a moderate push at the deepest part of the breath. Nothing that will turn your face red type of pushing, just use as much as it may require.

Third, if it still doesn't come out, don't push with all your might. Sit there continuing to do deep breaths until you either expel the stool, or you are forced to give up and try again later. Whatever you do, don't push excessively in a straining manner as that will make it worse in most cases and you'll run the risk of damaging internal organs.

If after three attempts like this, it still won't come out, consider going to see a doctor.

The Diet

Your diet plays a large part in what kind of gut bacteria you have. The types of bacteria you have in your gut are largely dependent upon what you feed them. So if you eat processed foods, the bacteria you'll tend to end up with are largely those that help breakdown sugar and fats. If you eat fiber rich foods, however, your gut will grow bacteria to process those types of nutrients.

It should go without saying if you eat a lot of fat and sugar heavy types of food, like meat, cheese, eggs, most processed foods, etc., that your constipation will get worse, not better. Take cheese, for instance, It is mostly a concentrated lump of fat. Around 90% saturated fat. I know from experience when I've eaten too much cheese in the past that I've had constipation problems. That was before I had PD. All that fat can gum up the works in your colon, especially if you are already prone to constipation by PD.

The type of diet that works best at reducing constipation is one that is starch and fiber rich. That means lots of bread, vegetables, fruit, and legumes of various types and forms. If you need to eat meat or meat products, and processed foods, serve them in very small portions and only occasionally. But it is best to eliminate them altogether. The more problems you have with constipation, the more strict you need to be with eliminating those foods. A plant-based diet will do more to correct your gut bacteria than most any other method.

Additionally, it is a good idea to stay hydrated. I usually drink plenty of water and other liquids each day. I tend to always have a water bottle full of water close by.

You can gauge how well you are doing based on the frequency of your bowel movements. Healthy individuals will have around one bowel movement a day. If you go two or three days without one, know that you are building up to a constipation episode and take preventative measures as soon as possible.


"But Rick, what about fiber supplements?"

Yes, they do help. When I had constipation on a regular basis, they were one part of my routine to help stave off that problem. All by themselves, they didn't do the trick, but they helped. Now I take them more for the B12 they contain than for the fiber. At any rate, if you can get your fiber from whole foods like I've listed above, you are far better off and will not need fiber supplements. That said, even if you are getting plenty of fiber from your diet, it won't hurt to add more from a supplement.

However, the most effective supplement I ever took for this problem was Magnesium. I took around 500 mg a day, which appeared to keep my stools soft enough. The only time I needed more fire power was when I was on Amatadine because that medication had the side effect of more constipation added on top of PD. However, magnesium was my primary supplement to fight against constipation. Also, it had the added benefit of helping my nervous system operate at peak performance.

The times I had the worst constipation was the days I forgot to take my magnesium for the day. There may be other supplements that work for other people, but those are the two that worked best for me.


"Aw, do I have ta?"

Yep, if you want to address the cause rather than just the symptoms. The colon, as I mentioned above, is a muscle. PD affects muscles, and it can affect the colon. It can interrupt the smooth movement downward of a stool. As PD progresses, it makes your muscles weaker due to the tremors and any dystonia affecting the muscle. The solution to this is exercising those muscles.

This was dramatically brought home to me back in 2015. In 2014, during our trip to Hattiesburg, MS from our home (at that time) in Marble Falls, TX, I was constantly stopping to use the bathroom. My bladder muscles had grown weak enough by that point that I frequently had a hard time holding it in. I had many close calls on that trip, and at least one or two misses. My need arose without warning and usually left me little time to find a restroom.

In Feb. of 2015, I had started to exercise regularly at the YMCA doing Zumba and Pilates. By the next fall when we left for Hattisburg, I had little problem and could go for quite a while before needing the bathroom. The reason? Mostly due to Pilates, because it works the core muscles. They got stronger, and therefore my bladder had more control. As a matter of fact, several of my muscles grew stronger during that period. I had several of my symptoms reversed because of it.

"But Rick, that's dealing with the bladder, not the colon."

Yes, but they are in the same area. It was harder to gauge the constipation. However, it was in 2014 I sat on the toilet for over three hours. I never had that bad of constipation since I've started exercising regularly, even when I took Amantadine. I know that it has been one of the things that has helped my constipation issues.


There are over-the-counter and prescription medications that one can use. The problem is that they can have side-effects and complications with other medications you may be taking. Be sure to check contradictions with other medications before taking even over-the-counter medications. By far, the best methods are the above ones, but in some cases that will not be enough and you may need more powerful methods. It is a good idea to check with your doctor before taking any additional medications, even over-the-counter ones. I personally have no experience with those, as I've never had need to use them.


DBS, or Deep Brain Stimulation, can help with constipation. It generally doesn't help non-motor symptoms, but as I've indicated above, the colon is a muscle that can be affected by PD, so there is some motor issues involved, even though there are also non-motor issues. All I know is currently, over the past year since my DBS surgery, I've had near zero problem with constipation. I am also doing the plant-based diet, so I know I'm getting plenty of fiber, but I no longer take magnesium and my stools and frequency of bowel movements are quite normal.

Now, am I saying get DBS to solve your constipation problems? No, there are other ways to deal with it. However, it could be one consideration in whether to get DBS or not. And I'm not saying for sure that it will solve it for you. It depends on why you are constipated and whether DBS will affect that or not. However, if it does affect it, it is one potential side-benefit of getting DBS.

That has been my experience with constipation to date. I'm sure as this disease progresses, I will deal with it again. But for now, I've conquered it using the above methods. Maybe it will help you too.

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