From the Guidelines
Patients with Parkinson's disease who suffer from constipation can benefit from diet therapy, including the use of fermented milk containing probiotics and prebiotic fiber, in addition to common dietary advice aimed at increasing water and fiber intake.
Treatment Options
- The use of probiotics as an adjuvant treatment for constipation is recommended due to its safety profile 1.
- Non-pharmacological lifestyle modifications, such as increasing fiber and fluid intake, can be proposed to improve colonic transit 1.
- A daily consumption of fermented milk containing probiotics and prebiotic fiber for 4 weeks has been shown to increase the number of complete bowel movements, improve stool consistency, and reduce the use of laxatives 1.
Important Considerations
- Constipation in PD patients is mainly a consequence of neurodegenerative process involving the enteric nervous system, but can also be a side effect of certain PD medications, such as dopamine agonists and anticholinergics 1.
- Reduced physical activity associated with motor impairment is a contributing factor to constipation in PD patients 1.
- Defecatory dysfunction in PD may be due to slow colonic transit or pelvic floor dyssynergia, and treatment options should be tailored accordingly 1.
From the Research
Treatment Options for Constipation in Parkinson's Disease
The treatment of constipation in patients with Parkinson's disease (PD) can be challenging due to various patient factors, including dysphagia, cognitive impairment, depression, and weak sphincter tone 2. Several pharmacological options are available, including:
- Bulking agents
- Osmotic and stimulant laxatives
- Chloride channel activators
- Ghrelin agonists
- 5-HT4 receptor agonists
- Probiotics 3
- Motilin agonists
- Dopamine receptor antagonists
- Muscarinic agonists
- Antibiotics
- Herbal formulations such as iberogast 4
Efficacy of Specific Treatments
Studies have shown that macrogol, an isosmotic electrolyte solution, is effective in treating constipation in PD patients, with significant improvements in stool frequency, consistency, and straining 5. Other treatments, such as prokinetics and laxatives, may also provide relief from GI morbidity caused by PD, leading to improved absorption of PD treatments 4.
Importance of Accurate Diagnosis and Treatment
Accurate diagnosis and treatment of constipation are crucial to prevent complications, such as intestinal occlusion, and ensure an optimal clinical response to levodopa 6. The concomitant use of antiparkinsonian, pain, and antidepressant medications may worsen constipation, highlighting the need for careful management of PD patients with constipation 6.
Pathophysiology of Constipation in PD
Constipation in PD is mainly due to slower colonic transit or puborectalis dyssynergia, which may be exacerbated by the use of certain medications 6. The enteric nervous system and the dorsal motor nucleus of the vagus may be involved in the α-synuclein pathology, leading to constipation as a prodromal symptom of PD 6.