Constipation is a very common challenge for our community, affecting between 50% and 80% of people living with Parkinson’s. While it can be a frustrating topic to discuss, understanding why it happens and how to manage it is one of the best ways to stay comfortable and make sure your medications work as they should.

How do I know if I’m constipated?

A stool is made up of digested food, proteins, bacteria, salts, and other things produced and released by your intestines. After you go to the toilet, what you see is the result of the food you’ve eaten, how much fluid you drank, your combination of medications and other lifestyle factors. So, what your poo looks like can be a really important thing to tell your care team.

The Bristol Stool Chart, Bristol Poo Chart or Bristol Stool Form Scale is a medical aid designed to classify faeces into seven groups. This chart is used by your care team, and it is a great tool for anyone wanting to monitor and improve their bowel movements. The types of stool you see on the chart depends on the time poo spends in the colon.

You can use the Chart to check what your poos are telling you, it shows seven different categories. Aim for the categories in bold:

  1. Rabbit droppings: Separate hard lumps, like nuts (hard to pass)
  2. Bunch of grapes: Sausage-shaped, but lumpy
  3. Corn on the cob: Like a sausage or snake with cracks on its surface
  4. Sausage: Like a sausage or snake, smooth and soft
  5. Chicken nuggets: Soft blobs with clear-cut edges (easy to pass)
  6. Porridge: Fluffy pieces with ragged edges, a mushy stool
  7. Gravy: Watery, no solid pieces (entirely liquid)

Every person will have different bowel habits, but the important thing is that the stools are soft and easy to pass.

Why constipation happens & the “Body-First” link

For many, constipation is a prodromal, early symptom, meaning it can appear up to 20 years before typical motor symptoms like tremors or stiffness. Modern research suggests a “brain-first” or “body-first.” The “body-first” model where Parkinson’s may actually start in the gut’s nervous system. Harmful clumps of a protein called alpha-synuclein are thought to form in the gut wall and then travel up the vagus nerve to the brain.

What causes it?

In Parkinson’s, constipation is usually caused by a combination of factors:

  • Slow transit: The condition affects the “automatic” part of our nervous system that controls digestion, which slows down the muscles that push food through your intestines.
  • Muscle coordination: Up to 61% of people with Parkinson’s experience “outlet obstruction,” where the pelvic floor muscles fail to relax or even tighten up when you try to have a bowel movement.
  • Medication side effects: Certain drugs, especially anticholinergics and amantadine, are known to cause or worsen constipation.
  • Bacterial interference: Some gut bacteria can turn unabsorbed levodopa into a substance (DHPPA) that slows gut movement by as much as 73%.

How manage your constipation

Creating a daily “bowel programme” is the most effective way to stay regular.

Hydration tips

  • Your thirst mechanism may be impaired due to PD symptoms, so you might not feel thirsty anymore. Just set a timer or use other cues to remember to drink.
  • Drink at least 1.5 to 2 litres (6 to 8 glasses) of fluid daily unless advised otherwise by the doctor. The best drink is water.
  • Limit caffeine, alcohol, and sugary drinks as they can cause bladder irritation.

Diet tips

  • Eat a balanced diet. As a guide, getting the recommended 30 grams of fibre per day if you are male or 25g if female. Be careful not to bulk bowels up with too much fibre if your GI tract is really slow.
  • In people with Parkinson‘s, increasing your fibre intake may actually bulk up your poos and cause further constipation.
    • If advised by an accredited dietitian, choose a breakfast cereal high in fibre (e.g., All Bran, Weetbix).
    • Gradually add wholegrains into your diet (e.g. use wholegrain or wholemeal bread and wraps, swap to brown rice instead of white, instead of white flour choose flour high in fibre).
  • Aim to eat 5 serves of vegetables and 2 serves of fruit a day. Smoothies are a great way to sneak them all in.
  • Add nuts and seeds to your diet. Put them into salads, on your yogurt and cereal or have small handfuls as a snack.
  • Add lentils and other legumes. They can be a great addition to casseroles, bolognaise and soups.
  • Eat smaller meals throughout the day. This will allow more time for digestion.

Toilet tips

  • Develop good toileting habits. Going as soon as you get the urge is the most effective time to completely empty the bowel (e.g. most people get the urge first thing in the morning or following a meal when eating something has stimulated movement in the bowel).
  • Be aware of the correct sitting position on the toilet. Sit on the toilet, elbows on knees, lean forward and support your feet with a footstool. Relax and bulge out your tummy, relax the back passage and let go. Do not hold your breath.

Exercise tips

  • Getting moving will help you get moving… any physical activity is great for constipation.
  • A post-prandial walk (10 to 15 minutes of walking after a meal) can help get things started. Gentle movement increases abdominal contractions, helps food move through the digestive tract more efficiently, and can improve blood flow to the intestines, all contributing to easier passage of stool.
  • Exercise also plays an important role in the prevention and management of constipation. Aim to exercise more than 30 minutes per day and, if possible, vary the types of exercise you do.

Medication & constipation

When hydration, diet and exercise are not enough, laxatives may be recommended by your health professional. Laxatives are medicines that help you pass a bowel movement. They can make the bowel action softer and easier to expel, or they may increase the motility of the bowel. Remember that fibre may just keep bulking up the slowed bowel, making constipation worse, so only take as advised.

Laxatives are not regarded as the first step in the management of constipation, but they may be necessary if the steps outlined above have little or no effect. The ideal laxative for a person will depend on which of the factors is causing the problem. Talk to your Nurse, GP or neurologist before taking any laxatives.

The risks of poorly managed constipation

If constipation is not managed properly, it can lead to serious health issues:

  • Medication failure: A backed-up system slows down your stomach emptying (gastroparesis), meaning your Parkinson’s pills can get trapped and fail to reach the small intestine, where they are absorbed. This leads to your medication taking too long to work or not working at all.
  • Impaction: Stool can become so hard and large that it creates a solid blockage that may need to be removed manually by a healthcare professional.
  • Severe complications: Chronic straining can cause haemorrhoids, and in extreme cases, the blood supply to the bowel can be blocked, leading to a “bowel stroke” that requires surgery.
  • Quality of life: Poor gut health is linked to increased pain, depression, and feelings of confusion or delirium.

Your care

Remember, the management of constipation for people living with Parkinson‘s is a forever problem. A dietitian can help advise on the best foods to eat for your situation.

The first step to improving your bowel control is to have a full continence assessment carried out by a health professional.

If your constipation is severe or acute, help should be sought from your GP, a Continence Nurse, pelvic floor physiotherapist, or a Parkinson’s Nurse specialist.

For more information, contact the Continence Health Australia’s National Continence Helpline at 1800 33 00 66. Continence Health Australia is a peak body for awareness, education, and advocacy for those with continence and their carers. www.continence.org.au

For more information:
www.invisibledisabilities.com.au
www.bladderbowel.gov.au
www.toiletmap.gov.au

Always consult your GP, Continence or Parkinson’s nurse before starting a new treatment or if you have gone more than three days without a bowel movement.

Adapted from information sheet: https://www.parkinsons.org.au/information-hub/constipation/

Share

Other articles

  • CARE TEAM | Support groups for carers & people with YOPD

    Whether you are newly diagnosed, well-versed in Parkinson's, or a care partner, finding the right support group can make a significant difference. Social activities provide a valuable network, combat feelings of loneliness, and connect you to new information. Being diagnosed as young onset, poses its own challenges in finding people a group of people that look like you.

  • NDIS | Understanding Your NDIS Plan

    Your NDIS plan is built around your goals and support needs and funding is divided into Core, Capital and Capacity Building budgets. Core funding is generally the most flexible. Capacity Building funding can support your allied health therapies (e.g. AEP, APD, Speech Pathology, Physiotherapy, OT, podiatry, psychology, social worker). Plan management offers flexibility while reducing administrative burden, but you have the option of self-management.

  • RELATIONSHIPS | Intimacy, Sexuality & Dating

    Parkinson’s can affect intimacy, sexuality and relationships in physical, emotional and practical ways. Sexual difficulties are common, but they are not experienced by everyone. Many people continue to have satisfying intimate relationships after diagnosis. Communication is one of the most important factors in maintaining intimacy and connection. Intimacy involves more than sexual activity. Touch, affection, companionship, emotional connection and shared experiences all contribute to healthy relationships. Professional support is available if Parkinson’s affects your sexual wellbeing, confidence or relationship.