Constipation Managment

parkinson disease constipation
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Constipation ( or Reduced bowel movements) is one of the common features of Parkinson’s disease and many neurodegnerative disorders.   Constipation means difficulty in passing stools or reduced number of bowel movements or both.  It is characterized by

  1. Reduced number of bowel (stools) movements or “Lavatory” (usually less than 1-2 times in a week)
  2. Stools that are hard and difficult to pass
  3. Incomplete evacuation of stools
  4. Bloating sensation in abdomen
  5. Pain while passing stools


Bowel movements are affected by various daily activities including eating, drinking and exercise. Constipation may also be caused by hormonal, neurological or anatomical factors, such as impaired muscle relaxation, or it may be a side effect of medication.

Constipation is primarily a nuisance and is unlikely to cause serious problems in majority. Sever constipation may lead to sense of unwell, nauseous or lethargic, and it can make older people confused and restless.

Some of the following measures will help to improve the constipation features in most of the Parkinson’s disease and Parkinsonism syndromes patients.

Management of Constipation

Drink lot of fluids

  1. Drink around 3 liters of fluid everyday, including water, tea, coffee, mild, juice, sambar, rasam etc.  Drinking plenty of fluids, which will help the digestion of fibres.
  2. Avoid carbonated drinks (Pepsi, coke, etc) may cause bloating.
  3. Have Warm drink, as soon as you get up in the morning.  Will help to improve the bowel movement

Fiber rich diet

  1. Eat foods which create more bulk (like whole grains, vegetables, fruits)
  2. Avoid low fiber starchy food (like bread..)
  3. Prune and dried fruits are great, as they are natural laxatives


  1. Exercises will help in reliving / preventing Constipation.  Work out daily morning
  2. Stress of pelvic muscles exercises (walking, stretching hips, etc)
  3. A scheduled daily exercises in the early morning will help to improve the constipation

Other simple suggestions

  1. Have bowel schedule – that is daily at a fixed time, go and sit on the “Potty job” whether you have sensations or not.
  2. Simple exercises and drinking fluids before the “Potty job” will help
  3. Use a comfortable / relaxed position (if required, use a small stool to support your foot on the western style lavatories)
  4. Reduce stressors
  5. Finally if nothing works, speak to your doctor for laxatives (next step)
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Medications / Laxatives

If non medication methods does not work, then laxatives would be prescribed by your doctor.   There are different types of laxatives which either work as bulk forming agent or as stimulant for bowel movement.  Your doctor would be in best position to suggest, which suits you the most.

Point of caution :

Overuse of laxatives, may cause dependence on them. Some of the laxatives are high in sugar, and may not suit diabetic patients.  Some laxatives have magensium and pottasium, which will not be suitable for kidney dysfunction patients, and some have high sodium levels affecting blood pressure.  Speak to your treating doctor before taking any laxatives.

Simple Daily Schedule to Reduce Constipation

1. Maintain a standard schedule for every day

2. Start the day ACTIVE. Do some Aerobic (walking/ running / dancing) activities and some stretching activities with special interest into the lower back and pelvic muscles exercises

3. Have a glass of warm drink or coffee in before going for ‘Potty’

4. Make a fixed schedule and time everyday to go to ‘Potty’ (e.g: Daily morning at 7am or Late afternoon, based upon your convenience) However, if there is an urge during any time of the day, don’t postpone the bowel movement

5. Have good hydration (around 3 liters of fluid), whole through out the day

6. Have a sufficient fibers and whole grain food in meals

Step -1
  • Modify your diet by increasing fibers and whole grains (Rice, Oat, Ragi, Wheat)

  • Use Soft cooked food

  • Have more raw vegetables / fruits

  • Increase Liquids, as much as you can



Step -2

If Step-1 fails, then start using stool bulking agents like

1. Ispaghul husk

2. Natural Bran

(Both Step-1 and Step-2 can be continued indefinitely to maintain good bowel movements)


Step -3

If Step-2 fails, then start trying Colonic / Rectal stimulants

1. Sennosides : 12 to 24 mg at bedtime

2. Bisacodyl : 10mg at bed time

3. Cascara : 5ml at bed time

4. Senakot tabs

(Step-3 onward, should not be used on daily basis)



Step -4

If Step-3 fails, then

1. Lactulose 10- 20 ml twice daily

2. Glycerine suppository

(Step-3 onward, should not be used on daily basis)




Step -5

If Step-4 fails, then ENEMA under supervision of trained health care provider / Physician.

(Step-3 onward, should not be used on daily basis)





Pelvic Floor Exercises

Pelvic Floor Exercises

Pelvic Floor Exercises