Although this article concerns constipation and Parkinson's disease it contains information that can be used for those with progressive supranuclear palsy especially since many have been given or are being given anticholinergic prescription or over-the-counter drugs including drugs normally given to treat Parkinson's disease.
Constipation is defined as having fewer than 3 bowel movements per week. There are two main reasons for the frequency of constipation in Parkinson Disease: Drugs used to treat Parkinson Disease (anticholinergics such as Artane, amantadine, selegiline, dopamine agonists, and levodopa) can aggravate constipation. Anticholinergics and amantadine (Symmetrel) especially slow peristalsis - the contractions of the gut that moves food through the stomach, intestines, and colon.
Parkinson disease may result in a loss of the Autonomic Nerves to the gut. It is these nerves that regulate peristalsis.
Other possible reasons for constipation include a craving for sweets, not enough fiber, and not enough fluids. In addition lack of activity and not enough exercise contribute to constipation.
At first, constipation may seem more of a nuisance than a real concern. However, a person who is frequently constipated, over a long period of time, may experience fecal impaction, also known as bowel impaction - a condition where dry, hard feces accumulate in the colon and cannot be passed. Sometimes watery feces may pass around the impaction, as diarrhea, leading the person to believe they are not constipated. Bowel impaction can be very painful and may require hospitalization.
It's important to get enough fiber and fluids each day. Besides helping to prevent constipation, fiber can lower cholesterol, help prevent many chronic diseases, and often help people with diabetes control their blood sugar. Fluids work hand-in-hand with fiber to keep the stool bulky.
Fiber, along with water, keeps the bowel working smoothly. Insoluble fibers works like a partner with water. Each bit of fiber soaks up water like a little sponge and swells up to many times its size. All these little water-soaked sponges add bulk to the stool, making it soft and easy to pass. They also exercise the muscles of the intestine, so they stay strong and healthy. More frequent bowel movements are often the result. This not only helps prevent constipation, it can also prevent or ease hemorrhoids. These occur when we strain to pass the stool. There's also good evidence that fiber can lower the risk of colon and rectal cancers.
Many people prefer laxatives, which are powerful, but work in a different way. Laxatives stimulate the nerve endings of the colon, causing rapid removal of bowel contents. Over time, stimulant laxatives harm the lining of the colon, causing even greater difficulty with constipation.
Fiber is found only in plant foods. Foods highest in insoluble fiber are whole grains, cooked dried beans, and fruits and vegetables with edible skins. Wheat bran is an excellent source of insoluble fiber. 20 - 25 grams of fiber daily is a minimum recommendation. If you're not used to eating whole-grain foods, or apples and potatoes with the skin, it's best to increase the fiber content gradually. Bloating and gas can occur as the system tries to get used to the unusual load of fiber.
Fluids are just as important as fiber. Without fluid, fiber particles remain dry and harden, actually making constipation worse. 4 - 8 glasses of water per day, plus juices, milk and other beverages are necessary.
Diet should be your first treatment for constipation. However, sometimes peristalsis (muscle action in the intestine) is slowed enough in Parkinson disease that other therapies may be indicated. If you get plenty of fiber and fluids, yet have fewer than 3 bowel movements per week, it may be necessary to take further steps.
One remedy is a prune juice cocktail. Mix 1/2 cup applesauce, 2 tablespoons of miller's bran, 4-6 oz. prune juice. Store in refrigerator. Take a tablespoonful per day at first, gradually increasing until you find the amount that works best. Most people find this mixture tasty.
Ask your doctor about a fiber supplement such as Metamucil or Citrucel. These can be stirred into liquids or foods such as applesauce, cereal, etc. They're carried in most drug and grocery stores.
Manual abdominal massage from the bottom of the rib cage to the top of the pubic bone, performed 2-3 times daily, sends mechanical signals to the bowel to "keep things moving."
Be aware that the natural position for moving the bowel is squatting. Raised toilet seats may aid sitting down and standing up, but are not ideal for bowel function. Try hiking your feet up on a small bench while sitting on the toilet.
Ask your doctor about an over-the-counter stool softener such as Colace. If bowel motility is good but stool is dry and hard to pass, doctors may advise occasional use of infant-sized glycerin suppositories to soften stool in the rectum and reduce straining.
If you've tried these treatments and still have a problem with constipation, consult your doctor to see if prescription medications or referral to a specialist is indicated.
The following is a formula that has been used by many patients. There are variants on the formula the most commonly used one is as follows:
ANTI-CONSTIPATION FRUIT PASTE
Take a 4 ounces package of Senna Tea.
Senna Tea is a traditional medicinal called SMOOTH MOVE
Put the Senna tea in 3 cups of boiling water.
Steep for 5 min.
Add the Senna tea to a large pot.
Next, add 1 pound pitted prunes, 1 pound raisins, 1 pound
figs.
Boil tea and fruit for 5 minutes.
Remove from heat and let cool.
Add 1 cup of lemon juice.
Use a blender to mix to a smooth paste. Place in glass
container. Store in freezer. Paste will not freeze but will keep
for a long time. Use 1 or 2 Tablespoons daily. This can be done
several ways including Spread on toast or cereal.