Both the literature and my clinical practice suggest that the incidence of constipation is high in patients with Parkinson’s disease, with roughly 67% of Parkinson’s patients experiencing constipation, even with many years. A significant proportion of these patients had constipation prior to the onset of Parkinson’s disease, manifested by a reduced number of bowel movements per week and a sense of incomplete evacuation, causing great pain to the patient. Constipation is a clinically common and complex symptom rather than a disease. It mainly refers to reduced frequency of bowel movements, reduced stool volume, dry stool, and straining to defecate. Symptomatic constipation is diagnosed when 2 or more of the above symptoms are present at the same time. Constipation is usually characterized by a decrease in the frequency of bowel movements, usually once every 2-3 days or more (or <3 times per week). Constipation is considered chronic if it has been present for more than 6 months. How does constipation occur in patients with Parkinson's disease? 1. Delayed colonic transport due to enteric nerve degeneration: associated with central and peripheral parasympathetic nucleus degeneration, which has been shown to exist in the vagus nucleus, medial lateral nucleus, interosseous plexus and submucosal plexus of the gastrointestinal tract. (including impaired nitric oxide-mediated downward inhibition, depletion of inhibitory neurotransmitters). 2, exit obstruction: constipation is more related to the effective transport of solids throughout the colon, so it is believed that there is a rare, independent "pelvic floor synergistic action disorder" in PD. 3, anti-Parkinsonian drugs: the greatest impact on gastrointestinal motility are anticholinergics and levodopa, especially anticholinergics, which have a clear constipating effect. However, some studies found no correlation between drug therapy, especially anticholinergics, and colon passage time, and the degree of constipation is not related to the application of anticholinergics, and whether levodopa causes constipation is controversial. What is the treatment for Parkinson's disease combined with constipation? The simplest non-pharmacological treatment is dietary modification, physical exercise and an active lifestyle. Early treatment is to increase the amount of liquid food and general enema therapy. Regular bowel movements, smoking and alcohol cessation, and drug abuse should be avoided. Avoid suppressing bowel movements when you have the urge to defecate. Long-term and repeated suppression of defecation may lead to a higher reflex threshold and loss of bowel movement, resulting in constipation. Promote a balanced diet, increase dietary fiber and drink more water. Moderate exercise, mainly medical gymnastics, can be combined with walking, jogging and self-massage of the abdomen. However, these measures are only effective for mild constipation and not for patients who have not had a bowel movement for more than 5
They are not effective for patients who have not had a bowel movement for more than 5 d. The drugs commonly used in China are lactulose, rhubarb soda, senna, phenolphthalein, cork, paraffin oil, etc. The drugs that have been proven to have better efficacy in the treatment of constipation internationally are lubiprostone (not yet available in China) and prilucapride succinate. The mechanism of action of Lubiprostone is to stimulate the secretion of chloride, which leads to the secretion of water and electrolytes; the mechanism of action of Prucalopride succinate is a selective gastrointestinal motility drug, which can promote the peristalsis of the intestine, especially the colon. Other gastrointestinal motility drugs include mosapride and itopride. The following measures can reduce the occurrence of constipation, such as: avoid eating too little or too fine food, lack of residues, and less stimulation of colonic motility. Avoid disturbance of bowel habits. Avoid the abuse of laxatives and the formation of dependence on certain laxatives that cause constipation. Appropriate physical and cultural activities, especially abdominal muscle exercise is conducive to the improvement of gastrointestinal function, more important for sedentary and less active and highly concentrated brain workers. Develop the habit of regular daily defecation, forming a conditioned reflex and establishing a good defecation pattern. When you have the intention to defecate in time, so as not to inhibit the intention to defecate and destroy the defecation habit. Drink at least 6 glasses of 250ml of water every day and develop the habit of having regular bowel movements, with the morning and after meals being the easiest times to have a bowel movement. Be cautious with the application of laxatives and do not use strong stimulation methods such as bowel cleansing.