constipation, nonmotor symptom, Parkinson disease



  1. Noll, Lynda Marie NP-C, CHPN


Constipation management in Parkinson disease can be challenging. Physiologically, there is a slowed colonic transit time, hypokinesia of abdominal muscular due to rigidity, and central pathology as well as a functional outlet obstruction. This is because of paradoxical external anal sphincter contraction when there should be relaxation for defecation. The paradoxical contraction is likened to a focal dystonia similar to other dystonias occurring in the rest of the body. A recent study showed the effect of decreasing anal dystonia with added levadopa in de novo patients. However, more studies are needed to replicate the effect. Often, the treatment for chronic constipation is based on provider and patient experience, with more studies needed in this area as well. Complicating factors include patient age, polypharmacy, multiple comorbids, dietary factors, and limited mobility.