Can Parkinson’s Cause Stomach Problems

Increased Feelings Of Anxiety Or Depression

Anxiety and depression have been linked to Parkinsons. In addition to movement problems, the disease can also have an impact on your mental health. Its possible that changes in your emotional well-being can be a sign of changing physical health as well.

If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk to your doctor.

Causes Of Constipation In Parkinsons Disease

The ways in which Parkinsons disease can increase the risk of constipation include:

• lack of dopamine in the brain impairs control of muscle movement throughout the body. Bowel muscles can become slow and rigid
• uncoordinated bowel motions the bowel muscles may be weak and unable to contract, or they may clench instead of relaxing when trying to pass a motion
• eating problems dietary fibre containing insoluble fibre adds bulk to your bowel motions and can help prevent constipation. However, if a person with Parkinsons disease finds it difficult to chew or swallow, they may avoid eating fibrous foods
• drinking problems you need water to plump up the dietary fibre in your bowel motions. Swallowing difficulties may discourage a person with Parkinsons disease from drinking enough fluids
• sedentary lifestyle lack of exercise slows the passage of food through your intestines. Parkinsons disease reduces muscle control, so lack of exercise is common
• medications many different medications can cause constipation. Medications used in the treatment of Parkinsons disease may slow bowel movements or cause a decrease in appetite.

Skin Cancer And Parkinsons Disease

Melanoma is a type of skin cancer consistently linked to PD. People who have had melanoma are at an increased risk for PD and people who have PD are at an increased risk of melanoma. Epidemiological studies have shown an increased risk of non-melanoma skin cancers in PD patients as well. Always be sure to talk to your doctor about any skin concerns.

Tips and Takeaways

• Non-motor symptoms such as sweating dysregulation and seborrheic dermatitis can be symptoms of PD
• Seborrheic dermatitis can usually be treated with lifestyle changes and over-the-counter creams. Sometimes prescription-strength creams are necessary
• Although many treatments have been developed for excessive sweating, they have not been tested specifically in people with PD. Discuss with your doctor to find out if any are a possibility for you.
• There is a link between PD and melanoma which you can read about in a prior blog.
• If any symptom is causing you discomfort or interfering with the quality of your daily life, be sure to discuss it with your doctor as it may be something that can be improved with treatment or modifications.

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Dr. Rebecca Gilbert

APDA Chief Scientific Officer

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Why Worry About Weight Loss Associated With Pd

Weight loss has been linked to a poorer quality of life and more rapid progression of PD. The reasons for this are two-fold. On the one hand, as outlined in the list above, weight loss can be a hallmark of advancing disease as it could be a consequence of more swallowing difficulties, worsened mobility, more impaired gut function etc.

On the other hand, having weight loss can further lead to poorer health. Inadequate food intake can contribute to malnutrition and vitamin deficiencies. Malnutrition can subsequently be the cause of increased susceptibility to infection, increased fatigue and increased frailty. The situation can spiral with more fatigue and frailty causing a further decrease in activity and function.

Osteoporosis, or porous and fragile bones, is more common in under-weight people since bone structure is dependent on weight-bearing. Since osteoporotic bones are more prone to fracture during a fall, this too can be a contributor to more disability and frailty. Bottom line is that it is important for your health to maintain a healthy weight.

Dietary Fibre For Constipation In Parkinsons Disease

Be guided by your doctor, but general suggestions include:

• Choose easy-to-eat fibrous foods such as soft fruits. Consider mashing or pureeing fruits to make them easier to eat. Make sure to include the skin, where most of the fibre is found.
• Eat at least two pieces of fruit and five serves of vegetables every day.
• Eat homemade vegetable soups.
• Sprinkle a tablespoon of bran, psyllium husks or chia seeds on your breakfast cereal or add the bran to baked products such as cakes. However, avoid bran if you have swallowing problems.
• Fibre supplements may be helpful, but you must drink enough fluids for these to work properly. Avoid fibre supplements if you have problems swallowing.
• Dont increase dietary fibre too quickly or youll risk bloating and abdominal cramps. If discomfort occurs, cut back your fibre intake, increase your fluid intake, apply a hot water bottle to your abdomen and see your doctor.

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Gastrointestinal Issues In Advanced Parkinsons Disease

Problems with motility of the gut can be a major source of difficulty throughout the disease course and can be particularly problematic in advanced PD as well. . Constipation, which can be one of the earliest symptoms of PD is a very common problem throughout the disease course. Two gut issues that tend to be particularly problematic in people with advanced PD are abdominal pain and fecal incontinence.

Medication Not Working The Way It Used To

In the early stages, taking medicine works well to get rid of symptoms. But as Parkinsons progresses, your medication works for shorter periods of time, and symptoms return more easily. Your doctor will need to change your prescription.

Dr. Valerie Rundle-Gonzalez, a Texas-based neurologist, says to pay attention to how long your medicine takes to kick in and when it stops working. She says you should feel like symptoms significantly improve or are almost gone while on medication.

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Breathing & Respiratory Difficulties

Some people with Parkinsons disease may experience shortness of breath. There is no clear cause underlying respiratory dysfunction in PD, its frequency or the effect that medications have on respiration. Several reasons for shortness of breath in PD include:

• Wearing off is a common experience among people with PD who have been taking levodopa for several years. These occur when the medication benefit wears off and PD symptoms return before the next dose.
• Respiratory dyskinesia refers to an occurrence of irregular and rapid breathing when levodopa medications reach their peak effect. These may accompanied by involuntary body movements, typically experienced as dyskinesia.
• Anxiety is a common symptom of PD that may also exacerbate shortness of breath, whether by itself or as a consequence of wearing off of the medication.
• Aspirationpneumonia is a pneumonia that develops after food or liquid goes down the wrong pipe. Advanced PD can increase the risk of swallowing difficulties, choking and aspiration pneumonia.
• Non-PD health issues include conditions such as asthma, allergies, lung disease, heart disease and other conditions that may cause shortness of breath.

Localization Of Pathological Forms Of

Since Qualman et al. published the presence of LBs in the esophagus in 1 PD patient and 1 PD patient in the colon in 1984, an increasing number of post-mortem and in vivo studies have focused on finding or developing a suitable method for reliable detection of neuropathological changes in peripheral organs that would be suitable for taking biopsies. Pathologically aggregated S in GIT has been identified to date in biopsies of PD patients from different parts of GIT . However, the number of studies provided, the size of the individual groups used in these studies and controversy in obtained results does not make it possible to clearly determine the primary initiation site of the disease pathology onset within GIT and where or to which organs the pathology subsequently spreads .

Table 1. Summary of studies focused on the presence of pathological forms of S in various peripheral tissues.

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Salivary Glands And Pharynx

Salivary glands as a tissue with a relatively high number of S aggregates have been studied in autopsies as well as in biopsies of PD patients . The presence of S inclusions in minor salivary glands biopsies was confirmed in all PD patients, whereas control biopsies did not show this pathology .

A needle core biopsy of the submandibular gland of PD revealed the presence of LBs was confirmed in 75% of cases but the study did not include control patients or patients with another type of neurodegenerative disease. However, due to minimal invasiveness, the possibility of using only local anesthesia, and the overall simplicity and reproducibility, this method presents a suitable method for monitoring Lewy body pathology in patients with PD .

The Gastrointestinal Effects Of Parkinson’s Disease

Surveys show that between 20% and 40% of people with Parkinson’s disease suffer from serious constipation . Larger numbers of people with PD have related gastrointestinal issues such as bloating, a feeling of fullness and nausea. As the disease progresses, all of these GI problems become more common. In rare cases, serious complicationssuch as megacolon and perforation or tearing of the colonmay arise from these GI problems.

The connection between the two may seem odd on the surface, but research shines some light on these unpleasant consequences of the disease.

A large survey of healthy people who were followed over several years revealed that men who reported having less than one bowel movement daily had a 2 to 7 times higher risk of developing PD than that of men who had daily bowel movements their risk was four times higher than that of men who had two or more bowel movements a day.

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Constipation And Digestive Issues

As Parkinsons disease progresses, your digestive tract will slow down and function less efficiently. This lack of movement may lead to increased bowel irritability and constipation.

In addition, certain medications often prescribed for Parkinsons disease, such as anticholinergics, can cause constipation. Eating a balanced diet with plenty of vegetables, fruits, and whole grains is a good first step remedy.

Fresh produce and whole grains also contain a great deal of fiber, which can help prevent constipation. Fiber supplements and powders are also an option for those with Parkinsons.

Be sure to ask your doctor how to gradually add fiber powder to your diet. This will ensure you dont have too much too quickly and make constipation worse.

A New Toilet Or An Alternative

If you have real difficulties getting to the toilet, it may be possible to get a grant to build a new one, perhaps downstairs. An occupational therapist can advise you on this.

Not all homes are suitable for building new toilets, so a commode might be needed. A commode is a moveable toilet that doesnt use running water. It looks like a chair, with a container underneath that can be removed and cleaned after someone has used it. They can be very discreet.

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Peripheral Neuropathy And Parkinsons Disease

A number of studies have tried to determine if PN is more common among people with PD as opposed to people without PD. PN is a relatively common condition in the general population, which makes it difficult to ascertain whether or not it is even more common among people with PD.

The available studies have varying results and are difficult to compare with each other as they:

• Include different types of populations of people with PD
• Assess peripheral neuropathy differently
• Assess for causes of peripheral neuropathy differently

A recent review looked at all the available data and determined that large fiber neuropathy was present in 16% of patients with PD, about double the prevalence of this condition in the general population. Skin biopsy-proven small fiber neuropathy was present in over 50% of people with PD, although this result was based on a small sample of patients.

Urinary Difficulties In Parkinsons Disease

The most common urinary difficulty experienced by people with PD is a frequent and urgent need to urinate. Urinary incontinence, the involuntary loss of urine, is also a symptom of PD. This may occur even when the bladder is not full. Recent research studies estimate approximately 27-39% of people with PD experience urinary difficulties, although urinary incontinence only develops in about 15% of those with PD. Bladder issues usually develop in the later stages of PD.2

There are several medications that can help manage urinary difficulties, such as tolterodine, oxybutynin, darifenacin, and solifenacin. These medications work to block or reduce overactivity in the bladder. However, these medications may make the symptoms of PD worse. It is recommended to discuss these treatments with a movement disorders specialist who has been trained to understand the effects of various medications on the disease.2

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What Causes Constipation In People With Parkinson’s Disease

In some people with Parkinson’s disease, constipation may occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity. If this system is not working properly, the intestinal tract may operate slowly, causing constipation.

Also, medications used to treat Parkinson’s disease can cause constipation.

Background: The Stomach Parkinson’s And Levodopa

Levodopa is not absorbed from the stomach, but the stomach plays an important role in controlling how levodopa reaches the parts of the small intestine where it is absorbed. Some medicines, including dopamine agonists and anticholinergics, can also delay gastric emptying, as can severe stomach acidity, although over-treatment of this problem can also prevent the break-down of levodopa tablets, leading to incomplete absorption.

Unfortunately, gastric emptying can be delayed by Parkinsons itself or by constipation caused by the colon-gastric reflex. Levodopa tablets may remain in the stomach for a long time, leading to delayed absorption in the small intestine and a delayed response to the treatment.

An enzyme called dopa-decarboxylase that is present in the stomach lining can convert levodopa trapped in the stomach into dopamine, making it unavailable to the central nervous system. Also, dopamine formed in the stomach may stimulate gastric dopamine receptors, leading to stomach relaxation and reduced gastric motility, and this can worsen the problem.

Liquid levodopa may improve motor fluctuations by ensuring better absorption than standard preparations, especially when taken after meals. Subcutaneous infusion of the dopamine agonist apomorphine is effective in controlling motor fluctuations by bypassing the gastrointestinal tract.

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What Examinations May I Need To Have

Your GP or specialist will probably ask a series of questions to find out what the problem is. These may include:

• When did the trouble start?
• How often does it happen?
• Can you feel when your bladder or bowel is full?
• Are you having difficulty emptying your bladder or bowel?
• How often are you using the toilet?

Parkinson’s symptoms, such as slowness of movement and rigid muscles, affect the muscles in the bowel wall. This can make it harder to push stools out of the body. You may be asked to keep a chart for several days of how often you use the toilet and how much you drink.

You may also be asked for a urine sample to test for infection and they will normally carry out a physical examination.

Bladder or bowel problems can be complex in Parkinson’s, so sometimes specialist tests or X-rays may be needed. All of these can usually be done in an outpatient department or clinic.

Changes In Sleeping Patterns

As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.

Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.

REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.

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Schedule A Parkinson’s Gi Motility Clinic Appointment

This specialized clinic sees patients with gastrointestinal complications of Parkisnon’s disease. They will also discuss motility testing and refer you for the appropriate study if necessary. Call the clinic at .

At a newly opened clinic within the integrated UCLA Health system for treating the GI symptoms of patients with Parkinsons disease, two clinician-scientist members of the UCLA Vatche & Tamar Manoukian Division of Digestive Diseases faculty are gleaning important clues about the early manifestations of the neurodegenerative disease at the same time that they are applying their expertise as gastroenterologists to improve patients quality of life.

It is well established that gastrointestinal motor function can be negatively altered by Parkinsons disease, and an emerging body of research indicates that the disease may start in the gastrointestinal tract before later spreading to the brain. But the GI tracts role in the pathogenesis of Parkinsons disease, and the mechanisms by which Parkinsons disease alters gastrointestinal motor function, are not yet fully described.

In the lab, Dr. El-Nachef is working with Dr. Bronstein to study the involvement of the intestinal nervous system in a zebrafish model of Parkinsons disease. One of our goals in this research is to assess whether we see a loss of neurons in the intestine, what the timing of that is, and how it tracks with the development of motor symptoms in this model, Dr. El-Nachef says.