What's normal? For some people 3 bowel movements a day can be normal - for others 1-2 times a week is normal but probably not a good thing because anything over 3 days allows for water to be absorbed followed by hardening of the stool. This hardening makes it even more difficult to pass the fecal matter. Medically 3X a week is necessary for the alimentary journey.
Hard stools can result in an anal fissure which is a painful tear which may be apparent by the blood on the toilet paper. When this happens regularly the spasms during defecation can push the hard stools against the wound and prevent healing. At this point you probably need to consult your doctor about how to handle the pain, the tear and softening of the stool.
It may be too late to remind you but men who have constipation are 3 times more likely to develop PD. Although this is no secret as it has been observed for almost 200 years, the Hawaii study confirmed it.
So why does constipation become an issue in Parkinson's disease which is often considered a motion disorder when the skeletal muscles just can't get the right messages? We know that skeletal muscle is under conscious control but smooth muscle is not under voluntary control nor is cardiac muscle. If the nervous system is not working properly, both smooth and skeletal muscles have difficulty in functioning as designed. Gastrointestinal (GI) dysfunction is the most common "non-motor" symptom of Parkinson's disease and the results of one small familial study indicated that it occured in about 60% of patients.
Add to that problem the fact that PD meds can also impact - quite literally - the GI tract creating that unpleasant situation of gas, bloating, nausea and general feeling of discomfort. Medications including antacids with calcium or aluminum and especially narcotic pain meds can contribute to or cause constipation problems.
There are medications such as Miralax; Zelnorm (Tegaserod); Metamucil or psyllium, a bulk-forming fiber laxative meant to be used occasionally. Others take Domperidone, a peripheral dopamine antagonist which does not cross the blood brain barrier and appears to be effective for the upper GI tract.
When you talk to your doctor, be proactive. Constipation is another Parkinson's symptom, this time of the autonomic nervous system. You need a healthy plan of action to maintain quality of life and your doctor shouldn't just dismiss it as if it were a muted commercial on TV. You and doctor must distinguish between Acute and Chronic Constipation. Prolonged constipation in a Parkinson's patient is a serious condition; Medical personel should treat it seriously.
We'll talk about GERD, IBS, Celiac's and PD another day.
Resources and Additional Reading:
Antidepressants such as amitriptyline (Elavil) and imipramine (Tofranil)
Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)