Parkinson's: unclogging the pipes

 

Snarky Parky & me

A Journey Into Parkinson's with Nancy Mellon

Coordinated by Corrine Bayraktaroglu

 
Poop Fairy by Corrine

 Poop #2

I know I wrote about it before (hence poop #2) but, the other day Kent sent me some interesting information about how to combat constipation.  You might think, it is kind of strange for a friend to send an email about poop. But Kent is in my PD Dance class and he suggested I might want to do a blog post about it. 

And I Do! The graphic is worth the post by itself! Yep it included a drawn poop scale. Are you curious now?

And that was just the first e mail. The second email included a you tube video for a  product called a Squatty Potty. How about now? Are you a little curious now?

What Kent sent were 2 newsletters, sent out by Kimberly Berg -she teaches boxing classes for people with Parkinson's. She call's it the Rebel Fit Club. She also has online boxing classes you can take. If you are interested you can check it out at rebelfitclub.

The first newsletter talked about the problem. The second one  was the 'here's what to do' one.

The important point to start with is that “Constipation is present in more than 80% of people with PD.”  The following is in red if you want to skip it,  it is why people who have Parkinson's might get constipated and also a list of  the normal reasons for constipation.

“Constipation may occur due to the improper functioning of the automatic nervous system which is responsible for regulating smooth muscle activity. By not working properly, the intestinal tract operates slower, causing constipation. Medications used to treat PD (levopoda, dopamine agonists, selegeline, amantadine, anticholinergics, and others) can also cause constipation” (What I take for sleep and anxiety, Mirtazapine, can also have constipation as a side affect.)

The normal reasons for constipation may also be part of the problem-

•                Not drinking enough water.

•                A diet low in fiber

•                Lack of exercise

•                Travel or another change in routine

•                Eating large amounts of dairy products

•                Stress

•                Resisting the urge to have a bowel movement

•                Antacid medicines containing calcium or aluminum

•                Other medicines (especially strong pain medicines such as
opioids, antidepressants, and iron pills)

 OK now comes the interesting part:

“A hospital in Bristol, England developed a visual guide for stools. It is called the Bristol Stool Form Scale or BSF scale. It helps people distinguish normal stools from abnormal without getting embarrassed over personal details.“

TaDa!  The Visual! 

Unless your stools are type 4 to 6 (normal), they are impacted. Impacted stools can be small, large, hard, soft, dry, moist—it doesn‘t matter.

“Impacted” means is that they had a chance to pile up and compress in the large intestine.

» Type 1: Separate hard lumps, like nuts
The lumps are hard and scratchy and painful to pass. There is a high likelihood of bleeding from mechanical laceration of the anal canal.

» Type 2: Sausage-like but lumpy
Type 1 stools are lumped together into a single mass and. Typical constipation. This type is the most destructive by far because its size is bound to cause extreme straining during elimination, and most likely to cause hemorrhoids, or diverticulosis. These stools are in the colon for at least several weeks instead of the normal 72 hours.

» Type 3: Like a sausage but with cracks in the surface
This form is like Type 2, but transit time is faster, between one and two weeks. Typical for latent constipation.

» Type 4: Like a sausage or snake, smooth and soft
This form is normal for someone pooping once daily.

» Type 5: Soft blobs with clear-cut edges
Ideal. It is typical for a person who has stools twice or three times daily, after major meals.

» Type 6: Fluffy pieces with ragged edges, a mushy stool
Loose, it may be difficult to control the urge.

» Type 7: Watery, no solid pieces
This, of course, is diarrhea.​

How to interpret BSF scale
Types 1, 2 and 3 = hard or impacted stools. Type 4 and 5 = normal or optimal.
Type 6 = loose stool and type 7 = diarrhea.

 On to the HERE”S WHAT YOU DO part 2 – Information  from Kimberly Berg:

She starts out with:  Prevention is the key!

The first part is stuff I already know and probably you do too, so if you want to skip it, it's in red.

•                Eat plenty of fiber. The usual line up is suggested: fruits, vegetables, legumes, and whole grain bread and bran cereal.

•                Drink 1½ to 2 quarts of water and other fluids a day. (Milk causes constipation in some people.)

•                Keep moving, get  daily VIGOROUS exercise

•                When you feel the urge go to the bathroom

•                I hadn't heard this- don't use Metamucil or other forms of psyllium- (this tends to make constipation worse in Parkinson disease.)

 

If you are having trouble already she suggests:

•                Drink two to four EXTRA glasses of water a day. Very important! (Very hard for me to do!)

•                Try warm liquids, especially in the morning.

•                Eating warm oatmeal with a cup of coffee in the morning.

•                Add fruits and vegetables with the skins to your diet.

•                Foods to include in your diet: almonds, apricots (dried), avocados, chicory, coconut, dates, endive, figs, flaxseed, grapes, mangos, olives, papayas, parsley, persimmons, pineapple, prunes, rhubarb, soybeans, turnips, walnuts, or watercress.

•                There are Senna “Smooth Move” teas you can buy, but don’t overdo these. They can cause cramping and may interfere with some cardiac meds.

•                Time It Right. (I don't think this is possible! But maybe?) If possible, try to time bowel movements during “on” periods when Parkinson’s medications are working. During these periods, there may be improved function and relaxation of the sphincter​ muscles, which can aid bowel movements.

•                And the always popular -Eat prunes and/or bran cereal.

 

Kimberly Berg offers a simple home remedy – She calls it the

Keep It Moving Colon Cocktail

Ingredients:

•                1/2 cup bran

•                1/2 cup prune juice

•                1/2 cup applesauce

Directions:
Mix together and refrigerate. Take 1 or 2 tablespoonfuls each evening. If needed, you may increase dose by 1 tablespoon each week. The first few weeks she warns, you may have extra gas, but will usually adjust after one month. You can also add some extra stewed prunes daily.

Fiber, along with water, keeps our bowels working smoothly. Fiber soaks up water, which makes the stool soft and easy to pass. It also exercises the muscles of the intestine, so they stay strong and healthy.

 

If fiber and fluids don't help, she has some other interesting tips:

Manual “belly 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.”

 

Get a Squatty Potty! (OK, I admit I have one. Though mostly it has become a step stool for the toilet for the little girls. But it is kind of cool and very easy to use and not expensive to buy.   You still sit on your toilet, but you can now put your feet up on the 'squatty potty,' so basically you are in a comfortable squat. When not in use,  it's shaped so it pretty much can slide under your toilet bowl. The ad for it on you tube is sure to become a legend in the field of  potty humor.) This is what  Kimberly says about it “The natural position for pooping is SQUATTING. I can not recommend this enough: A must have for EVERYONE!!!! (Kimberly gives it 4 exclamation marks! WOW!!!!!!)

Raised toilet seats may aid in getting up and down on the toilet, but are NOT ideal for bowel function. The Squatty Potty is highly recommended by clinicians.”

 

She ends her newsletter with:

Most physicians recommend diet and exercise should be your first treatment for constipation. However, sometimes peristalsis (muscle action in the large intestine) is slowed enough in Parkinson’s disease that other therapies may be indicated. If you get plenty of exercise, fiber and fluids, yet still have fewer than three bowel movements per week, it may be necessary to take further steps. Ask your doctor about a fiber supplement that can be stirred into liquids, and are found in most grocery stores. They may also need to prescribe medication.

And I am ending this very long post with; I still use the product ”Calm” every day. It is a magnesium supplement and works for me.

Cheers,

Nancy & the Snark

Footnotes or Endnotes from Corrine

HAH! Your post couldn't be more timely lol! I just had my 10 year colonscopy and have trouble with this issue due to having a rather lazy colon.  I follow a lot of the healthy steps outlined but I have to be careful not to eat brans, oatmeal etc. except in extreme moderation. My gastro doc suggested I use Miralax daily as opposed to other methods that involve stimulants.