The Scoop on Poop and Parkinson’s (Part 1 of 2)

This is one of my favorite talks to give because people always shy away from it, but it is so important so I ask you… “How often do you poop?” Many people with Parkinson’s disease can’t poop every day resulting in constipation. Constipation is going longer than three days without a bowel movement causing the stool to harden and become more difficult to pass.

Constipation is present in more than 80% of people with PD and may before symptoms like tremor and stiffness even start.

So what’s the scoop on poop and Parkinson’s?

With Parkinson’s disease, 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, by affecting peristalsis (gut movement). Other causes of constipation include:

• 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)

So what if I don’t poop everyday?

By not having a bowel movement every day, your pills don’t get delivered to the part of the bowels where they can be absorbed making them less effective. You will feel bloated, uncomfortable and less likely to want to move around. A person who is frequently constipated, over time, may develop hemorrhoids, a condition in which part of the tissues lining the anus slip outside, becoming enlarged and painful.

Another concern is the possibility of bowel impaction, also known as fecal impaction — a condition where dry, hard feces accumulate in the colon and cannot be passed. Sometimes watery feces may pass around the impaction, as diarrhea, leading the person to believe they are not constipated. Bowel impaction can be very painful, and may require hospitalization. In extreme cases, surgery may be necessary.

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.

Look at the picture, what does your poop look like?
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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.

Stay tuned for part 2 of The Scoop on Poop and Parkinson’s to find out what you can do to prevent and treat constipation.