Parkinson’s is commonly known for motor symptoms caused by the disease, such as tremors and rigidity. Those living with Parkinson’s, however, know that the disease is much more than that, and the challenges caused by their non-motor symptoms significantly affect their quality of life — such as gastrointestinal (GI) issues.

In this article, we’ll discuss gut health and Parkinson’s disease (PD) to help you better understand and deal with your gut issues.

Common Gut Health Issues

The GI issues linked to Parkinson’s have gone largely under the radar, with more studies focused on topics like dopamine and its potential for treatment. Now, however, there is a renewed interest in studying the relationship between gut health and Parkinson’s disease due to its significant impact in people’s lives.

Lewy bodies appear in the intestinal nerve cells of people with PD. Those living with PD have fewer nerve cells in their intestine, disrupting the complex enteric nervous system and hindering it from functioning as normal. Common GI issues that result from this, as noted by Dr. Wael El-Nachef, are:

• Constipation (including diarrhea and fecal urgency/soiling/incontinence)
• Bloating
• Weight loss and malnutrition
• Poor absorption of medications (particularly carbidopa-levodopa)
• Heartburn/reflux
• Difficulty swallowing

Constipation

Constipation is the most common non-motor symptom of PD, being present in up to 80% of people with PD. It can be caused by two issues:

1. Slow transit: Stool moves too slowly through the GI tract.
2. Anorectal dysfunction: Muscles in your anal and rectal area, which regulate the passage of your stool, aren’t functioning properly.

Typically both of these issues are present.

If you experienced extreme constipation that suddenly turned into diarrhea, you may be experiencing slow transit, resulting in constipation with overflow diarrhea. This means that your intestines have become backed up with stool, so only soft, watery stools can leak through the mass.

To resolve constipation with overflow diarrhea, don’t take anti-diarrheal medications unless you’re at severe risk for dehydration and under the advice of your doctor. These medications, such as Imodium (loperamide), will slow your GI tract down further and may even cause it to shut down entirely.

You can usually clear the stool with a bowel cleanse or two, similar to what you would take before a colonoscopy. In some cases, it can require manual disimpaction or prescription-strength laxatives.

If you’re experiencing constipation that feels like you’re straining and “pushing against a closed door” just to get stool out, you may be experiencing dyssynergic defecation. In this case, the muscles around your rectum aren’t allowing stool to pass freely. Biofeedback therapy — which involves using special machines and sensors to help you identify and control muscle activity in your pelvic floor — is typically effective.

Other typical constipation treatments, such as over-the-counter (OTC) laxatives (Miralax), OTC rectal therapies (enemas), and prescription medication can also help.

Bloating

Bloating and distension are also common problems for people with PD. It’s mainly caused by constipation, but at times it can also be caused by diet issues (like drinking carbonated beverages), small intestinal bacterial overgrowth (SIBO), or gastroparesis (stomach paralysis).

SIBO isn’t well-studied in PD, but 34% of people with PD that experience bloating, nausea, and/or dyspepsia will test positive for it. Current theories say that SIBO relapses because the decreased motility of the GI tract is still present, and treatment can focus on drugs that speed up motility.

Gastroparesis can be a side effect of levodopa or constipation, but PD can also directly involve the nerves of the stomach and interfere with its movements. Common symptoms are weight loss (due to depression, difficulty swallowing, loss of taste/smell, difficulty timing meals with medications, etc.), bloating, and most importantly, poor absorption of levodopa. Currently, the best treatment for gastroparesis in those with PD is prucalopride.

Swallowing Issues (Dysphagia)

PD can also interfere with the muscles in your esophagus in two main ways:

• Dysmotility in the esophagus: Associated with the sense of food getting stuck, reflux and regurgitation, and chest pain with swallowing.
• Oropharyngeal dysphagia: Associated with difficulty transferring food/liquid from the mouth to the throat, leading to choking or coughing while eating and difficulty swallowing pills.

Consult with a doctor if you experience these symptoms. Swallowing issues should be taken very seriously, as they raise the risk of aspiration pneumonia. This is a life-threatening condition caused by food/liquid/saliva going down into the lungs instead of the esophagus.

Tips for Keeping Your Gut Healthy

Gut issues can cause significant disruption to your normal life, but that doesn’t mean you have to accept them. Here are some tips to help you stay on top of your gut health:

• Start your day right by hydrating properly (helps stimulate digestion) and eating a healthy breakfast (packed with fiber, nutrients, and antioxidants to help you build a balanced gut microbiome). To help with your diet, find a good registered dietician with experience in helping people with PD. A good way to check is by asking if they know about levodopa absorption issues with protein. Check out our diet and nutrition guide on what foods to eat and avoid.
• Stay up to date on your colonoscopies. If you experience significant GI symptoms, you might need a colonoscopy and an upper endoscopy.
• If possible, avoid opiates, as they can lead to GI side effects. If you have to take them, ask your physician for Symproic (naldemedine) to treat the side effects.
• Understand that most medication you receive to address severe constipation may fail unless you do a bowel cleanse first.
• Keep track of the OTC treatments (laxatives, enemas, suppositories, etc.) you try when you experience GI issues. Knowing what worked and what didn’t can be helpful in a later GI appointment.
• Watch out for weight loss (especially a loss of muscle mass), swallowing issues, and sudden severe abdominal pain. These issues can lead to further, possibly life-threatening complications, so it’s best to check in with a doctor.

Wrap Up: Always Listen to Your Gut

When you’re living with Parkinson’s, taking care of your gut is incredibly important. Recent studies continue to highlight promising treatments for common GI issues. If you’re interested in learning more, check out PCLA’s upcoming event on Gastroparesis and Parkinson’s on August 8.

If you’d like to get connected with a support group or resource to help talk through GI issues, please reach out to us — we’d be happy to help.