Symptoms - Gastrointestinal Issues
In addition to the motor symptoms Parkinson’s disease (PD) is known for, the condition can also cause symptoms in the gastrointestinal and urinary systems. The gastrointestinal tract, which begins at the mouth and ends with the anus, is responsible for the digestion of food. PD can cause multiple problems along the gastrointestinal system. In the urinary system, PD can cause issues with the bladder.1
Gastrointestinal issues in Parkinson’s disease
People with PD may experience several symptoms throughout the gastrointestinal system, including difficulties in the mouth, swallowing problems, and constipation.
- Mouth: People with PD may have more difficulty brushing their teeth effectively, which can lead to an increased risk of periodontal disease and cavities. PD may also cause difficulty in swallowing (also known as dysphagia), which can lead to having too much saliva. The excess saliva can also cause drooling. Besides the social embarrassment, drooling can also cause poor oral hygiene, bad breath, difficulty speaking and eating, an increased risk of respiratory infections due to inhaling saliva, and a negative effect on quality of life. Some people with PD experience dry mouth, and PD may also impair the taste of foods. Treatment for oral problems of PD includes sucking on hard candy or chewing gum to help with saliva issues, medications that can reduce saliva formation, or injections of botulinum toxin into the salivary glands. For dysphagia, medications for PD may be helpful. Speech or swallowing therapists can provide instruction on techniques to reduce the risk of aspiration and ease swallowing.
- Stomach: PD can cause the normal movement of the stomach to be impaired, so that food or medications taken orally don’t flow naturally into the intestines. This is also known as gastroparesis and can lead to feelings of nausea, vomiting, excessive fullness, and bloating. Treatment of gastroparesis is challenging, and research is ongoing to determine effective treatments in people with PD.
- Constipation: Constipation refers to difficulty emptying the bowels or infrequent bowel movements. It is generally defined as having fewer than three bowel movements a week. Constipation is the most frequent gastrointestinal symptom, affecting people with PD, reported in 80-90% of patients. Constipation is also believed to be one of the earliest signs of PD, developing before the characteristic motor features of the disease. Constipation may also be a side effect from some of the treatments for PD, including dopamine agonists and anticholinergic drugs. Patients experiencing constipation are encouraged to increase their fiber and fluid intake. Stool softeners or a product that increases the fluid in the colon, such as lactulose, may also be recommended. Other options are colon-cleansing agents such as MiraLAX® or enemas. Probiotics may also be helpful.1,2
Urinary difficulties in Parkinson’s 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