It is easy to become obsessed with bowel activity, but it is not necessary to have a bowel movement every day – it can be quite normal for some people to empty their bowels only three or four times a week. What is important, is that passing stools is not painful nor causes unnecessary strain. Focus on what is normal and healthy for you and remember that bowel activity is affected by food and exercise, so will vary according to what you are eating and doing.
Remember that learning to manage your bowels will take time and patience, so don’t expect to solve problems overnight. It may take a few weeks to adjust diet etc, so don’t give up too quickly. There are also plenty of ways you can help yourself:
Diet
A healthy lifestyle will enhance bowel efficiency and increased fibre and fluid are key factors. However, too much bulk from fibre can increase constipation so the balance needs to be right – your doctor should be able to refer you to a dietician for help with this.
Any increase in fibre should be gradual to avoid flatulence (wind) or bloating. There are many ways in which you can increase fibre in your diet, including:
- eating wholegrain cereals and bread
- eating fruits and vegetables - fresh, frozen, raw and cooked. if you have trouble chewing and swallowing, look for soluble varieties and fruit juice drinks. prunes are particularly good, natural laxatives
- drinking plenty of fluids, which will help the digestion of fibres, so try to drink approximately eight cups (8oz/225ml) throughout the day, including water, tea, coffee, milk and juice. Carbonated drinks may cause bloating and alcohol can act as a diuretic, which can make constipation worse, so it may be best to drink these only in small quantities
- having a warm drink and something to eat as soon as you get up in the morning, as both stimulate bowel activity.
But if you feel unable to increase your fluid and fibre intake because of eating and drinking difficulties, you could try these practical suggestions:
- use insulated cups for warm drinks, if necessary with a lid and spout to avoid spillages. Weighted cups are also useful if you have a tremor
- if large meals are too daunting because eating is slow or you have difficulty chewing, try several smaller meals a day instead
- place a rubber mat under your plate to prevent it slipping
- try special cutlery to make eating easier, such as a combined knife/fork; a 'rocking' knife that allows cutting one handed. An occupational therapist can advise further.
However, you may find increasing your natural fibre and fluid intake does not relieve your bowel difficulties. If constipation is the problem, then medications such as bulk formers or stool softeners may help. There are several products on the market so ask your doctor or a dietician for advice.
Exercise
Physical exercise may help in relieving or preventing bowel problems. Exercise can stimulate the bowel muscles and improve your ability to pass stools. It can also strengthen the pelvic floor muscles, which helps reduce constipation.
If you find exercise difficult, a physiotherapist can advise further. Parkinson Italia also have very useful exercises on their website and the Parkinson’s Disease Society has an exercise factsheet and a video.
Going to the toilet
It is important to try to relax when going to the toilet. Try not to rush and make sure that you do not become too preoccupied with your bowels. If your feet do not touch the floor when sitting on the toilet, then try putting a small stool under them, so that they are resting on something and you are more comfortable. Don’t sit on the toilet for more than about five minutes and don’t strain hard to pass a stool. Listen to your body, leave it for a while and try again later. If possible, try to pass stools when you are ‘on’.
Be proactive
It is important to be proactive in initiating a dialogue with healthcare professionals in order to best manage your symptoms. At one time, the non-motor symptoms, such as constipation, received far less attention than the motor symptoms, but there is now a growing awareness of this aspect of the disease. You can help manage your constipation by recognising that assistance is needed and talking to the healthcare professionals that can provide such help.
Unfortunately failure by healthcare professionals to recognise those most at risk of developing bowel difficulties used to be a major stumbling block in managing the condition. This, coupled with the patient’s embarrassment in approaching the subject, meant that any problems often went undiagnosed or untreated for some time. Fortunately, most of those at risk are now identified early and preventative measures can be put in place to reduce the risk of severe complications. A proactive approach to treatment really can reduce the impact that bowel disorders have for most people.
