Yes – constipation is one of the many ‘non-motor’ symptoms that can affect someone with Parkinson’s disease. There are several contributing factors – one is a general reduction in activity, which contributes to slow bowel transit, as well as insufficient fluid intake, but also the regulation of bowel function, which is a direct consequence of part of the disease process in Parkinson’s disease. The disease affects several functions of the bowel’s motor system, resulting in slowed bowel motility.
Frequent urination is also a common ‘non-motor’ symptom. The bladder relies to some extent on dopamine for optimal function, and in more advanced stages of the disease, it is often impossible to compensate for this with medication. As the bladder fills, the pressure within it increases, leading to automatic contractions over time, which are counteracted by the partially conscious control of the sphincter muscles. In Parkinson’s disease, these contractions become more intense (known as uninhibited neurogenic bladder dysfunction), which can be exacerbated by concurrent prostate enlargement in men, or bladder infections (cystitis) caused by bacteria or viruses. There are several possible treatments involving various medications that suppress the reflexes triggered by bladder distension, and it is also possible to reduce urine output at night by raising the head of the bed by approximately 15–20 cm (with the heart positioned above the kidneys, which alters the pressure in the kidneys and consequently reduces urine production at night).
Cramps can occur in slightly different forms and have various causes. One type is a cramp in the calf during the night, which is usually caused by a lack of fluids or salt and is generally temporary, occurring once or twice a week; the cramp is often short-lived but frequently painful. If, as a Parkinson’s patient, you experience frequent urination at night and do not drink enough fluids, these cramps may be indirectly related to Parkinson’s disease. The measures mentioned above may help to some extent, but primarily by achieving a more optimal fluid balance. Fluid replacement tablets (such as ReSorb) 1–3 times a day in addition to your usual fluid intake can be effective.
Another cause of cramps and stiffness is insufficient treatment efficacy for Parkinson’s disease. For example, it is common for a cramp to occur in a leg or foot early in the morning, when it has been many hours since the last dose of medication. This is a phenomenon associated with ‘off periods’ and is usually somewhat insidious, more prolonged and may be painless, but can lead to misalignment so that one walks on the outside of the foot for a time in the morning. Off-related dystonia is therefore a common form of spasm-like muscle contractions and is best treated by adjusting the medication in various ways to avoid off periods.
//Håkan Widner