MANAGING SYMPTOMS( continued)
In normal intestinal functioning, food is primarily liquefied by strong digestive juices in the stomach so that it can travel smoothly through the small intestine, where nutrients are absorbed. Next, rhythmic contractions called peristalsis propel remaining material into the large intestine, where excess fluid is reabsorbed. Parkinsonian disorders can impair the peristalsis of the large intestine, allowing excessive time for its contents to lose their fluid, producing stool that is dry and hard.
Fluid is Foremost
Liquids, like water and juice, add fluid to the colon and soften the stool bulk. Drinking 48 – 64 ounces( 2 quarts) of clear fluids per day is the single most important tool for managing chronic constipation. Beverages containing alcohol and caffeine are actually dehydrating and should be used sparingly. Milk products can also worsen constipation and should not be counted in the daily total of necessary fluids.
If you have problems choking on thin liquids, try using thickening products, which are readily available at your pharmacy. In addition, fluid intake can be enhanced using treats like Jell-O, frozen fruit bars, or fruit smoothies.
Fiber is Fundamental
Low fiber intake aggravates constipation by decreasing the necessary bulk and texture required for stools to form and pass properly. Most Americans eat about 8 – 10 grams of fiber per day, whereas about three times that amount is optimal to prevent constipation. Dietary fiber is composed of the non-digestible components of grains, fruits, and vegetables.
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Try increasing small servings of whole grain pasta or rice, beans, peas, and deeply colored vegetables throughout the day. If swallowing or choking problems occur, these healthful foods can be pureed without altering taste. Red meat and dairy products can actually make constipation worse, so portions of these should be minimized.
Role of Exercise
Inactivity is the enemy of regular elimination. Constipation often worsens after a period of marked immobility, such as a hospitalization or accident that reduces mobility. Regular walking aids regular bowel function. If walking is not possible because of balance or other problems, exercises such as pumping the legs, crawling, or waist-bending can help. Also, twice-daily abdominal massage from the rib cage to the pubic bone can act as a mechanical cue to the bowel.
Early Treatment
If you are getting sufficient fluids and fiber but need additional help to restore regular bowel function, several remedies may be useful. It is important to check with your personal healthcare provider before starting these interventions.
• Weak tea( green or black) or hot water— 6 ounces with the juice of ½ lemon on waking each morning helps stimulate bowel action.
• Prune juice cocktail: Mix ½ cup applesauce, ½ cup prune juice, and 2 tablespoons miller’ s bran. Store in a covered container in the refrigerator. Take one tablespoon per day initially, and gradually increase if needed.
• Over-the-counter stool softeners containing docusate sodium can be very helpful. Choose a product that does not combine a stimulant laxative with the stool softener.
• Fiber products containing methyl cellulose or psyllium are less desirable and should be used only if there is ample fluid intake throughout the day. Otherwise, these products can further dry and harden the stool.