Advanced Treatment
Laxatives are drugs that stimulate the muscular action of the large intestine, as opposed to merely making the stool softer or bulkier, which is what the early treatment measures do. Laxatives tend to lose their effect with repeated use, so they should not be used daily. Many types of enemas contain laxative drugs. The use of any laxatives, even those sold over the counter, should be discussed with one’ s physician or another healthcare professional.
Complications
Constipation can become more than just bothersome. Untreated, constipation leads to straining to pass stool, causing hemorrhoids and anal fissures( small tears in the skin). Constipation over an extended period can cause stool to compact so tightly in the rectum that the normal pushing action of the rectum cannot expel the mass. This is known as a fecal impaction and can quickly become a medical emergency. Seek medical help immediately if home management for constipation is no longer effective.
PSP and the Bladder
Lawrence I. Golbe, MD
Many brain disorders, including all of the parkinsonian disorders, can affect the urinary bladder. The normal nerve circuitry linking the bladder to the spinal cord perceives the stretching of the bladder by a large quantity of urine. These circuits normally set in motion a reflex, not unlike the knee jerk reflex, that stimulates the muscle in the bladder wall. This squeezes the bladder, causing it to empty. It is the job of the normal brain to inhibit this function. When we voluntarily initiate the act of emptying the bladder, we temporarily suspend this inhibitory brain function. Patients with PSP have difficulty inhibiting reflex bladder emptying. As the bladder slowly fills with urine from the kidneys, this produces sudden urinary urges( urgency) and, in many cases, incontinence, a condition sometimes called irritable bladder. In PSP, degeneration of a small cluster of nerve cells near the lower end of the spinal cord( the nucleus of Onuf) contributes to the problem.
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Urinary urgency and incontinence can be treated in a variety of ways. First, it is wise to check for a bladder infection. The inflammation caused by infection can irritate the bladder lining, fooling its sensory nerves into perceiving that they are being stretched. This stimulates the reflex contraction of the bladder wall muscle. Treating the infection with antibiotics and fluids can correct this problem. There are many possible causes of bladder infections, including enlargement of the prostate in men, which can be treated by medication or surgery, and dropped bladder in women, which can be treated with surgery. The overall disability of PSP can cause a bladder infection by making trips to the bathroom difficult and infrequent, allowing urine to accumulate excessively in the bladder, which permits bacteria in the urethra( the tube from the bladder to the outside) to spread into the bladder and grow. Many people with PSP drink little fluids, either because they cannot swallow easily or because they cannot easily walk to get a drink. This reduces the frequency of urination and the natural cleansing of the urethra by regular flows of urine.