Objective: Explore common evaluation and management strategies for constipation in patients with Parkinson disease (PD) at a tertiary center.

Background: PD is diagnosed based on the presence of cardinal motor features; however, non-motor symptoms are common and can be equally debilitating. Constipation is one of the most prevalent symptoms, often preceding the motor diagnosis by years. There are no dedicated treatments or defined algorithms for managing constipation in PD; thus, it is important to understand current strategies in order to identify areas in need of improvement.

Method: We conducted a retrospective chart review of patients with PD seen by a movement disorder specialist at the University of Vermont Medical Center from January 1, 2019 – August 10, 2021. In a random sample of 100 patients, we collected data including demographics, disease history, medication use, referrals, and ancillary testing from available records. We compared demographic and disease characteristics between individuals with and without constipation using paired t-tests. In those with constipation, we used descriptive statistics to quantify the use of medications, diagnostic tests, and referrals.

Results: One-hundred patients were included in this analysis. Seventy-six had constipation documented in the available medical records. Compared to those without constipation, they were older [73.1 vs 66.8 years; p=0.005], had a longer disease duration [7.5 vs 6.3 years; p=0.007], had more advanced disease [3.1 vs 2.4; p=0.01], and took higher levodopa equivalents [836.4 vs 526.0 mg; p=0.02]. 

The most commonly used treatments for constipation included docusate (71%), polyethylene glycol (62%), and sennosides (59%). Prescription medications like linaclotide (5%), lubiprostone (4%), prucalopride (0%), and plecanatide (0%) were rarely used. Only two patients had a dedicated clinic visit with a gastroenterologist to discuss constipation. Tests to specifically evaluate gastric motility or outlet obstruction were not performed.

Conclusion: At a rural academic center, constipation is common in PD and associated with older age, longer disease course, and higher medication doses. Diagnosis is based on history rather than diagnostic testing and managed by movement disorder specialists, typically with over-the-counter agents. Further analyses will explore the success of various treatments to help define an algorithm for treating constipation in PD.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/trends-in-the-evaluation-and-management-of-constipation-in-patients-with-parkinson-disease/