Abstract
Constipation is one of the most common gastrointestinal features of Parkinson's disease
(PD), occurring in over 50% of all PD patients during the course of their disease.
Furthermore, constipation is now recognized as an important, prodromal symptom and
may predate the onset of the classical motor symptoms by decades. Thereafter, the
prevalence and severity of constipation in PD tend to parallel the course of both
motor and nonmotor phenomena such as cognitive decline and depression. Difficult defecation
(obstructed defecation, dyssynergia) is the primary pathophysiology underlying constipation
and likely reflects involvement by the PD process of one or more of the many skeletal
muscle groups that are involved in effecting defecation. Management of constipation
in PD may be complicated by several patient factors including dysphagia, cognitive
impairment, depression, and weak sphincter tone. While the armamentarium available
to those who treat constipation, in general, has expanded considerably in recent years,
the evidence supporting any therapy in the management of this symptom in PD has remained
slim.
Keywords Parkinson's disease - parkinsonism - constipation - dyssynergia - enteric nervous
system - colon transit - prokinetic - prosecretory agents
