Imagine this: a loved one with Parkinson’s disease (PD) stands up from the dinner table, shuffles slowly across the room, with discomfort evident on their face. Later, they complain of bloating and strain in the bathroom. What may seem like separate problems, motor function impairment and constipation, are often two sides of the same coin. Worse, constipation in Parkinson’s isn’t merely an annoyance: it aggravates urinary problems, interferes with medication effectiveness, and quietly chips away at quality of life.

According to Parkinson’s Foundation statistics, PD affects an estimated 1.1 million people in the United States, with roughly 90,000 new diagnoses each year. These numbers are expected to continue rising as the population ages.

And, constipation has an undeniable link with PD. A large systematic review published by Karger International found that constipation is one of the most common non-motor symptoms of PD, and it  increases the risk of PD almost 2.5 times compared to people without constipation. Constipation, as a symptom of PD, often also manifests many years before motor symptoms become evident.

How Parkinson’s Slows the Gut: Autonomic and Enteric Nervous System Effects

Parkinson’s is classically described as a disease of dopamine-producing cells in the brain that control movement. But its reach goes far beyond motor circuits. The disease apart from affecting the autonomic nervous system (ANS), which controls involuntary functions like heartrate and breathing, also involves the enteric nervous system (ENS).

The ENS is dubbed the “second brain” due to its ability to function independently of the central nervous system.  PD’s impact on the ENS produces widespread gastrointestinal dysfunction, including slowed gastric emptying, reduced intestinal transit, and impaired rectal evacuation.

Slowed motility means stools move more slowly through the colon, become desiccated, and become harder to pass. In practical terms, this yields bloating, straining, infrequent bowel movements, and, in some cases, fecal impaction.

Why Constipation Matters Beyond Discomfort

Constipation in Parkinson’s creates two critically important downstream problems:

It worsens urinary problems and incontinence.

Constipation increases intra-abdominal and pelvic pressure and can distort normal rectal-bladder relationships. A study published in the National Library of Medicine (NLM), shows a significant association between constipation and bladder dysfunction in PD, even after adjusting for age and cognition, meaning bowel and bladder complaints commonly travel together in Parkinson’s.

It impairs medication absorption—especially levodopa.

Levodopa remains the most effective medication for Parkinson’s motor symptoms, but it must be absorbed in the small intestine. When gastric emptying is delayed (gastroparesis) or stool transit is prolonged, levodopa can be trapped in the stomach or small intestine, delaying onset, reducing peak levels, and causing unpredictable “on-off” motor fluctuations. Another NLM study documented that slowed gastrointestinal motility diminishes levodopa absorption and contributes to motor variability.

Put simply: constipation can make patients feel stiffer and more immobile not only because of gut discomfort, but because their Parkinson’s medications stop behaving reliably.

The Vicious Cycle: How One Problem Feeds the Other

The interaction between Parkinson’s and constipation is a feedback loop:

• Parkinson ’s-related autonomic dysfunction slows gut transit, leading to constipation.
• Constipation increases abdominal pressure and pelvic dysfunction, aggravating bladder symptoms and incontinence risk.
• Constipation and gastroparesis impair levodopa absorption, making motor symptoms less predictable, resulting in decreased mobility and physical activity.
• Reduced mobility and activity further slow gut transit and weaken pelvic floor function , exacerbating constipation and incontinence.

This “dastardly duo” therefore produces more than discomfort: it multiplies functional disability, complicates clinical management, and raises caregiver burden.

Early Warning Signs to Watch For

Caregivers and clinicians should treat bowel complaints in PD as more than a nuisance. Early warning signs include:

• Fewer than three bowel movements per week, or a clear change from the person’s baseline.
• Straining, hard stools, or a sensation of incomplete evacuation.
• Signs of slowed gastric emptying such as new-onset bloating, nausea, or early satiety.
• Worsening “off” periods or delayed medication response, especially after meals.
• New or worsening urinary urgency, frequency, or episodes of incontinence.

If any of these appear, a proactive bowel evaluation is warranted—constipation often responds to relatively straightforward interventions if treated early.

Practical Strategies to Break the Cycle

Addressing Parkinson’s-related constipation requires a layered approach—dietary, behavioural, pharmacologic, and coordinated with Parkinson’s medication management.

Diet and Hydration

• Increase dietary fiber gradually (fruits, vegetables, whole grains) while ensuring adequate fluids. Rapid increases in fiber without fluid can worsen constipation.
• Small, frequent meals may help those with delayed gastric emptying.

Promote Mobility and Regular Activity

• Gentle, regular physical activity (walking, tai chi, tailored physiotherapy) boosts intestinal motility and helps with stool transit.

Scheduled Bowel Routines and Pelvic Floor Care

• Establishing a consistent toileting schedule—ideally after meals—takes advantage of the gastrocolic reflex and helps regularize bowel habits.
• For those with pelvic floor dyssynergia, biofeedback or pelvic physiotherapy can assist effective evacuation.

Medications and Laxative Strategies

• Start with osmotic agents (e.g., polyethylene glycol) or fiber supplements as first-line under medical guidance.
• For refractory cases, stimulant laxatives, stool softeners, prokinetic agents (to improve gastric emptying), or peripherally acting secretagogues may be used. Use only under medical supervision to avoid potential interactions.

Optimize Parkinson’s Medication Timing

• Because food and gastric emptying affect levodopa absorption, clinicians may recommend taking levodopa on an emptier stomach or adjusting timing relative to meals and protein intake. Addressing constipation can itself improve medication reliability.

Treat Coexisting Urinary Problems Holistically

• When constipation and urinary dysfunction coexist, evaluate both systems—treating constipation can reduce urinary urgency and incontinence. Bladder-focused interventions (timed voiding, pelvic floor therapy, medication) may be necessary in parallel.

Specialist Collaboration

• Neurologists, gastroenterologists, urologists, and pelvic floor therapists should coordinate care for complex cases. Early referral prevents complications like fecal impaction, recurrent UTIs, or severe motor fluctuations.

Conclusion

Parkinson’s disease is more than tremors and stiffness. Its reach into autonomic and enteric systems makes bowel health central to both comfort and clinical control. Treating constipation in PD is not a trivial housekeeping matter—it is a meaningful lever for improving medication effectiveness, reducing incontinence, and restoring daily function.

AT LL Medico, we deal with age-related conditions on a daily basis and we recognize the immense burdens some people carry. While many of the conditions require medical intervention, there are also many that can be managed non-clinically. It is in this area that we strive to assist by providing a comprehensive range of senior care products at competitive prices.

If you are afflicted by this compounded conundrum, or caring for someone who is, visit llmedico.com and browse our range of adult diapers, laxatives and other digestive aids, nutritional supplements, and much more.

We realize that sometimes, our range of products can be daunting so, if you need advice, give us a call at (855) 422-4556 or email support@llmedico.com. In the words of Maya Angelou, “You may encounter many defeats, but you must not be defeated.” Let your life not be defined by the crosses you may be asked to bear.