Bowels and Constipation
Bowels and Constipation
Constipation is common among older adults, in general. However, it is very common among people with Lewy body disorders, and the reason is dysautonomia. Lewy body disorders tend to impair control of gut motility by the autonomic nervous system. At the stomach level, bloating may develop when the stomach fails to empty into the upper small intestine. At the other end, constipation is the consequence of Lewy processes affecting motility in the colon. Colon motility (peristalsis) is what moves the remnants of digested food (stool) to the rectum for expulsion. These regions are shown in Figure 15.1. Drugs that block the neurotransmitter acetylcholine are notorious for worsening constipation; these include medications used to treat urinary urgency (overactive bladder). All of the anticholinergic drugs for bladder overactivity that were listed in Table 12.1 cause constipation, as does another bladder drug, trospium (Sanctura). The tricyclic drugs for depression shown in Table 12.1 have variable anticholinergic properties and also tend to be constipating. One needs to balance benefits against the side effect of constipation if considering these medications. In the setting of DLB or PDD, constipation is typically due to autonomic nervous system dysfunction, often exacerbated by medication side effects. However, there are exceptions and the primary care clinician or internist should consider whether colonoscopy is appropriate. This procedure involves inserting a scope into the anus and then advancing the instrument to visualize the entire colon. In this way hidden colon cancers are detected before they become deadly. It is common knowledge that several natural remedies help prevent constipation: fruits, vegetables, fluids, and fiber. Individuals with constipation should make sure that their diet includes adequate fruits, which make a good snack. Meals should include vegetables, such as green beans, peas, and squash; catsup and potatoes do not count as vegetables. Intake of six to eight tall glasses of water, juice, or other fluids may help maintain moisture in the stool, making it easier to pass. Finally, fiber needs to be included in the diet in order to give the stool bulk. These strategies are often insufficient for persons with Lewy disorders, and additional measures are often necessary.
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