Let’s talk about… constipation

World Parkinson’s Day (11th April) kicks off Parkinson’s awareness week, an annual opportunity to raise funds and increase awareness. To mark the occasion, the Parkinson’s UK’s North West RIG is publishing a series of blogs throughtout the week.

First up, let’s address a subject that people with Parkinson’s are often all too aware of: constipation.

Why are we talking about constipation?

First, it’s one of the earliest non-motor symptoms to emerge in Parkinson’s. Researchers at University College London have shown that constipation is one of the strongest predictors of developing Parkinson’s within 5 years. This is important for two reasons:

  1. Diagnosing Parkinson’s is incredibly difficult in the early stages. Symptoms that emerge before movements are affected offer the opportunity to reach an accurate diagnosis sooner. Importantly, this also means faster initiation of the treatments that will make people’s lives easier.
  2. As yet, there are no treatments that prevent or delay Parkinson’s. But, trials of new drugs are underway. However, even the most promising drug will fail if it’s not tested on the people it’s designed for (there is little point evaluating a disease-modifying treatment in people who have no disease to modify). So, while uncomfortable (on several levels), talking about constipation may be critical for the future of Parkinson’s medication. 

All that said, there are many reasons a person may be experiencing bathroom-related troubles, most of which are unrelated to Parkinson’s. This brings us to the second reason why we’re talking about constipation: how to identify the people with constipation who are in the early stages of Parkinson’s.

In a recent development, a team of researchers from Israel, Germany and Canada have uncovered the link between the very earliest stages of Parkinson’s and constipation. The team induced Parkinson’s-like pathology in the dorsal motor nucleus of the vagus in rodents. In humans, this is one of the earliest regions to develop Parkinson’s pathology. It also happens to connect with the gastrointestinal tract (the organs by which food and liquids make their way from one end of us, to the other, see image below).

After Parkinson’s pathology became established in the rodent vagus, its connections to the gastrointestinal tract became less active. Through a series of experiments, the authors confirmed that this drop in activity caused the rodents to pass bigger and less frequent droppings. Sound familiar?  

This work offers a new opportunity to use constipation as a predictor of Parkinson’s more accurately. Developing tools to detect changes in the vagus in people who are also constipated would help us predict who will develop Parkinson’s, and who may just need to hydrate more.

At Manchester Metropolitan we are using artificial intelligence analysis of medical images to measure the health of the vagus for the first time. We hope this will help us to identify people at risk of Parkinson’s long before they experience any motor symptoms.

In the meantime, for those of you who may be struggling with constipation, one of our members has some words of wisdom:

“The big P has several manifestations. One is certain muscles not responding to instructions from headquarters. As in my case, lips not being firm enough to stop drooling for one thing. At the other end of my languid body I have a more pressing problem. My rear end exit muscles have retrograded from automatic back to manual. Constipation is the word! The action required message just does not arrive and there is a pile up, luckily the police don’t turn out. It seems nothing can be done for the mechanism except the usual medication, but help is there in terms of softening the issue, if you get my meaning. A dose of CosmoCol each morning allows an easier passage, if not to India at least to somewhere useful nearby.”

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