title: Management of constipation in Parkinson's disease.
abstract: BACKGROUND
  Constipation is a frequent non-motor feature of Parkinson's disease (PD). It is the most common gastrointestinal symptom of the disease and it can precede motor symptoms by as much as 20 years. Constipation can produce discomfort and affect activities of daily living, productivity and quality of life, thus warranting early diagnosis and treatment.
  
  
  METHODS
  In this review, the safety and efficacy of traditional and novel strategies for constipation management will be discussed. A treatment algorithm for constipation in PD will be presented.
  
  
  CONCLUSIONS
  Polyethylene glycol and lubiprostone are first-line compounds recommended by evidence-based medicine guidelines for the treatment of constipation due to slow colonic transit in PD. Management of constipation secondary to defecatory dysfunction due to pelvic floor dyssynergia can be done by levodopa or apomorphine injections, botulinum toxin type A injection into the puborectalis muscle, and nonpharmacological interventions, like biofeedback therapy or functional magnetic stimulation, which showed some benefit in PD patients with constipation, but in general more extensive studies are warranted.
authors.affiliation: Raul Carrea Institute for Neurological Research (FLENI), Neuroscience Department, Movement Disorders Section , Buenos Aires , Argentina.
authors.forename: Malco
authors.initials: M
authors.lastname: Rossi
authors.forename: Marcelo
authors.initials: M
authors.lastname: Merello
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Lloret
mesh_terms: D000527:Alprostadil / Q000031:analogs & derivatives / Q000627:therapeutic use; D003248:Constipation / Q000188:drug therapy* / Q000503:physiopathology; D003672:Defecation / Q000187:drug effects; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D000068238:Lubiprostone; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011788:Quality of Life
chemical_list: D054368:Laxatives; D011092:Polyethylene Glycols; D000068238:Lubiprostone; D000527:Alprostadil
keywords: Parkinson’s disease; algorithm; constipation; gastrointestinal; lubiprostone; polyethylene glycol