Clinical aspects of bowel symptoms in Parkinson's disease

Background The clinical importance of bowel symptoms in Parkinson's disease (PD) remains to be described in detail. Methods A 33-item questionnaire including background parameters, the Cleveland Constipation Score (CCS), and items from the Neurogenic Bowel Dysfunction score was sent to 468 PD patients. Results were compared to a control group (CG) (n = 45). A CCS of at least 15 was used to define severe constipation. Results Four hundred and sixteen subjects (89%) responded. Median CSS was only 4 (range 0-21) in PD and 2 (range 0-13) in the CG (P < 0.05). Severe constipation was found in 7% with PD and 0% in the CG (P < 0.05). Incomplete emptying at defecation, need for assisted defecation and use of oral laxatives was reported more frequently by PD patients than by the CG (all P < 0.05). The severity of PD was associated with assisted defecation (P < 0.001), unsuccessful attempts at defecation (P < 0.001), incomplete emptying at defecation (P < 0.05), and the CCS (P < 0.01). Time since diagnosis was associated with infrequent defecation (P < 0.0001) and the CCS (P < 0.05). The use of levodopa was associated with less unsuccessful attempts at defecation (P < 0.05). Conclusion Most patients with PD only have minor constipation-related symptoms. However, severe constipation is associated with time since diagnosis and severity of disease.