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PD Constipation – Macrogol Laxative — SCE Neurology MCQ

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EasyMovement DisordersPD Constipation – Macrogol LaxativeSCE Neurology

A 55-year-old man with Parkinson's disease complains of severe constipation. He has a bowel movement only every 5–7 days despite adequate oral fluid intake. He is on co-careldopa and ropinirole. What is the recommended approach?

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Correct answer: D — Constipation is a common non-motor symptom of PD — increase dietary fibre, ensure adequate hydration, consider macrogol (polyethylene glycol) laxative as first-line pharmacological treatment

Constipation is one of the most common non-motor symptoms of PD, affecting up to 80% of patients. It results from both autonomic dysfunction (reduced colonic motility) and dopaminergic medication effects. NICE NG71 recommends addressing constipation proactively with dietary fibre, adequate hydration, and macrogol (PEG) laxatives as first-line. Stimulant laxatives (senna, bisacodyl) and prokinetics may be needed. Lubiprostone and prucalopride are second-line options. A: Constipation is intrinsic to PD. C: Reducing dopaminergic medication may worsen motor symptoms without resolving constipation. D: Opioids worsen constipation. E: Colonoscopy may be needed to exclude structural causes but laxatives can be started empirically.

Reference: NICE NG71 Parkinson's Disease (2017); BNF