Managing constipation in Parkinson’s using self-care techniques.

This is a self-management research project which will take place in the participants home, with all information posted or emailed, and telephone calls made throughout the study. Phone calls are expected to take approximately 10-15 minutes. The Researcher will be available for participants to phone at any time throughout the study and contact details are given at the beginning. Participants will receive information on self-care techniques, with one technique sent daily over a week, starting off with general and safety information, then followed by Reflexology, Fluid intake, Diet and fibre, Toilet routines, Medications and Exercise. They will be required to choose 2-3 techniques to incorporate into their lifestyle for the intervention phase. A phone call will be made at the end of the week by the researcher (a Registered Nurse) to ask which techniques they have chosen and answer any questions. During the 3-week treatment phase participants will be asked to continually complete a bowel diary and document lifestyle techniques used daily and they will be phoned weekly to check well-being, provide support and encourage adherence. General and safety information-overview of constipation, risk factors, lifestyle modifications and safety information including Red flags to watch out for and when to seek medical assistance. Reflexology-It has been around since ancient Egyptian times and works by applying pressure to reflex points on the hands or feet, which correspond to areas on the body. Every part of the body has a corresponding reflex area, so the hands and feet are micro-maps of the body. A self-care Reflexology technique has been formulated for constipation which will be outlined in a short video with the aim that the techniques should only take about 5 minutes to run through daily. Fluid intake-Inadequate fluid intake is thought to be a contributing factor to constipation. Participants are encouraged to calculate their daily fluid requirement, weight multiplied by 30mls. Then keep track on how much fluid they are drinking to ensure they meet their target each day. Diet and fibre-Dietary fibre is discussed, as well as foods with a natural laxative effect. Participants are encouraged to eat five servings of fruit and vegetables each day and a healthy diet should contain fibre from a variety of sources. It is suggested that they make changes to their diet slowly to prevent bloating and drink plenty of fluids alongside increasing fibre intake, as well as minimise low fibre starchy foods. Toilet routines-Peristalsis is stimulated by eating breakfast, so the best time to open your bowels is around 20 minutes after breakfast or a hot drink in the morning (Kyle, 2008; Parkinson’s New Zealand, 2011). Privacy is needed when using the toilet and positioning is helpful. Participants are encouraged to establish a bowel routine and take advantage of the gastro-colic reflex by making time to sit on the toilet after meals, particularly after breakfast and think about their seating position on the toilet. A correct seating position diagram will be provided. Medications-Constipation can be a side effect of some medications and is more likely to occur when taking five or more different medications (Barichella et al., 2016; Kyle, 2008; S. Thomas, 2014). Participants will be encouraged to talk to their pharmacist about reviewing both prescription and over-the-counter medications. They will be advised to take their medications, so they are “on” when the gastro-colic reflex is working. It will be highlighted that it is not advisable to make any medication changes or stop taking medications without consulting their doctor, as some medications should NOT be stopped abruptly and need to be reduced slowly. Exercise-Exercise prevents constipation through stimulating peristaltic movement in the bowel and keeps our muscles strong (Nazarko, 2005; Parkinson’s New Zealand, 2011). Studies have shown that walking 0.5 km per day is sufficient to prevent constipation (Kyle, 2008). Participants will be encouraged to aim for at least 30 minutes of exercise each day and choose an activity they enjoy, so it is not a chore.