This patient is a 77-year-old male diagnosed with levodopa-responsive PD at 61 years old. His first nonmotor gastrointestinal complication was sigmoid volvulus from chronic constipation that occurred at age 66 and treated with sigmoidectomy. Four years later, patient’s constipation progressed in frequency and duration with no bowel movements for up to six days. He started a daily bowel regimen consisting of aloe vera gel capsules three times daily, docusate 100mg three times daily, wheat dextrin twice daily, and magnesium hydroxide as needed.
Despite three months of this regimen, patient was hospitalized for a bowel obstruction requiring a multi-day colon preparation for a colonoscopy with decompression. He was diagnosed with Ogilvie’s Syndrome (colonic pseudo-obstruction) due to an atonic colon. At discharge, polyethylene glycol 17g twice daily and water enemas were added to his regimen.
Patient remained constipated with no bowel movements for 2-4 days, requiring 20-30 minutes for bowel movements. He was started on pyridostigmine 60mg daily, titrated up to three times daily for the autonomic manifestation of constipation in PD.
One month after initiation of pyridostigmine, he only required 5-10 minutes and had bowel movements twice daily with Bristol Type 5 stools for the first time since his PD diagnosis.