Autonomic Abnormalities in Parkinson's Disease


  • Autonomic abnormalities occur when the nervous system does not work properly and can not regulate body functions. A variety of symptoms may occur including constipation, orthostatic hypotension, urinary frequency, drooling, or difficulty swallowing.


  • 70% of Parkinson’s disease (PD) patients report constipation, with complaints of decreased frequency and increased bloating.
  • With PD, the gastrointestinal tract is lined with muscles that slow just like other muscles in the body.
  • The slower small intestine can cause bacterial overgrowth, resulting in bloating and fatigue, which are treated with antibiotics.
  • Read the website document on Constipation for more information.


  • Orthostatic hypotension occurs if the blood pressure drops when changing position.
  • Dizziness, lightheadedness, and fainting may occur when sitting up or standing.
  • Before feeling dizzy, some people complain of neck pain, difficulty getting thoughts together, or low energy.
  • Drugs to treat high blood pressure may have to be discontinued. Consult the provider before making any medicine changes.
  • Orthostatic hypotension can often be managed by staying well-hydrated, wearing compression socks, and drinking salty fluids like V8 juice.
  • Some people require medication to increase the blood pressure.


  • Urinary frequency is an autonomic abnormality, which may lead to incontinence (inability to hold the urine long enough).
  • Medications to treat urinary disturbances have side effects such as increased confusion and blood pressure changes, which may limit their use.
  • Urinary problems may be treated with Botox by a urologist.


  • The forward posture common in PD brings the saliva to the front of the mouth, causing drooling.
  • Keeping a lemon drop or Tic Tac in the mouth is a reminder to swallow.
  • Drooling may be treated with Botox.


  • Some people with PD have muscle slowness between the mouth and esophagus, causing difficulty with swallowing.
  • Delayed emptying of the stomach may also occur.
  • Swallowing problems and delayed emptying may contribute to levodopa not working well because of the delay in getting the medication to the small intestine where it is absorbed.
  • On/off cycles may be influenced by the delay in getting the medicine to the intestine.