Figure 4. Algorithm for the management of constipation in patients with synucleinopathies.

Management includes non-pharmacological approaches, removal of aggravating factors (e.g., opioids), fiber supplements, stool softeners, and pharmacotherapy with laxatives. The asterisk (*) denotes non-pharmacological and pharmacological agents tested in clinical trials of patients with Parkinson disease. Enemas and manual disimpactions may be required in severely affected patients (not shown in algorithm).