Need help, big time, with constipation

[kickingandscreaming]

I have always been quite regular, but now I definitely am not. I have always taken in adequate fluids, exercised daily and eaten lots of vegetables and high-fiber foods.

it's crucial for me to be regular if I hope to succeed on PD.  I have been taking senna twice a day and psyllium husk (aka Consyl) daily, I have tried a generic version of Colace,  All with no luck.  I am hesitant to keep taking the two that require sufficient water intake (psyllium and Colace) as I am now on Hemo and need to restrict fluids.  And I don't want to waste my limited fluid intake just to take a medicine.  Actually, I'm pretty sure part of cause of my current sluggishness is precisely a lack of "adequate" fluid intake.  That and Renvela which I believe to be constipating.

This is was I hate about being sick. Once you cross the line into Sick Country, then one ailment leads to another and after a while NOTHING performs as it should.  And you are sucked deeper and deeper into the medical-industrial vortex.  I need some help here.  If I fail at PD,  then I might just choose a "good" dealth over a continued struggle.

[Darthvadar]

Liqurice worked well for my mum when on haemo....

Few pieces, well chewed, hot drink (small amount was all she needed)... Thankfully, when on PD she didn't need to be as careful with fluids...

I hope things get better for you, soon....

Darth...

[talker]

I have always been quite regular, but now I definitely am not. I have always taken in adequate fluids, exercised daily and eaten lots of vegetables and high-fiber foods.

it's crucial for me to be regular if I hope to succeed on PD.  I have been taking senna twice a day and psyllium husk (aka Consyl) daily, I have tried a generic version of Colace,  All with no luck.  I am hesitant to keep taking the two that require sufficient water intake (psyllium and Colace) as I am now on Hemo and need to restrict fluids.  And I don't want to waste my limited fluid intake just to take a medicine.  Actually, I'm pretty sure part of cause of my current sluggishness is precisely a lack of "adequate" fluid intake.  That and Renvela which I believe to be constipating.

This is was I hate about being sick. Once you cross the line into Sick Country, then one ailment leads to another and after a while NOTHING performs as it should.  And you are sucked deeper and deeper into the medical-industrial vortex.  I need some help here.  If I fail at PD,  then I might just choose a "good" dealth over a continued struggle.

Hi kickingandscreaming,
Avoid the senna and psyllium husk for now, they are good, yet as you state, 'water' is the concern here for the psyllium 
Senna does a number on magnesium, and this is something you don't want at this time, as magnesium is a great bowel activator.
Senna would be highly useful if used with other herbs, as in a mix.

Try any of these in capsules or tea:

yellow dock 

licorice root

hops

cascara sagrada

Dandelion

They each have some of what you need to get the 'job' done.
But they may also have some things that you may not need under the circumstances.
Do check each out.
I do mix small quantities of these and put them in gelatin capsules
Talked a bit about mixes on my blog.
Remove the @ sign and copy and paste:
@http://www.thetalker.org/archives/1515/talker-on-more-herbal-mix-tonic/

also see:
http://ihatedialysis.com/forum/index.php?topic=8269.0

[Simon Dog]

Have you considered asking your doctor?

My doc suggested colace - it seems to have helped a little - as it is not habit forming.    At one point my stools were so hard they would not even make the turn in the toilet to make it to the outflow.

[nursey66]

My husband uses sugar-free hard candy, the kind with sorbitol in it. Works wonders. It says on the bag excessive use can cause diarrhea , he had it down to a science, how many pieces to eat to get it just right. His Neph and other Drs were aware he used that, even now with the transplant, he will use it in moderation on occasion .   

[kickingandscreaming]

"Senna does a number on magnesium, and this is something you don't want at this time, as magnesium is a great bowel activator."

Are you saying that senna reduces magnesium and therefore reduces an element that could activate the bowels?  "A number" could go either way.

[kickingandscreaming]

"My doc suggested colace - it seems to have helped a little - as it is not habit forming. "

 Colace is one of the things I said I was doing, but I'm concerned because it require a full 8oz of water to mix it with.  And until I am actually doing PD, I am restricted on fluids.

[Shaks24]

Not sure if its a no no for D patients but Magnesium Citrate is very quick and effective. They have generic flavored versions of it at Walgreens and its very inexpensive. I used it once before dialysis and oh my gosh. I would just make sure it ok for D patients. I got the grape flavor and the taste was not bad. Below is a funny product review by someone who was constipated and took it.




Pros: works fast, one dose, very effective

Cons: works FAST, VERY effective

Note: This is NOT a review of Phillips Milk of Magnesia, there is no product category for Magnesium Citrate, and Epinions will not allow new products in this category, so I have to improvise. I wish I could put it in the right place, but I can't.

I like to keep myself pretty healthy, and I'm not afraid of natural body functions, so this seemed like a good topic of review for me.

To start off, I needed to be constipated. To accomplish this, I have been eating lots of dairy and red meat, and almost no vegetables or fiber this week. I didn't completely plug up the pipes, but things did slow way down.

My wife is a fourth year pharmacy student, so I asked her for the best laxative product on the market. She told me, "If you need to go, use Mag-Citrate." I don't like to do things half way, so I went with her suggestion.

Walgreens, The Pharmacy America Trusts
I went to Walgreens and found the store brand of Magnesium Citrate in the constipation section. A 10oz bottle was $1.99, which seems very reasonable to me. The instructions say that an adult should take the entire 10 ounces of green liquid, followed by a full glass of water. I made my purchase from the very helpful pharmacist and went home to try out my product.

The Green Machine
I'm not a big medicine person. When I was young, I tried to figure out any way possible to take medicine without it being medicine. I would grind up pills and mix them with sugar or apple sauce. If I had to take any kind of cough syrup, I would wash my tongue off with soap and then brush my teeth after. I don't like to take medicine.

I opened my bottle of green yuck and chugged it. Not a great taste by any means, but I got it down. I quickly drank not one, as recommended on the bottle, but two full glasses of water, then started brushing my teeth.

I've got the urge to burble!
Before I finished brushing my top molars, I felt a shift in my intestines. Things were starting to flow. Things were starting to churn, and burble and twist.

Realizing that something was afoot, I began to brush faster. After a few seconds, my toothbrush began to fly and I started making strange squeaking noises from my nose in an attempt to encourage myself to go faster.

Then I threw the toothbrush in the sink, yanked my pants down and flew ass-first across the room to the toilet.

Thank God my wife has trained me to leave the seat down!

Did someone open a fire hydrant?
OH MY SWEET MARY!
My wife was not kidding when she recommended this as the best laxative on the market. I haven't taken all of them, so I can't say for sure, but I don't imagine that anything could act any faster or clear my bowels any more effectively. In less than 5 minutes after I took the bottle, everything I have ever eaten in my whole life had passed through my intestines.

I think I saw Jimmy Hoffa go by, but I kept flushing to keep the room from overflowing, so I can't be sure.

OK, that might be an understatement. It was much much worse. I'm sure you've had that feeling where your body gets strangely warm and tingly and odd sensation when you really have to go. It was like that for about 10 minutes while I groaned, cramped, and rocketed around the room.

This stuff works!

Maybe I should have been really constipated before using it instead of just bogged down a little.

First Rule of Magnesium Citrate: If you need to go, use Mag-Citrate!

It keeps going, and going, and going...
After about 10 minutes of near constant flow, things began to settle down. I would guess that was because my body was completely empty. I was basically a burlap bag at that point. Had I eaten anything, I imagine that it would have fallen out before I finished chewing. It would be like pouring water into a bucket with no bottom. I didn't actually try to eat anything, because I was afraid to leave the toilet.

Second Rule of Magnesium Citrate: If you use it, never venture more than 5 feet from an open toilet.

After about 5 minutes of excretory inactivity, I felt some more motion in the bowel region. I wasn't feeling real good at that point, so I decided enough was enough, I took my anti-diarrheal medicine. From a medical standpoint, that might not have been the best idea, but it seemed logical at the time. Fortunately, I'm also doing a Great Epinions Write-Off on Anti-Diarrheal medicine, so I had some handy.

Third Rule of Magnesium Citrate: Block off about 3-4 hours in your datebook for personal time.

Even after taking my Imodium, it was several several hours before I felt sure enough of myself to stray from the immediate area of the restroom. I didn't have any more attacks like the first one, but I did have to stop back a few times for honorable mentions.

Conclusion
If you are really constipated, and want relief NOW, Magnesium Citrate is the drug for you. This stuff isn't calm, gentle, overnight relief. This is the Navy Seal Hell-Week of laxatives. Your intestines and rear end will feel battered, weak, and abused by the time it's done, but the job it does is like no other.

Footnote:
I now understand why the Jabberwock in Lewis Carroll's poem was so easy to slay. It burbled as it came. Obviously it had taken Magnesium Citrate prior to battle, and was just looking for a bathroom. After the boy killed it, he only took the head back.

He couldn't stand to be around the rest of the body for obvious reasons.

Fourth Rule of Magnesium Citrate: Never enter battle against a beamish boy immediately after taking Magnesium Citrate.

 

[talker]

"Senna does a number on magnesium, and this is something you don't want at this time, as magnesium is a great bowel activator."

Are you saying that senna reduces magnesium and therefore reduces an element that could activate the bowels?  "A number" could go either way.

When used alone (senna) can affect magnesium . 
Have no actual experience with this, (senna herb used alone) but there is a notation in my book stating so.

[kickingandscreaming]

"Below is a funny product review by someone who was constipated and took it."

Great story.  I don't know if I feel brave enough to try it.  And I no longer have that much "personal time!"

[Shaks24]

I hope you find something that helps. My clinic suggests Mirolax but its in a powder form and you dissolve it in water. It works ok for me when I need it.

[Vt Big Rig]

Ask your doctor/NP about lactulose.

[Charlie B53]

Me thinks Shaks34 must be related to Bob.  Got quite the handle on telling a story.

But there ARE times, after 4 or 5 days, that I might actually consider using something like that.  But maybe less than 1/2 dose, or smaller.  I could always take more later if it didn't work.   Better safe......

[PrimeTimer]

Even tho my husband is diabetic and should not have sugar, sometimes for relief he eats a couple of Little Debbie's Oatmeal Creme Pies. He can always increase his dose of insulin and I must agree with him, it's better than being all backed up and in pain. Otherwise he resorts to his prescription of Lactulose. For overnite relief, about a cup of oatmeal nuked in the microwave helps and sometimes what Congress does/doesn't do will also do the trick. My husband prefers those little cookie pies tho, probably because it's the perfect excuse to eat something sugary. Can't say I blame him.

[PrimeTimer]

My husband uses sugar-free hard candy, the kind with sorbitol in it. Works wonders. It says on the bag excessive use can cause diarrhea , he had it down to a science, how many pieces to eat to get it just right. His Neph and other Drs were aware he used that, even now with the transplant, he will use it in moderation on occasion .

Ooh boy, your husband is right about that! That's why mine doesn't like eating sugar-free candy. In fact, I just threw out a couple bags but perhaps for "emergency purposes", he should reconsider!

[Jean]

Okay Shaks, I laughed until the tears rolled down my face. Kicking and, I was just like you, before CKD, once a day within the first 10 minutes I was up, one movement and that was it. I never had to think about running to the bathroom at the mall. Now, however. Well, at any rate my Dr. has me using a stool softener every day and it pretty much works quite well.

[kickingandscreaming]

Finally, after trying Magnesium Citrate (1/3 of bottle) with no effect; Miralax with no effect and too many others to remember, I finally tried Dulcolax suppositories.  Now I need a plumber to unclog the john.  I guess you can't win.   

[Shaks24]

Yay! The flush of victory. Glad you found relief. Just goes to show how we are all different as far as what works and what does not for us. I do know that drain cycles on PD can be painful and drug out when you are constipated so its a good thing to have the plumbing working well.

[Charlie B53]

Seems like the 'Silver Bullet' wins again!

Seriously, suppositories are a good choice, well preferred over a small warm enema.  Both can get the job done.  I far prefer the slower gentler effects of the 'bullet' then that of the more urgent 'and sometimes smelliness 'flooding' of an enema.

Now if  you can just find a diet combination that will help PREVENT the need, you will be in great shape.

The daily addition of a few pieces of softer fruit, apples grapes, raisins, plumes, prunes, melons, etc..

[kickingandscreaming]

I am already eating an apple/day.  I am hesitant to add too much fruit as I am a Type 2 diabetic and I have been controlling it (without meds) just through low carbing it.  Even 1 apple/day is a departure from my usual fruitless days.  A good plate of beans would set it straight, but would wreak havoc with my phosph. levels.  Frankly, I'm not used to eating as much meat as I currently am prescribed to do.  So I think that is having an effect also.

One thing I failed to mention at the beginning is that I just (last thursday) had laporoscopic surgery to reinstall my PD catheter.  My sense of that procedure (and I sort of remember this from the first time) is that it stuns the GI mechanisms, so I think my whole food processing apparatus is in shock still.  It's now been a day since the great "relief" and I haven't had any action since.  So I'm not out of the woods yet.  And I'm very concerned as I will probably be starting PD training next week and want to be in good shape for it.

[Charlie B53]

Oh yeah, cath placement surgery.  I remember when I had mine they wanted me to stay in the hospital until I had a BM.  Fed me really well.  I opted out and went home.  Maybe should have stayed.  Had a growing 'uneasyness' that became downright painful.  Can't say it was constipation.  I never felt any kind of feelings quite that far down.  Just a growing pain in the guts that almost had me to the point of screaming and calling for an aid car.  After a few days of NO BM and tremendous pain, I felt, and HEARD a 'Pop' in my intestines and the pain was instantly gone.  Within the next hour, or two, I finally had the urge to 'Go'.    All I can think is that a section of the intestines had turned over, or twisted, somehow blocking it off so nothing could pass.  The 'Pop' must have been when it finally had enough pressure to flip it straight and let the accumulated matter pass through.  Immense relief!

I too am diabetic.  Currently using very little insulin, pretty well controlled by diet.  You may be surprised just how much fruit can be allowed.  You just have to be selective as to the type and quantity daily.  A couple of apples, small handful of raisins, a few prunes, will not jump your sugar if well spread throughout your day.  Just remember it is 'moderation', not over-indulgence.  Incorporate the bit of fruit with each meal, or your in between meal snack.

[dialysisuser82]

  two pieces of dried plums with some coffee when you woke up.

             

[hatedialysis2]

Have you tried including probiotics and adding high fiber foods to your diet?   The RDA for fiber is 25g per day for women and 38 g for men.   Most of us do not get anywhere close.  Fiber will also give you the extra benefit of absorbing some of the toxic overload built up between dialysis treatments.   Check the net for a list of foods that provide you with both soluble and insoluble fiber.     

you can check this link on the effect of probiotics on constipation    http://www.health.harvard.edu/blog/probiotics-may-ease-constipation-201408217377

I would check with your doctor before taking any magnesium supplements.   Although it is a remarkable mineral and needed for over 300 enzymatic functions in the body you will want to check your serum and RBC levels before you consider supplementing as renal failure patients do not excrete extra magnesium.   Also, most magnesium supplements out there have a very low absorption rate and do not get into the cells where they are needed.   

[Charlie B53]

Even Diabetics (like me0 can get pllenty of veggies in their diet.

Fresh and frozen, steamed to tenderness retains lots of nutritive value and adds loads of fiber without jacking your sugars.

The trick is to stay away from the sauces that many smother their veggies with.  Those cream and cheese sauces are not your friend.

Carrots, broccoli, brussel sprouts, green/yellow beans to name just a few.  Take a walk through the produce aisle at the grocery, most everything there can be yours.  Take another walk through the frozen aisle, veggies section.  Most all there is good.   Double check with your Dietitian, they should have pages listing which items have more/less phosphorus then if you eat very much take a binder or two with that meal only.

All that fiber will make thing come out much smoother and easier, and STILL not raise your sugars by much.

Many many years ago I had constipation problems.  The VA sent me CASES of Metamucil monthly.  I got to where I hated to even look at a canister.

I had a wise old Dr once tell me that "Prehistoric man did NOT eat processed foods.  If it comes in a can or a box you probably should not be eating it."

I very rarely eat a hamburger any more.  And then if I do I always add extra extra letuce and tomato both.  A guy HAS TO have his vegetables EVERY DAY.

[kickingandscreaming]

Just for the record, my constipation is ongoing and recurrent.  It's getting to be a real issue.  I'm wondering if the real problem is that I am no longer drinking my daily glass of kefir (home made fermented goat's milk with tons mor probiotics than yogurt of probiotic pills).  I had be taking it daily for several years and didn't have a problem with regularity.  I stopped it recently because i got such warnings about avoiding dairy.  I think this could explain a lot.  But I'm still worried about the dairy part.

And I'm eating way more meat and way less veggies than I used to (too much potassium!!!).  I was a vegetarian for 35 years, so veggies have been a big thing to me and now I'm having to be avoidant of them.  This renal diet really sucks and is a very far cry from a healthy eating regime.