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CONSTIPATION--problem with so many of our drugs

This thread will talk about constipation. The nemesis of cancer patients. If you post helpful information make sure to identify that all recommendations should be cleared with your doctor. Preferably, your Gastroenterologist (GI doc) or Primary Care Physcisin PCP). Cancer docs, I would say that this isn't there strong suit.

Page 44 . Description of Squatty Potty

Description of normal defecation

Page 10 description of Laxatives, emollients, stool softners, and usage dangers:

Page 12 has a Question list & treatment plan to discuss with doc. Used several times as reference, I decided page 12 had so much info on it, I'd link it here.

NIH National Cancer Institute : Gastrointestinal Complications–for health professionals (PDQ®)

Link to rectal Issues thread:

Link to main BCO board thread:

Amusing :)Five Constipated Men

Puns are welcome, not often we get such a situation that is more worthy.



  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    59 minutes ago, edited 21 minutes ago by sas-schatzi sas-schatzi wrote:

    This was a post to someone else re: hemorrhoids, But all the concepts appy to the prevention of diverticulosis which leads to diverticulitis. For us the great offenders for causing both are PAIN MEDS, poor fiber diets, poor hydration, and alcohol. AND all the chemicals they give us that cause constipation.

    Post hemorrhoidectomy:

    it's truly a pain in the butt. I'm sure they gave him a ring to sit on.. Docs are different as to when they tell them to increase the fiber in their diet. The point of which is to allow for bulkier stools. When bulkier stools pass, they naturally dilate the anus. This helps to keep scar tissue from tightening the anal opening. At first he will not be happy. But there are several things that can help. The body has a natural time that it wants to evacuate in the morning. The key here is to never deny that urge. So, always allow time in the morning for this to happen. So, you need to factor in always getting up early enough to allow sufficient time to respond to the urge. Drinking a warm glass of water at least 8 oz's can help.  For some it may have to be 2-3 glasses. Lemon added to the water helps some. Some swear by coffee. But hydration along with the fiber is a must. Too much fiber without proper hydration will lead to a dry constipated stool.

    Backing up for a moment-----the large colon has several functions. One is related to the absorption of some nutrients, but that is not cogent to this conversation-------so I will bypass it.

    The colon stores stool and reabsorbs water. Stool exits the small intestine on the right side lower quadrant. at that point it is the consistency of sand. It then travels up the right side across the top part of the abdomen , then goes down the left side, The last portion of the large colon is called the sigmoid colon. It generally has a shape that could be described as a "s". In truth, it's shaped differently to a degree in each of us. As the stool moves along this path more water is absorbed from it. By the time it reaches the sigmoid colon it becomes formed.

     If the core body lacks enough water, it draws more fluid out of the stool. In this case then the stool that reaches the last part of the colon will be very dry-------constipated------hard. The muscles of the colon wall have a very hard time pushing it forward. If this occurs the stool in the rectal vault-the portion just above the anus becomes very hard and difficult to pass. and painful. They look like little hard rocks. In pushing this hard stool out, the pressure causes the blood vessels to dilate. These dilated blood vessels are called hemorrhoids.

    They are analogous to varicose veins of the legs or esophageal varices of the esophagus, or aneurysms.The point being when blood vessels in the body are put under too much pressure in the body , they will dilate. Eventually they will burst and bleeding will occur. The larger the blood vessel when it bursts the greater the bleeding.

    The needs of the body for fluids are dependent on climate to a great degree. Each individual has a different need. Your doc and reading will describe range. 8-12 oz glasses a day. But again each body is different. Plus there may be other conditions that can influence how much you can drink i.e heart and kidney disease.

    Using two supplements can work to your advantage and also promote health of the rest of the body. Omega 3 OIL either Flaxseed or fish. Buy a good brand from a healthfood store. Some brands should never be exposed to heat and need refrigeration. I would never buy off the super market shelf. The second is superdohilous -it has acidopilous and multiple other strains of normal colon bacteria. The quality again is based on where you buy it. Of course discuss this with your doc.

    SO, the plan to train the colon:

    1.In the morning allow enough time to take a proper poop. That may mean adding ten to 15 minutes to your morning routine.

    2 Immediately upon awakening drink the warm water 8 -16 oz's. That will begin the process that gets the trained colon to be prepared to function within a short time. Continue with usual routine shower / shave etc. As soon as the colon signals it's ready to go. Don't delay go. If you delay the body starts to reabsorb that water from the stool at the end colon. Too much of a delay can lead to constipation.

    3. Keep the colon healthy by eating between 25-35 grams of fiber a day-average 30gms.The amount needed is being changed by science in these last few years, so, don't be surprised when you read different numbers. General Mills Fiber One has the highest cereal fiber content in the smallest amont of food . I swear they stole my phrase taste like cardboard.  "No longer tastes like cardboard". Definitely has improved over last few years. If you started off each day with a 1/3  bowl you can meet a 1/3 if the days requirements. The average American only gets 12-13 gms of fiber a day.

    4 Drink enough fluids otherwise you will become constipated. 8-12 glasses a day.

    5 Consider adding omega 3 (flax or fish) and acidophilous to diet(more that what yogurt offers) which colonizes the last portion of the small intestine, and bifidius and many more colonizes the large intestine. Superdophilous is a probiotic that includes many of the good bacteria. Should be purchased through a reputable nutritional store. There is still much debate about Probiotics. If you wish to google it, please, use the following search term "Evidence based researech probiotics".

    6 Be aware of the things that alter bowel function------PAIN meds, alcohol, antibiotics, other prescription meds. Dehydration. Illness. Overuse of antibiotics. Some medications can affect the motility of the gastrointestinal tract. This means it slows down or speeds up the way the muscular layer of the GI tract works. Other drugs kill off the good bacteria of the GI tract.

     This covers the basics, great topic eh?

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Definitions . Diverticulosis-------Osis is the suffix used to mean "condintion of"----Diverticula is the formation of small pouches that form in the colon wall. Putting the two words together Diverticulosis is the condition of having pouches in the colon wall. This can start in the 3-4 th decade of life. Most people have them by the 7-8th decade. They may never cause a problem, and only be known about because a colonoscopy was done. These pouches are analogous to the bubbles formed on inner tubes when to much air pressure is put in the tire.  In the case of the colon, the pouches form b/c of too much pressure on the colon wall created by constipation.

    Diverticulum is the word used to describe a single pouch. Diverticulae is the term used to describe more than one diverticulum.

    Diverticulitis is the word used to describe inflamation of one or many of these pouches. "Itis" is the suffix used to describe inflammation. Signs and symptoms: Pain, generally left sided, can be low middle and even low middle right. It depends on where the diverticulae or diverticulum is inflamed.  So, b/c female reproductive organs are in the mid to lower abdomen right & left for ovaries and mid for uterus, pain of diverticulae can wrongly be assumed to be related to female organs. History of frequent constipation with severe pushing to evacuate stools is important information in the history. Outcome in time, one or more of these diverticulae can rupture. This allows leakage of bacteria of the colon into the sterile abdomen. Another sign can be what's called pencil thin stools. That means the stools start to become thinner and thinner over time. This is present in longstanding diverticulosis b/c the wall of the left colon starts to thicken to try and help push out the  hard stool. Thus, the channel that the stool goes through is narrowed and the stools become less and less bulky, and become thin as a pencil. There also can be bleeding b/c the blood vessels in this area are broken b/c of the pressure. This blood will be red b/c it is coming from blood vessels in the colon wall versus blood coming from the stomach. Blood that is coming from the stomach will be black b/c it's mixed with acid. In the case of bleeding from diverticulae, the stools may be streaked with blood or may have more pronounced amount of blood. It all depends on how large of a blood vessel that has ruptured. Blood on stools does not mean that there has been a rupture or leakage of stool into the sterile abdomen. Fever is a sign that a diverticulum has ruptured into the sterile abdomen. Fever is the bodies response to a systemic infection. This rupture doesn't have to be large. Pinhole leaks can lead to significant response by the body.

    People that have diverticulosis may often have hemorrhoids too.

    How the Diagnosis is made: the condition of diverticulosis is often made by colonoscopy in a non acute situation. In the acute situation where a rupture is suspected  based on the signs and symptoms that the patient presents with, a Cat Scan is the diagnostic approach of choice. A scope done in the acute situation can cause further harm. In fact if a rupture is suspected,  a scope generally won't be attempted for at least six weeks after healing is allowed to occur.

    Management in the least acute situation to the most severe:

    1.Least acute: Surgical intervention is determined not to be needed at present and the patient is managed medically. This is usually done by the following: nothing by mouth until pain is gone and oral antibioticss, then advanced to clear liquids, something like Ensure or Boost, then soft low resisue foods, then regular diet.

    2.Next level: Surgical intervention is determined not to be needed and the patient is managed medically, but the situation is worse than in #1. Patient is not given anything orally, and IV antibiotics are used. The patient is advanced based on s/s's and diagnostic tests the same as the advancement described in #1. Clear liquids through to regular diet. With this colon surgey is not indicated at the present time. But Cat Scan indicates the presence of changes in the colon and signs that there is inflammation in the area. The approach here is to let the colon calm down, let healing occur and avoid surgical intervention.

    3.Next level is a severe situation where the diverticulum has leaked/ruptured into the sterile abdomen. Management is by surgery, damaged portion removed, and a colostomy is performed. A colostomy is creating of an opening into the abdomen where a healthy portion of the colon is attached to the surface of the abdomen. This opening is separate from the main incision in the abdomen. This type of patient may be "nothing by mouth" and on IV antibiotics for several days before surgery. The surgeon will describe for the patient the possibility that this colostomy may be reversed in 3-6 months. Food is not reintroduced until colostomy shows evidence of working. The intoduction of food is done in the same sequence as described in #1.

     4. Next level of severity is the diverticulum has ruptured. If surgery is performed immediately without the advantage of several days of antibiotic therapy, it's an indicator that the rupture is large. The abdomen is sugically opened. The surgeon analyses the structures and extent of damage in the same fashion as in #3. The damaged portion is removed and a colostomy is created. What is different is that based on the evaluation of the surgeon, the damage is so extensive that the colostomy may be permanent. A permanent colostomy in this acute situation is not an absolute outcome. Surgeon's are mindful of the change that ostomy's bring to a person's life. So, even in the most acute situations, the surgeon may opt to try for a reversible colostomy.

    A gastroenterologist may recommend to a patient based on their history of diverticulitis occurrences that an elective colon resection be done. This recommendation may seem drastic, but it is done in the patients best interest. An elective colon resection can avoid the worst case scenario of having a rupture that leads to having to have a colostomy either reversible or permanent. In an elective colon resection, the surgeon removes the section of the large intestine that has diverticulae.

    Web MD teaching article

    webMD slide show

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Hope this all helps.

     Your reading on the drugs is true. MY nemesis was Celebrex. It had a black box warning in the Pysicians Desk Reference not to be used with anyone with a history of ulcers, diverticulosis, diverticulitis, has been known to cause spontaneous gastric rupture. I took Celebrex in 2001 and ended up with a colon resection. I avoided the colostomy by having the offending portion out. In the diverticulosis section I had # 2.--- we then waited six weeks and did and elective colon resection.

    As far as Nsaids look at the package insert for any drug. It will be the same as the PDR. If it advises that it should not be taken under the same circumstances as the Cox 2 inhibitors>Celebrex,mefoxicam etc. Don't do it. Ask your pharmacist to look the drug up in the PDR.

     All Narcotic pain meds cause constipation.

    As far as food , there is so much controversy on this, it's a quagmire. So, I'll offer no comment on it . Sorry, it's that controversial. I won't even comment on what I do.

    Never heard the word stoma rerun. She may be referring to a colonoscopy.

    Should probably make a topic thread out of this material. Constipation for cancer patients is a huge issue.

  • apple
    apple Member Posts: 1,466

    it is a great topic SAS..

    i believe in controlling it aggressively and naturally.  for me (after a well sedated surgery) that included senna.. and fiber supplements.  The think i like about senna tea is that you can take a sip periodically thruout the day and maintain smooth moves and never have the explosive stools that are so dangerous. 

    What do you think about senna tea?  I buy it as 'slim tea' in the Chinese grocer and brew a cup a day.. I often don't drink the whole cup..


  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    - Well folks new thread on constipation

     Apple sweetie, Senna has been used for years as a stool softner. Please, be the first to post on the poop thread LOL

     Senna is used in many prescription and OTC drugs

  • Springtime
    Springtime Member Posts: 3,372

    MiraLAX saved me so many times!

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Miralax has been the friend of many , But it can be expensive. Thanks for your comment springtime--sheila

  • carol57
    carol57 Member Posts: 1,550

    I happened to sit on an airplane next to a rep from a small pharmaceutical company the other day. He described his company's drugs, including one that caught my ear:  entereg, which is an IV-administered drug that can be used during surgery to prevent the drugs and narcotics administered during surgery from shutting down intestine/colon function.  Apparently not every hospital includes this in its formulary, but after my 'shut down' experience post bmx/recon, I know for sure that I would ask my surgeon about this option if I had to do another long surgery.  This drug will not help constipation caused by post-surgical and ongoing narcotic pain relievers, because it's an IV-only drug, but it's worth asking about if facing surgery. It somehow interrupts a narcotic's impact on intestines/bowel without interfering with the desired pain relief.  I am reciting this from memory and hope I got it right. Perhaps someone else is familiar with it and will explain it more or better.  

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Carol------ oddly enough when Entereg was in Phase 2 clinical trials, I came across it somewhere.  It was the first individual stock I bought. It's produced by Adolar. Glaxo bought the rights for distribution , but I think that may have changed.  It works on the  MU receptors in the gut to block narcotic effect.It has to be used within one hour pre-op and the until bowel sounds return or 5 days. It was so promising, but  when it got approved , hospitals that use it, have to have special training of pharmacy and nursing personnel. After loosing most of my money, I dumped the stock, but that was when it had been rejected /delayed by FDA.
    But my selling of this may have been premature. The whole story on Entereg hasn't been written. Perhaps overtime, it will not be considered the problem it is at present. Remember all drugs have consequences.

     The reason I bought it was, If the drug was approved--it meant all patients pre-op would likely get it-------that's huge world wide. The second application that they would then try to develop would be for use with those that take narcotics on a daily basis-------that's huge worldwide.  I dreamed of being rich.. My little bit of money helped them continue the development of their drug, all I got out of it was a tax deduction LOL and tears LOL. It's now approved as cited above. If it turns out as I had initially hoped. It will be one of those OH WELL experiences.

     Your description is right on mark. Carol.  Sheila

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Edit:1-/22/2013 7 am. Plugging in here this response to a member re: medication used in people with ahistory of colon problems

    FYI--this is for all future times b/c of your hx. Great care and observation should be used when taking any med that can change bleeding time I'll list a few classes, but do not consider it a complete list.

    Platelet(Clotting) inhibitors :

    Low Molecular Weight Inhibitors(LMWH)---lovenox, arixtra, fragmin, xarelto---this group of drugs would be particularly dangerous for you someone with gastrointestinal bleeding history b/c there is NOT a reversal agent. A reversal agent stops the drug from working.

    Platelet inhibitors different than the heparins(easy way to think of them). Ticlid, papaverine, Plavix(newer drug in the Plavix family forget it's name) None of these drugs have reversal agents either. Warfarin/Coumadin -has a reversal agent

    Regular Heparin--has reversal agent.

    NSAIDS(non-steroidal anti-inflammatory drugs)--Motrin, Ibuprofin, advil, aleve, naproxyn, and Tylenol. No reversal agent for any.

    Cox I inhibitors--aspirin. No reversal agent.

    Cox 2 inhibitors--Celebrex, mefoxicam----not sure what else in this class is left on the market. Personally, after a great deal of research and approval of 4 docs Celebrex exacerbated my divertic. and I ended up with a colon resection. In a do over I would have trusted the PDR NOT the docs. Black box warning [not to be used with anyone with a hx of diverticulosis, diverticulitis, ulcers, has been known to cause spontaneous GI rupture]. I had hx of OSIS and ITSIS.

    Herbs and oils: Flaxseed/fishoil, ginger can intersct with Coumadin. Not near a complete list

    Please, use ""--the one, to study any new drug. It has as much or more info than the PDR(Physicians Desk Reference).Transferring this to the constipation thread as I don't think I did this in depth there :)

  • pupfoster1
    pupfoster1 Member Posts: 176

    Oh God this was such a MAJOR issue for me during chemo and then with the narcotics.  I actually would cry it hurt so hard to go.  I tried it all.  Stool softeners, Miralax, nuts, Prune juice, Metamucil, then even enemas.  The stool had gotten so hard it was like a big rock trying to come out.  Tore me up.  The trick is to load up on fiber, stool softeners, etc. BEFORE your tx, surgery, whatever so you can stay ahead of the problem.  What sucks is I never had any issues there before all this crap (no pun intended).  Was regular as can be.  Finally I'm doing better but still have some bad bouts and end up with a painful hemorrhoid.  Oh well, at least I'm here to complain about it right? 

    Take care all,


  • sundermom
    sundermom Member Posts: 98

    Senokot - 2 tablets at night and 2 tablets in the morning. I agree with what some have said here. You have to head off this issue BEFORE it really becomes an issue :)

  • apple
    apple Member Posts: 1,466

    oh and prune juice.. problem is .. i really love it.  i have to set strict controls.

  • voraciousreader
    voraciousreader Member Posts: 3,696

    CVS and now Walmart under the Equate label and Walgreens now sell a generic MiraLax for a lot less! Amen!

  • BlueCowgirl
    BlueCowgirl Member Posts: 132

    Chiming in as someone who can count on one hand the normal bowel movements I've had in the past year...Thankfully, have only been in the sobbing mess on the bathroom floor situation a few times.

    Thanks for all the great information. One thing I'd like to add re: Senna - until recently, I took a generic version that had basically the same inactive ingredients as Senakot. I was getting stomach cramps after I ate a meal. EVERY meal. I read the ingredients on the bottle and was horrified. Switched to "Nature's Way" brand, which is basically just ground Senna leaf in a plant derived caplet, and VOILA! no more post-meal stomach aches. If Senakot is working for you, great, and I hate to slam it, but...If you are having post-meal abdominal cramping, switching might help!

  • tenaj
    tenaj Member Posts: 365

    Warmed prune juice or cooked prunes with its liquid even works better, especially if you follow it with a cup of coffee.

  • stephN
    stephN Member Posts: 133

    I'm with the prune girls.  I eat five prunes every day.  After all the surgeries of the last few months, it's been an ongoing problem.  The prunes help keep things regular.  And, if worse comes to worst, I'll use a glycerin suppository for the short term.  

    Yikes.  Love this conversation!  ;o) 

  • lulubee
    lulubee Member Posts: 903

    My mother's trick: she always soaked prunes and dried apricots overnight and then ate them with breakfast. She simply put 2-3 of each in a juice glass, covered them with water, covered the glass with a saucer or something, and left them on the table overnight.  

    When I had my BMX and recon surgeries, the Chinese medicine doctor I saw for accupuncture recommended a couple of things that helped me with post-surgery constipation.  He said to get a tablespoon of honey down first thing every morning -- either straight off the spoon, on toast, or dissolved in green tea.  He also said to keep a few small, cold watermelons and put them in the blender -- rind and all -- and sip the juice throughout the day. I did that and I do think it helped.

  • Linda54
    Linda54 Member Posts: 509

    I am so glad you started this thread Sheila.

    I use to go every morning then wam...has not been the same since my surgery...going on 4 yrs. I have tried everything and nothing seems to help except Cascara Sagrada 450mg. It is an herbal supplement found in the vitamin section. It is for digestive health.  I do not take it everyday but when I feel the need I will take one for several days in a row.  It helps me.  I had surgery last summer to repair a rectocele.  I really do not need to be getting constipated but it happens.  I want something that will make me go everyday but the extra fiber does not do it for me...I am on two scripts and the rest is supplements.  I am on Clondine for hot flashes and a diuretic to keep my kidneys from pulling out too much calcium in the urine. I was having problems before I went on these.  I have heard that taking calcium supplements will cause constipation. Is this true?

  • lulubee
    lulubee Member Posts: 903

    Yes - I also use glycerin suppositories.  The good thing about them is they work within 10 minutes which is very convenient at times.

  • Laurie08
    Laurie08 Member Posts: 2,047

    1/4 cup of virgin olive oil mixed with juice.  Drink wait one hour, if no results- repeat.  I have been told it can not give you diarrhea, which other methods can create.  I had 2 babies via c section then a BMX all with in 3 years.  I gave it a go and found it more comfortable than prune juice. 

    Just thought I'de throw it out there :)

  • sas-schatzi
    sas-schatzi Member Posts: 15,875

    Linda , calcium supplements can cause constipation. Makes it a real problem when the Aromatase Inhibitors cause osteopenia/osteoporosis. So, we definitely need to get our calcium from food sources versus supplement.

  • Linda54
    Linda54 Member Posts: 509

    I was DX with osteoporosis in my spine and osteopenia in the hips a few months ago. I am not taking any of the meds. I am treating myself with Strontium Citrate and K2.  I may try to see if I can get enough calcium through the foods I eat. That may be difficult to do. My osteo was caused from too much calcium going out in my urine...that is why I am on the diuretic.  I have not taken any aromatase inhibitors. Thanks

  • msmouse
    msmouse Member Posts: 2

    Really glad to see this topic! I was always one of those folks that was able to "go" 10 minutes after I woke up. A small hemorrhoid (a gift from my pregnancy 26 years ago!) that never bothered me. Knowing now what I didn't before chemo I would have listened to the G.I. doc about taking care of it after my colonoscopy 2 years ago. Chemo ended mid Oct but the hemorrhoid is just now settling down. My G.I. tract has gotten back on the right path finally! I have always been fiber person & I loved stewed fruit with my oatmeal. Living in the desert you always have water around. Once chemo started I couldn't go for days even with the fiber, fruit, fluids. Senna, Miralax, and glycerin as a last resort. The ladies taking calcium? are you taking extra magnesium? I find the magnesium helps with the constipating issues of the calcium supplements. As soon as the rads are done I am headed back to the G.I. doc & having my "little gift" removed. Just in case!

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,641

    Hooray for prunes, which are now being marketed as dried plums! Senna tea can also be found as part of a line of herbal teas. The senna variety is called Smooth Moves.


  • ptdreamers
    ptdreamers Member Posts: 639

    Calcium citrate doesn't seem to have the same constipating effect as calcium carbonate.

  • Linda54
    Linda54 Member Posts: 509

    thanks ptdreamers.....I read about the calcium citrate...and I do take a magnesium supplement.  Starting today I am going to do a test...leave off the calcium for a few days and try to consume all I need in foods.  I will let you know what happens.

    I tried drinking a cup of warm water this morning when I first got out of bed....went as soon as I felt the need...but I did take one of the Cascara Sagrada capsules last night.  It is recommended that you NOT take this supplement longer than 7 days straight.  I usually take 2-3 days straight then leave it off until I feel I need it again.

  • fredntan
    fredntan Member Posts: 237

    I've never had the best bowels, and then boom my first sx-mast. things havn't worked right until last week. finally listened to my dd and tried a probiotic. I had tried the miralax, the glycerin supp., had lots of fiber, drinking lots of water, coffee, the Probiotic is a lifesaver for me. I didn't clear it with my MO-I have five weeks of chemo left. But I read about it in the cancer book they gave me

    what about the hemoriod I have now? does it just go away? I'm 45-can they do a colonoscopy a little early since I had BC?  

  • claireinaz
    claireinaz Member Posts: 662

    Magnesium caps (up to 800) at bedtime, pericolace (brand name) too, and milk of magnesia during the day if I feel "slow". Drink LOTS of water (I drink about 80-100 oz daily). So far just a bit of problem with the whole constipation issue.


  • BlueCowgirl
    BlueCowgirl Member Posts: 132


    I had what MO diagnosed as bleeding hemorrhoids which bought me a ticket to a colonoscopy at 38...But I haven't had it yet because my radiation oncologist DID NOT want it done right before or right after Rads, and since then I've had a slew of other stuff going on (reminds me, need to make that appt!)

    My point is a) you can probably get one covered and b) if you are getting radiation after chemo, your radiation oncologist may ask you to wait unless it's a real emergency. Good luck with the rest of your chemo!