CONSTIPATION--problem with so many of our drugs
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Christesta, you're right, IBS changes the equation. Pre-chemo I had to be very careful with any laxative. Now - just need a howitzer. Hahaha, not really, but sometimes feels like it!
Hlb, let us know how you do with the mag citrate.
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Ferrous sulfate caused me problems. My
gastro doc told me to take psyllium capsules. I take 3 a day and 1 fish oil cap. No more problems!!0 -
What I want to accomplish in this post is to discuss: A. Dangers of using laxatives, and B. Define the different types of laxative's, give some examples, and provide links for more information.
This following link is to the free dictionary. The seven "dangers of laxatives" was taken from the free dictionary, but I lost the direct link. OH WELL. I hope it's not too confusing, but I'm going to edit in my comments in parenthesis and italized print. I am starting with the dangers first, as I clearly would like everyone to realize drugs used to change constipation are NOT without consequences when used improperly.
http://medical-dictionary.thefreedictionary.com/laxatives
A. Dangers of Laxatives.
1. Laxatives should be used only with the advice of a health care provider. Sassy:(New onset changes of bowel habits should be discussed with doc. Once a cause is found for bowel changes, then follow the plan you and your doc agree to. If you want to change bowel plan--BE SAFE--talk with your doc. If the cause for the constipation is not found prior to taking a drug like a laxative, it may have life threatening consequences. For example, if a bowel obstruction is present and a stimulant/purgative laxative is taken it may lead to a rupture of the intestine. Please, heed this warning
2. Constipation may be a symptom of serious organic illness as well as the result of improper diet, habits, and Sassy(use of other drugs, we know this one very well)
3. Laxatives taken regularly tend to deprive the colon of its natural muscle tone and thus can be the cause of chronic constipation rather than its cure. Sassy(simple straight forward statement)
4. Mineral oil taken regularly interferes with the absorption of certain vitamins, especially those that are fat soluble. Sassy(A,D,E,K.)
5. Purgative salts(saline laxatives) can produce dehydration. Sassy(Dehydration is not seen with use of the recommended dose under usual circumstances. Again supports why you should discuss a plan with your doc)
6. Laxatives that produce bulk may cause stonelike balls (bezoars) to develop. Sassy(Not sure where this author thought bezoar applied here, it DOES NOT. I left it in sequence for anyone reading the original material might not know, that the word bezoar was an incorrect use of the word)
7. A strong cathartic such as castor oil can have fatal results if used when there is nausea, vomiting, abdominal pain, or other symptoms of appendicitis. It is also dangerous to use during pregnancy. Children cannot use as large dosages or as strong laxatives as adults. Sassy( the thought here is an incomplete list of diagnosis problems. I will list more so that you realize that not all bowel stoppage is related to constipation. List: Stomach emptying problems, small intestinal blockage, colon blockage. Rotation of colon on itself--volvulous, intussuception-like a collapsing telescope, Ileus the wavelike or snakelike movement of the GI tract stops. the term for this wavelike or snakelike movement is peristalsis. The KEY is that Appendicitis is not the only thing that can cause the symptoms described above. As well, castor oil is not the only cathartic that can cause problems
B. Types of laxatives: The following links are from medicine.net. After searching many different threads, I feel medicine.net was the easiet to use. It doesn't however give absolutely complete information. But it does give you a place to start. This is not a complete list of products and this is not meant to be an endorsement or recommendation of any individual product. Many laxatives use a combination of more than one drug to accomplish an evacuation.
1. Bulk-forming laxative: Promotes bowel evacuation by increasing fecal volume. the following link describes how to use them, s.e.'s to watch for, and other percautions. Examples of bulk producing agents are: Psyillium-Metamucil, methylcellulose-Citrucel. polycarbophil-Fiberco, Benefiber.
http://www.medicinenet.com/laxatives_for_constipation/page3.htm
2. Stool softners: Called emollient laxatives, prevent hardening of the feces by adding moisture to the stool. Some examples of stool softners are Docusate sodium, Colace, ducolax.
http://www.medicinenet.com/laxatives_for_constipat...
3. Lubricant laxative: Promotes softening of the stool and facilitates passage of the feces through the intestines by its lubricant effect. Some examples of lubricant products are mineral oil, glycerin, Milk of magnesia. The hyperosmotic laxatives are glycerin, Miralax, Nulytely, Colyte lactulose (Chronulac, Duphalac), all of which act by holding water within the intestine. Lactulose may also increase peristaltic action of the intestine. The following link to medicine.net describes mineral oil and it's probems and percautions.
http://www.medicinenet.com/laxatives_for_constipation/page5.htm#lubricant_laxatives
4. Saline laxative: The active ingredients in saline laxatives are mostly magnesium, sulfate, citrate, and phosphate ions. These ions draw water into the intestines. The additional water softens the stool, increases pressure within the intestines, and increases intestinal contractions resulting in the discharge of softer stool. Fleet Phospho-Soda, milk of magnesia, and magnesium citrate are examples of saline laxatives.
http://www.medicinenet.com/laxatives_for_constipation/page7.htm
5. Stimulant laxative: Induces bowel movements by increasing the contraction of muscles in the intestines, and are effective when used on a short-term basis. Examples of stimulant laxatives include aloe, cascara, senna compounds, bisacodyl, and castor oil. Bisacodyl (Dulcolax, Correctol)
http://www.medicinenet.com/laxatives_for_constipation/page6.htm#stimulant_laxatives
Cautionary note:
1. Enemas and suppositories should never be used in a low immune state or while under care for your cancer without the explicit instruction of your MO.
2. As always consult your doc on any information discussed here.
Please, take the time to read thread from the beginning. So, many have offered great suggestions
Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out shouting "holy crap....what a ride" SAS
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Chrisesta, b/c of your IBS/IBD how you respond to any of the drugs under the laxative class are going to cause your bowels to respond differently then expected. Sorry. Start with the lowest dose of any laxative. Check in on IBS/IBD web sites for suggestions
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I haven't read through all the posts, so I apologize if someone has already mentioned this. I had issues with constipation before cancer due to frequent long distance travel---jumping time zones can mess up your body's routines. But I have had success with acupressure. There are no needles involved, and you can do it yourself. The main points are (1) 1-2 inches below the navel, (2) at the base of the webby part of your hand between the thumb and index finger [NOTE: everything I've read says pregnant women should NOT use this one], (3) just past the elbow crease when you bend your arm and put your hand on your chest, (4) at the base between the big toe and second toe. I try to press and maintain pressure for ten deep breaths at each point two times a day---before I get out of bed in the morning and when I get into bed at night. The schedule is not important, just doing some every day.
Please note that I am not an expert. I got this info from books and tried it on myself. I hope you find it helpful.
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Snorkler, no one has mentioned this here before, and it fits totally b/c we all travel. Even under normal conditions many people complain of constipation associated with leaving home. I put a link on the insomnia thread about resetting the circadian rhythm after air travel. Which would help the GI tract. IF i can locate it, I will add it below. Thanks for adding this
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I finally went through all the posts and found lots of helpful information. Thanks to everyone for keeping this thread active!
I don't think anyone mentioned chicory or dandelion. When these roots are roasted and ground you can make beverages from them. I'm not exactly sure how they work; I think they stimulate the liver which gets the whole digestive tract going. Also, since everything we ingest (including medications) is processed by the liver, it makes sense to keep it in good shape.
In other countries these products are more common. Here in the US I found a coffee substitute called Pero in one of the local supermarkets; it is a mix of roasted grains plus chicory. It is water soluble so can be easily added to regular coffee if you're not crazy about the taste. The dandelion root tea I got from drugstore.com. It has a mild, almost nutty flavor. There is a coffee substitue called Dandyblend that has both chicory and dandelion. When I go through what I've bought already I'll probably try it.
One last thing before I forget: fresh ginger. I add a nickel-size piece to either the dandelion tea or regular black tea once or twice a day. You can also just pour hot water over it with a squirt of lemon and/or lime juice. It's supposed to be good for the digestive system in general. Best of luck to everyone!
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A pebble dropping in water creates and untold wave.
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Thanks for all of the good advice.
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Try Miralax. I use unflavored. By second day, able to poop. Other meds for producing bm make me very nauseas. Good luck. Drink LOTS of water. 64 oz.
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I'm starting this post with a link back to another post that I wrote about my Pain and Poop Chart. http://community.breastcancer.org/topic_post?forum_id=6&id=781867&page=9 I also want to say that I tried MANY of the suggestions on this thread and none of them worked during my chemo weeks. I'm not saying that they aren't good or reasonable normally, just that they didn't work for me and that's why I was in a mess.
What I did not write about was the fact that the constipation may have been affecting my WBC. I had not been able to finish a whole round of my oral Xeloda (I also get Ixempra by infusion) since the very first round in April because my WBC would always tank. Even the first round I had to have neupogen shots. This was coupled with severe pain and severe constipation.
On Round 4 of 6, my MO put me on a Fentanyl pain patch and prescribed a combination of Lactulose and Senna S for the constipation. You can see the prep that I did for that round in the link above. The results were kind of amazing! I didn't automatically get regular bowel movements. (that may NEVER happen) But I did not have hard, dry, very painful stool that could have been causing microtears in the lining of my bowel and rectum.
There is evidence that microtears can cause the body to send white cells there to stem infection in the area. I believe that the microtears and my body trying to prevent infection was part of the problem with my low WBC during chemo. The combination of microtears and chemo dropped my counts too low.
I had labs the week after infusion (when I also began oral Xeloda). Counts were down and I had one neupogen shot. Stopped the Xeloda. Had labs one week later and counts were up - no neupogen and started 2 more weeks of Xeloda at a reduced dose. I was skeptical that my counts would be good enough after 2 weeks of Xeloda to do the next infusion but was hopeful since the Lactulose/Senna S combo seemed to be working.
Round 5 of 6 rounds of Xeloda/Ixempra - I had a dose of mag citrate 2 days before chemo (Sunday) since it takes a long time to work in me, to be sure that my colon was reasonably cleaned out.
Had labs the day before chemo (Monday) and they were NORMAL!! For the first time since starting chemo. And this is after two full weeks of Xeloda. I had chemo the next day (Tuesday) and for the first time ever since starting chemo I had a bowel movement on chemo day. Then again on Wednesday.
All of that is to say that, in my opinion, we should not discount the role that pooping plays in our treatment and health. They are not two separate things, they are intricately interrelated. I know that some of the success with my WBC is due to lowering the dose of Xeloda, but I also know that some of the success is due to getting my colon working again. Poop Power!
Another note: some chemotherapy drugs, like Ixempra, are metabolized and excreted in the feces. There can be a small portion of the drug that is NOT metabolized and is excreted in the feces. If the feces are hanging around in your colon for 3 - 5 days, it is not a GOOD thing. I found this information on dailymeds.org that sassy recommends.
I hope you were able to slog through this long post and that there is something in here that might help you during your treatment.
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To all, we all have discussed chemo/ anethesia brain. We now can call it anesthesia/chemo/drug brain. This article is in AARP magazine. It discusses the drug classifications that can cause memory loss. It describes why each drug class can cause memory loss. It gives specific names of drugs. It gives alternative drugs that can be substituted. I would suggest reviewing it with your prescribing doc if you have concerns regarding any of your meds. I also suggest you put it in your favorite places on your computer. Also, printing it off for future referrence if you have a printer. Please, pass this on to other BCO friends, friends etc.
sassywww.aarp.org/health/brain-heal...
Haven't been here much in alongggggg time, but this artcle is a MUST SHARE type with those I care about
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Not sure if this has been mentioned- but blackstrap molasses helped me 100% when it came to my hemmeroids and the consitpation that happened. I wrote a blog post about my experience if no one minds that I post it. Be advised it is not suitable for work or more sensitive dispositions. http://www.super-crush.com/blahblahblah/?p=153
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JWoo - blackstrap molasses helped me too!! I was skeptical since I'm not a folksy remedy type person, but after one spoonful I felt reduction in less than a day. I only had to do a spoonful a day for about a week before they went away. Now I do Miralax to keep me regular but at least I don't have to deal with the hemorrhoids anymore!
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Cougarlicious-
It was a lifesaver for sure! I actually stopped taking anything else after about a week. No issues at all with constipation anymore and I really think it is mostly the molasses that is doing it. Sometimes grandma really does know best and those old folk remedies are the best thing! (Obviously checking with all your doctors first before proceeding of course.)
It probably helps that I am a vegetarian (though not having FRESH veg to eat has been a huge part of the problem and also just torture for someone that loves crunchy veg) but I am ovo/lacto, with a huge love of cheese and still eat plenty of it.
Meat is digested mostly by the bacteria that used to live in your intestines, so, if anyone is a big meat eater, maybe cut down a little to see if that helps?
I do drink a smoothie a few times a week with prune juice and unsweetened Bulgarian yogurt in the mix, so that is helpful as well.
Anyhow- I hope this info might help someone, and best of health, luck and love to everyone!
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I have never had any luck with laxative find a right, um, balance. Once I started adding Chia seed in my diet I really never had a problem. Adding a heaping tsp to a 10-12 oz smooth had the desired effect and I didn't feel nervous about when it would hit
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Now almost to my last chemo T/C. My most hideous constipation happened when I had to take narcotics for surgical pain due to a bad staph infection. That was solved with Colace and Benefiber.
Now how I handle the big C is tons of hydration, 2 teaspoons of benefiber in my morning coffee, a Colace, stewed prunes (I cook a lb with a half cup of water on low with one Equal and a bit of cinnamon; about a half hour tip a nice sauce forms, if it gets sticky during cooking at a bit add a little water). Just 4 prunes a day is fine. I might add an Activate light yogurt. The walk my dog to get things moving literally. Works great!
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Does anybody else have an oncologist that pushes Miralax? Mine told me to start taking it daily, and then told me, "Don't stop taking it!" She said that people have terrible problems with obstruction when they stop it. She said, "It really is a miracle laxative." But I'm thinking, how miraculous is it if people become dependent on it? Is anybody else getting this advice from their doctor? Basically, she's telling me to take it for the rest of my life.
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Got to warn you all, particularly stride. Now the silly T/C regimen has me on the other spectrum, diarrhea. For that reason I would advise more of a wait and see before you load up on everything, particularly a daily laxative. Now I'm taking Imodium and I have never had this problem before! Ugh.
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It depends on if you get constipated. I was severely constipated and my MO said to take Colace. It didn't really help that much so she added Miralax daily along with the Colace. It has helped so much! I know that the Taxol causes my constipation so I see nothing wrong with needing the Miralax. We all need different things to help with the side effects of the various drugs we're on so if I get "addicted" to Miralax at this time in my life so be it. However, I'd wait if I were you just in case you have the opposite problem because some people do. Good luck and hoping your chemo gives you no SEs.
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Colace did nothing for me either, my OB recommended I try Miralax, saying it was the best aid to constipation out there. And so far she's right! But I don't plan on taking it the rest of my life, just through chemo as I never had constipation issues until now.
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Recently read the October issue of Life Extension magazine which has an article about constipation which recommends effervescent vitamin c and magnesium crystals - saying that fiber/bulk doesn't work for many people.
http://www.lef.org/magazine/mag2013/oct2013_Immediate-Relief_01.htm0 -
Bump---I watch this thread and bump every few days to keep it active. Thanks to all that post. All your posts are helping others in a very relieving way0 -
Doc has me eating pears. Dried are more effective and dont make me as gassy as prunes.0
