CONSTIPATION--problem with so many of our drugs
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YAY Judy, you have been through so many years of trouble, to have found NORMAL, another YAY. Another thing that is happening, I believe, is that your colon is still healing after so many years of insult. It takes along time for the colon to heal itself, a year or more. Not surprised, it's a couple years in your case. Tissue and the Microbiome. Remember to feed your bacteria well
Lily, Again please read the Diverticulosis post on the first page. You will see a description of why pencil stools occur. It's a consideration of origin of that type of stool. Also,Yes, tumors can cause it too. Having a GI doc do the appropriate studies to determine cause and treatment is what you should work towards. Hope you pooped and are OKAY
Susan, looked at the net for Coca-Cola. Saw posts, but nothing based on science. It may show up in later questioning. I have found at times if I looked a few days down the road after a initial search things pop up that didn't before, with the exact same question to the search engine. But I can relate to the unusual. After my only delivery, I was constipated. The resident ordered a Milk and Molasses enema. It was the most gentle thing I experienced. What amazed me was I had been in nursing since 1969, it was 1984. I had never heard of it.
What I thought at the time was how did someone conclude that Milk and Molasses was okay to use? Same with Coca-Cola for a sitz bath? If it does no harm, and feels better, then .....................................
Now I have to go look up M&M enema's OCD ..........
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Smurfette, I reread my response re: your suggestion of Dulcolax. I didn't mean to diss Dulcolax suppositories. They are great. My brain was running in the line of thought, of what was best in Lily's scenario. With the rectal vault so full of hard stool, if a Fleets was allowed, it's oz's of liquid had more of a chance of moistening the stool. Plus, with so much stool, they're is the problem of inserting the suppository into the middle of the stool. Eventually it will work, but will take longer.
It does raise an interesting thought. Hope I phrase this right.
If all enema's are contraindicated in an immunocompromised b/c of the potential of micro-tears in the mucosa leading to systemic infection, can a Dulcolax suppository be safely used?
Previously, many pages ago, I stated that nothing should be put in the rectum of an immunocompromised person. That is an accepted knowledge. But in the scenario of an impaction where the impaction needs to be removed in a different way to get things moving safely, again is it safe to use dulcolax suppository. Sheesh, just going to call the company.
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Looking for info re: above question came across this. Good info. Much is cover in these 30 pages, but nice to have a single page source
Gastrointestinal Complications–for health professionals (PDQ®)
.http://www.cancer.gov/about-cancer/treatment/side-effects/constipation/GI-complications-hp-pdq
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Contacted the company re: Dulcolax use in the immunocompromised patient where it's use is being considered because of impaction. It's being bumped up channels b/c an answer is not readily available. I'll let you know know when I get an answer.
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Okay, found a nice source for M&M enemas. MDAnderson Center.
They give the recipe for M&M .
https://www4.mdanderson.org/pe/index.cfm?pageName=opendoc&docid=31
This is their cautionary on their patient education instruction sheet. Even though MDA is a major world resource, please, discuss with your doc.
Do not use an enema if you are on chemotherapy and your platelet count is below 50,000.
If you have taken a Fleet mineral oil enema, give yourself the milk and molasses enema 1 hour after the Fleet enema.
Recipe6 ounces (3/4 cup) hot water
3 ounces powdered milk (do not use cow's milk)
4.5 ounces (2/3 cup) molasses
The source for this patient education handout is the American Cancer Society. So, even though milk and molasses is not widely known, apparently it is considered a good treatment.
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The Journal of Emergency Medicine Safety and Efficacy of Milk and Molasses Enemas in the Emergency DepartmentGary M. Vilke, MD; Gerard DeMers, DO, DHSC, MPH; Nilang Patel, MS; Edward M. Castillo, PHD | Disclosures J Emerg Med. 2015;48(6):667-670.
Abstract and Introduction
Abstract
Background Increased scrutiny is occurring from regulatory agencies about the use of nonsterile enema preparations in the emergency department (ED) for constipation. This includes the "off-label" use of milk and molasses (M&M) enemas, as there are no reported data in the medical literature to determine safety and efficacy.
Objectives To evaluate the success and complication rates of administering M&M enemas in the ED.
"" frameborder="0" marginwidth="0" marginheight="0" scrolling="no" style="border: 0px currentColor; border-image: none; vertical-align: bottom;">Methods This was a structured retrospective study at two EDs over 8 years. Primary success was defined as the patient having a bowel movement. Secondary measures of success included improved pain score by 2 or more points or lowering of a heart rate initially over 100 beats/min by 20 or more beats/min. Complications included: hemodynamic compromise, increased pain, electrolyte disturbances, bacteremia, bowel perforation, rectal pain or bleeding, cardiac dysrhythmias, anaphylaxis, electrolyte disturbances, dizziness or syncope, or hospital admission for issues surrounding enema.
Results There were 2013 enemas given, of which 261 were M&M enemas; 214 were given alone. Success rates defined only as bowel evacuation for M&M enemas alone were 87.9% (188/214) and, when used after other treatment failures, were 82.4% (28/34) successful. Five additional patients improved with the secondary measures (90.2% success). There were 8/261 complications (3.1%), of which four had an increased heart rate, two had decreased blood pressure, one had an increased pain score, and one subsequently developed a fever.
Conclusion M&M enemas have a low complication rate when used in the ED.
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In the above study abstract from the publication in the Journal of Emergency Medicine, in the 1st paragraph is this statement " This includes the "off-label" use of milk and molasses (M&M) enemas, as there are no reported data in the medical literature to determine safety and efficacy."
Translation: it is not on the (powdered) milk label or the molasses label that it can be used for enema's. I amuse easily.
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Lily hasn't posted today.
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i have been busy, feel bit better but know i really need to go to the Dr but I just cannot face any more invasive stuff, there is no privacy here, toilets in ED have no locks, seriously, and enemas are given in general toilet with no regard for privacy..........
But tonight i had space to eat a normal meal and feel normal afterwards.......first one in five days so think have turned a corner........
I know also i should get colon checked out but am being an ostrich and taking loads of stool softener.........I feel at end of my tolerance rope emotionally
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Lilly - sending hugs. It sounds like a familiar place for most of us -" no more damn doctors." We know what we need to do, but it's just...... Too many doc appointments, too much time sidelined. Hope things start flowing and you get up the energy to face your GI doc, if nothing else.
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Please, Lily, you are at serious risk. Please, You won't like the consequenses
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Lily did you poop?
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Oh lily, you are classic for a blow out. That's what we old nurse's called it. After seeing folks go through it. Don't want it to happen. Just bummed that you aren't getting the message that you are putting your self at great risk. Life risk.
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yes but not as much as I sense is ther
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Okay, Lily, we can only say so much. You are a responsible woman. We all have stressed the need for you to seek care from you PCP, go to a walk-in, or an ER. You have chosen to not do so. Sorry, we must step out of the talk. Beyond this it may put us in jeapordy. Please, recognize I have not made this statement in 30 pages.
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Getting ready to go on a week long trip. I always have trouble keeping myself regular when I'm traveling, and this time I will be staying some of the time in a home w/friends instead of in a hotel. I've already set out a small package of dried prunes to pack.
I've found I have more problems when I don't eat a green salad every day. And darn it, I just don't feel like having that every day in the winter.
Judi - did you have to start the Metamucil fiber bars gradually? Do you eat one a day?
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MT, I LOVE THE METAMUCIL BARS! No, I just eat one a day. Today, I had a BM. I'm hoping that this will do the trick. Only problem, they can be a little expensive. Six bars cost me $9.99 but I get my fibre and a BM so I'm not going to complain. Funny how we can look at the cost of food and some foods you will spend the money, and others no way. I'll have a Tim Hortons coffee everyday at a cost of $1.50 and don't even blink an eye but a Metamucil bar at $1.50 I can have a little heart attack. MT, enjoy your week long trip!
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Oh sas-schatzi I never took your response to mean diss the suppositories.
Thanks so much for all the info and the links. Much appreciated. Having a few days with my daughter and grandson but will read them thoroughly when I get home
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it seems we can't get these bars in Spain......
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Lilly, maybe the bars are under a different name. But Lily, they may not be your answer. Trust me, listen to Sas. I've followed her advice before and it worked. You need to see a DOCTOR and listen to them!
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I am going to the Emergency Department this afternoon as it is not resolving, will probably have to wait 5 hours to be seen if lucky.....
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Lily, don't wait until this afternoon .... get there NOW! Nothing is worth this crap!
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time difference I left just after posting....seven hours in ED....totally blocked, two enemas with tubes did not work, X ray showed clogging but no blockage or reason for it, have to take two special medicines tomorrow with four pints of water and go back to hosp in two days if nothing moves.........there is no lock on door of only toilet in whole ED which is where they do the enemas, humiliation rules, nurses even asked if it worked in front of many other people, no privacy....
Blood tests done and were fine but no idea what they tested for
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Oh Lily, at least you got to the Ed ... but now you have something that may help you. This is not the time to worry about privacy .... the nurses have seen it all. Good on the blood tests but now to get to the root of the matter. Sas can probably fill in the missing gaps here.
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Lilly - so glad you finally got to the doc. I agree w/Judi. After BC & x-biopsies & mammograms & ultrasounds & breast MRIs & 3 surgeries & rads & etc, I just whip off my shirt with no thought for modesty anymore. Do you remember what the two special meds are that you have to take? We'd be interested in the names. Hope everything comes out all right. Pun intended but I'm surely not laughing at you - just sending positive wishes.
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Probably a CBC that will show if White blood cell count is elevated. That would mean that bacteria crossed the line(colon wall into the blood stream). Elevation of WBC can occur with micro-tears & Divertiula in absence of a rupture which trust me if a rupture occurred you'd know it. Elevated WBC's without any other abdominal signs would be an early sign of trouble.
At least electrolytes panel which would show dehydration. Dehydration can be a source of constipation. The body pulls out (reabsorbs) fluid from the large colon as it transits the colon. Normal. But if the internal body is dry, it will pull even more fluid. It's a protective mechanism. Hence, one of the reasons for encouragement to drink fluids on a routine basis.
Lily, totally sucks when medical/nursing personal do not respect dignity. Been subjected to it too. Sucks.
Not bright on their part that after two enemas "with no return" to have discharged you. "With no return" is a accepted descriptive term for documentation. The only advantage on your part now, is they've set themselves up for a lawsuit if you have an untoward(trouble) outcome.
CHIT---SHIT................This doesn't work when people (nursing /docs) don't get it right. We spend several days trying to get you to go there, and then they screw it up.
How many days without pooping?
What drugs?
Are you in an immunocompromised period?
Apparently not b/c they gave you two enema's. Did they ask you about immuncomprimized history? Please not gonna be happy if that's not been done.
Did anyone do a digital rectal exam for an impaction?
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they did enemas before blood test results, my glucose was 94, its normally in the 70s........no questions about immuno compromised anything. Was put on a drip too.
Had physical rectal exam, nothing digital, and Xray of abdo which showed total colon full except rectal area.
14 days without a proper poop.
Some Questions were in full waiting room in front of other patients and families, I was the only one there on my own. Everyone looked at me afterwards. I dont mind nurses in private
Stuff to take is called Casen Lax, then Cintapride 15 mins before ev meal for 15 days, i have to go and get bith from chemist toda
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trying to verify drugs
Casenlax is Mirilax equivalent.
http://www.drugs.com/international/macrogol.html
Cintapride is a prokinetic drug which promotes gastric emptying and gut motility in patients that have a proven motility problem.
Equivalent to Reglan and Zellnorm in the USA Odd use of this drug. Lily you haven't got proven gastric motility problem. That's done by testing. You just haven't pooped in 14 days. One does not equal the other, it may, but no absolute.
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So far its done nothing except make me feel heady and I am drinking loads of wáter, triple what they suggest, I think I need a colonoscopy......am tempted to go and get the prep stuff just to get whats in there out of me
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Hold on Lily, Don't go over board on the fluids. That could create more problems with diluting your electrolytes. casenlax/ Miralax is Polyethylene glycol. Polyethylene Glycol is the active ingredient in Nulytely/ Golytyle. One of the main drugs used for the clean out for a colonscopy. The following is from page 10
"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.
www.medicinenet.com/laxatives_...#lubricant_laxatives".
You have to give them time to work.
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