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Thread: Miralax best practices...

  1. #1

    Miralax best practices...

    Over the years my bowels seem to gave gotten progressively more sluggish it seems. This is complicated by my pain treatment regimen (30mg Oxycontin - 1 every 12 hrs.) which I've been on for tears and years. Up until about a year ago, taking 2-3 stool softeners daily and then 2 or 3 bisacodyl 8-10 hours before 'poo time' and a magic bullet to 'start' me had a ~90% success rate now down to ~60-70%. My general routine is every other night unless I'm unsuccessful or not successful enough, in which case I repeat every night until I go. Went to see a gastro doc for the first time today and he's put me on Miralax powder (aka PeG 3350 NF). Dosage is the standard 17 grams mixed in water, juice, etc. After reading the label I find it says treatment for 2 to 4 days may be required to produce a BM! Drugs.com says 1-2 days. Neither of which sounds too good to me. For years I've been used to taking bisacodyl (5mg) approx 8 hrs before bowel/bed time with very rare 'surprises'.

    Obviously may main concern is predictability or lack there of. The directions say to dose daily but I go every other day not every day. Would like to hear from anyone else who is also using Miralax and maybe also be on an opiod pain management regimen. The main thing I want to know is when to take it for a predictable (or semi predictable even) result...12hrs before 'poo time', 8hrs, etc.? I know everyone is different regarding their bowel tendencies. I'm just looking for a good starting point so to speak in order to shorten the 'trial and error' period...as I'm sure this goes for all off us, we don't like surprises when it comes to BMs. If I can't nail down a predictable schedule then I'll be forced to return to the more predictable although less effective bisacodyl...I can't live my life constantly worrying about having an accident at any given time (obviously).

    Thanks in advance for any advise anyone has to offer.
    C6/7 Complete

    14 years post injury

  2. #2
    Okay, standard disclaimer. Your mileage may vary, etc. I counter act the effects of opiods with a mix of senokot-s and docsoulate-sodium (Ducolax). Take em every night. Every so often if I seem to get backed up, I do a couple days of fill dose miralax (again at night), without the senokot and ducolax, and that will do the trick. I do my BP in the morning with the help of an Enemeeze.

    Hope that helps.

    ps. SCI sucks

  3. #3
    Dose low and work from there.

    I use to do the full dose, and all hell broke 'loose'.....Pain meds would always back me up. I do 1/2 tspn of Miralax in the morning before work, and maybe 1/2 tspn in the afternoon...I use the can everyday, not sure if dosing on your off day is wise. It will take some experimenting to figure out your comfort zone....good luck!

  4. #4
    Quote Originally Posted by t8burst View Post
    Okay, standard disclaimer. Your mileage may vary, etc. I counter act the effects of opiods with a mix of senokot-s and docsoulate-sodium (Ducolax). Take em every night. Every so often if I seem to get backed up, I do a couple days of fill dose miralax (again at night), without the senokot and ducolax, and that will do the trick. I do my BP in the morning with the help of an Enemeeze.

    Hope that helps.

    ps. SCI sucks
    Couple of questions...Do you also go every other day like me? What dosage of senokot-s/ducolax do you take? I take the store brand stool softeners (Docusate Sodium, same as Colace)...any difference between them and Ducolax? Does Doculax also contain Bisacodyl?

    I gather that I may not need the stool softeners the morning before my night time BP when using miralax...am I right?

    Sorry I sound so gun shy re: Miralax...I'll probably make sure I have nothing planned for a couple of days before I use it the first few times. In 11 years I've never had an accident while out in public and I'd like to keep it that way.
    C6/7 Complete

    14 years post injury

  5. #5
    Quick meds info...

    Colace and generic colace (docusate sodium) are the same in effectiveness. It is a stool softener.

    Dulcolax is the brand name of bisacodyl. It is the same active ingredient.
    There may be a different coating on the Dulcolax, but the medicine is the same. It is a laxative/stimulant. It is the same active ingredient as in the suppositories that most SCI folks use (Magic bullet or Silver bullet).

    It seems like less people take the Dulcolax pills, like you are doing. More people take Senna as their "daily stimulant", if they need it, and use dulcolax in the suppository form right before their bowel program. My Dad used to take his colace a couple times a day spread out, and his senna at night with his bowel program in the mornings.

    I think most people who use Miralax in the SCI world use it for daily "maintenance", so to speak. It is often recommended as an alternative to taking the senna and colace combos daily (so you typically stop them both), because it both helps to soften stool (colace function) and push it along (senna/laxative function). And it is widely recommended for people on daily opiods/pain meds that cause constipation - even folks that are AB.

    Remember, the instructions on the bottle are not as useful for neurogenic bowel. Those are just the general instructions for the average AB person who picks it up off the shelf.

    Totally understand your apprehension. My Dad is exactly the same way. His greatest fear is having an accident in public and because of this he is very very slow to make any changes in his bowel regimen.... even if he is having a lot of problems/discomfort.

    Unfortunately, there is no way to know how it will effect you until you give it a try, and the recommendations for SCI folks is to try something before a week before you make any conclusions about its effectiveness to give your body some time to adjust.

    Overall, it seems that people have pretty good experiences with Miralax from what I have seen posted. With our docs, I have noticed that the physiatrists tend to stick with the "older" systems of colace/senna/dulcolax suppositories. The SCI nurses we talk to and our GI doctor (who is an expert in SCI constipation issues) bring up the Miralax more, and often recommend it if the senna/colace are not working as well.

    Maybe others who made the transition to Miralax will post about how they crossed over...

  6. #6
    I take a *lot* of meds that cause constipation, including high doses of narcotic pain medications. I tried using Miralax several times based on the rave reviews it got from my fellow CCers and absolutely hated it.

    The problem I had with Miralax is the incredibly long lag time between taking it and seeing results -- it was four or five days from when I took the first dose. By the time I finally saw that a full dose softened my stool way too much, I'd already taken 3-4 more full doses. Naturally, as soon a the stool got too soft, I cut back the amount I was taking by half. Six days later I was back to pooping rocks. Try as I might, four to six days before being able to see how the new dose affected me, and even longer before being able to know what taking that dose for multiple days did, made it impossible for me to tweak the dose to precisely the amount needed.

    Instead, I take docusate sodium and magnesium supplements daily to soften, and senna the night before I do bowel care every other day to stimulate movement. It's working great -- my stool is soft, formed, and bowel care takes about 30 minutes.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  7. #7
    Thanx a lot for the great replies. When I took my first dose of Mirilax I was going on my 2nd repeat (tried 3 days in a row each 1/2 cup or less) and not much better tonight after taking my secound dose this morning. I also take 2 stool softeners 2x a day everyday.

    @TheHipCrip...What dosage of Magnesium and senna do you take? I've not tried senna since early into my injury, been taking 3 - 5mg Bisacodyl tabs the morning of bowel night until this switch to Mirilax. The only Mag I ever take atm is the gawd awful tasting Mag Citrate when I get reallly behind...and sometimes it makes me pay with two extra back to back garden hose sessions.

    ...in my first post I forgot to include that I also take 2 - 5mg daily percocet for break thru pain in addition to the 30mg Oxys.

    On another note my gastro doc mentioned something very interesting but not quite available. An implant that somehow stimulates the bowel when activated...I'm guessing maybe uses an electrical current. He said he'd get back to me when he knew more in a month or two. Can't remember exactly what it was called but it ended in 'stim'. Gonna see if I can google up something about it.
    Last edited by Boompow; 03-25-2012 at 01:09 AM.
    C6/7 Complete

    14 years post injury

  8. #8
    we sound similar. i take percocet and mscontin, poo mon. wed. and friday. take generic colace twice a day. it usually takes miralax 2 to 3 days to work. if i start gettnig stopped up i drink a full dose of miralax mixed with milk. after about my 3rd day i go really good. then don't take any more, just stick with the colace from then on.

  9. #9
    Quote Originally Posted by thehipcrip View Post
    Instead, I take docusate sodium and magnesium supplements daily to soften, and senna the night before I do bowel care every other day to stimulate movement. It's working great -- my stool is soft, formed, and bowel care takes about 30 minutes.
    I'm interested to know exactly what amounts you are taking as I too am having many problems. How much magnesium do you take daily? I take it docusate sodium is also known as Coloxyl, is that correct and how much of it do you take daily? In what form do you take the senna and how much?

    Your concoction has me interested because my wife is taking magnesium supplements for migraines and that is having an extreme softening effect on her bowels, in other words she is running to the toilet all the time. I need to try something new as my current routine (2 Senokot night before routine and Movicol once or twice per week) is not working and my bowels have become extremely sluggish.

    Cheers

  10. #10
    Quote Originally Posted by Boompow View Post
    @TheHipCrip...What dosage of Magnesium and senna do you take? I've not tried senna since early into my injury, been taking 3 - 5mg Bisacodyl tabs the morning of bowel night until this switch to Mirilax. The only Mag I ever take atm is the gawd awful tasting Mag Citrate when I get reallly behind...and sometimes it makes me pay with two extra back to back garden hose sessions.
    Bump...just need a ballpark estimate...

    btw...the bowel stimulating implant is called 'InterStim' and it was approved 1 year ago this month. Have another appointment with my gastro doc in a few weeks...gonna tell him to sign me up. With all the opiates I take (and will be taking for the rest of my life) because of CPS (Chronic Pain Syndrome) my constant constipation battles are steadily eating away at my quality of daily life, not to mention the increased burden it places on my wife when I have to repeat 2-4 days in a row to finally empty out in some cases. Unfortunately my bathroom toilet isn't accessible enuff for me to pull along side it and transfer over...so I either have to do my bp in bed on my side with chucks under me or use a bed side toilet chair, the latter of which reeks total havoc on my hemorrhoids cause a lot of pain below my level of injury thus triggering AD 'spikes' all throughout the 2 days after, then it's time for my next bp again! And yes, that's with using Anucort suppositories and/or lidocane jelly. All this together constitutes the bane of my existance atm...everything has to work around or with my BPs which are not predictable. I won't even go on about the constant abdomen discomfort when I'm backed up.

    InterStim site:

    http://www.medtronic.eu/your-health/...s-it/index.htm
    Last edited by Boompow; 04-11-2012 at 10:46 PM.
    C6/7 Complete

    14 years post injury

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