2 yr PO & major bowel issues still persist...HELP!

[Evonne]

I am almost 2 yrs PO and just about everthing has finally settled in EXCEPT for my bowel issues. I had problems early on finding something to help with my severe nerve pain, I finally found a combo that will only take the edge off but I believe it adds to my difficulty in the BR.

I am currently on quite a cocktail:

Baclofen 60mg
cymbalta 90mg (nerve pain)
provigil 200mg
macrodantin 50mg (for re current UTI's)
sanctura 40mg (over active bladder)
amitiza 48 mcg (bowel)
fiber capsule
multi-vitamin
iron
calcium
senna-s

fentanyl patch 50 mcg/48 hrs

I also take fiber in my drinks all day, try to eat an activa yogart/day, and mix small cup full of bran flakes/applesauce & prune juice and take tht twice a day

After all this the ony thing that will bring on a movement is milk of mag.
I use it so often though that I am worried it is not good for long term use and it is not as effective as it used to be...........so my psy. prescribed RELISTOR.........i gave myself the 1st injection .6ml (i weigh 130 or so) i was supposed to have a movement within 4 hrs.....NADA. I was to take Relistor every other day as needed so i skipped a day still no BM and inject another .6ml i tried my stomach this time the last time i did my thigh.....these are only SQ injections.

And, again NADA so it's been 6days now and here I am all compacted and bloated. This has been the story of my life and the AD symptoms it brings on worry me (sweating, dizzy, walkin into walls etc) So, I again turned to mixing milk o mag/ mineral oil and I'm so backed up now that it will take 2-3 days to get all cleaned out.....most times I wonder if i really every do get fully cleaned out. After all this, all I have to say is I am thankful I have a place to come and talk about all this SHIT....literally

My psy. has been open to anything and everything and we have tried so much and I am happy he's a great doctor. Any and all suggestions or helpful info is very much appreciated.

Thanks Gang,

E-von

[SCI-Nurse]

Relistor has not been studied in SCI that I know of. It can have some pretty serious side effects, and is not designed for routine use, but instead of periodic constipation (primarily in those taking heavy doses of opioids for chronic or acute pain). It may cause cramping that could cause you AD.

Did you have problems with constipation before your injury? I am not sure what PO is in your post.

Of the meds you are taking the following are constipating:
Fentanyl
Iron
Calcium
Sanctura
Cymbalta

Why are you taking Provigil? While it is more likely to cause diarrhea it has also been associated with constipation. It has many other potential serious side effects though.

How much senna are you taking?

I would urge you to avoid routine use of mineral oil. It will interfere with your absoption of fat soluable vitamins (A, D, E, K) over time.

How many times a day are you taking Amitiza? Generally it should be taken twice daily.
Have you tried routine use of Miralax?

How much water are you drinking daily?
Total daily intake of fiber? Have you tried ground flax seed?

How often do you do bowel care, and with what methods?

How much exercise are you getting daily?

(KLD)

[Evonne]

Originally Posted by SCI-Nurse

Relistor has not been studied in SCI that I know of. It can have some pretty serious side effects, and is not designed for routine use, but instead of periodic constipation (primarily in those taking heavy doses of opioids for chronic or acute pain). It may cause cramping that could cause you AD.

Did you have problems with constipation before your injury? I am not sure what PO is in your post.

Of the meds you are taking the following are constipating:
Fentanyl
Iron
Calcium
Sanctura
Cymbalta

Why are you taking Provigil? While it is more likely to cause diarrhea it has also been associated with constipation. It has many other potential serious side effects though.

How much senna are you taking?

I would urge you to avoid routine use of mineral oil. It will interfere with your absoption of fat soluable vitamins (A, D, E, K) over time.

How many times a day are you taking Amitiza? Generally it should be taken twice daily.
Have you tried routine use of Miralax?

How much water are you drinking daily?
Total daily intake of fiber? Have you tried ground flax seed?

How often do you do bowel care, and with what methods?

How much exercise are you getting daily?

(KLD)

nope, no problems with constipation b4 injury

I used PO in the wrong context---It has been 2 yrs after my accident is what i was tryin to say

I am takin the provigil because all the other pills i took (in the beginning anyway) made me sleepy so my Dr. prescribed it. I've been on it for a long time now tho (2yrs) what are the bad side affects associated with it??? Guess I could axe it and probably would not even miss it. When I went back to work full-time I was having a hard time stayin awake and it worked really good for me

I just stopped the senna(8.6-50m) last wk because the medication was recalled (i took 2 pills in am and 2 pills in pm) I'm gonna wait till June 3rd when I see my Dr. to get a replacement for senna and just try something else in general because the Relistor did not work!! I was hoping to get more ideas from here to try.

Yes, I was taking Amitiza twice a day (1 am & 1 pm) When I gave you my meds i just gave u total daily amts. I take some am & some pm & some at noon

Yes, i have tried Miralax. i took it in the hospital. Is that something u can take daily?? As i recall, it did not help bring on a BM but when one did finally come it was easier to expel and not so formed.

I take 1 fiber capsule in the am and 1 in the pm and 1pt of liquid mixed with fiber

I exercise 3 times/wk 2 hrs per day on average (out-patient therapy) and the rest of the time I walk all day un-assisted. I am working now full-time and I work in sales and am out and about all day so I stay pretty active.

One thing I do notice though is when I am really constipated and my stomach is so BLOATED all the way up to under my boobs (colon area i guess??) I am not able to be so active and all i want to do is lay in bed because my stomach hurts so bad and is so spasmed up and also makes my back spasm and all this tightens up and makes it really hard for me to walk and just function in general. Once I finally am able to go everything clears up and I am back to normal, but it only lasts for a while. I really need to find something that will consistently work for me.

I think I answered all your questions, thanks so much

[rfbdorf]

Miralax (Miracle Laxative) works well.. My wife has been using it for nearly 4 years. Our understanding is that it is safe to take daily. It does not cause a BM, but softens the stool and encourages it to come down in spite of the heavy meds.
KLD asked about a bowel program - what do use use to trigger the BM? Suppository, mini-enema, dig stim?
- Richard

[Evonne]

Originally Posted by rfbdorf

Miralax (Miracle Laxative) works well.. My wife has been using it for nearly 4 years. Our understanding is that it is safe to take daily. It does not cause a BM, but softens the stool and encourages it to come down in spite of the heavy meds.
KLD asked about a bowel program - what do use use to trigger the BM? Suppository, mini-enema, dig stim?
- Richard

I have tried suppositories, they have not worked for me (maybe wrong brand??) I have also tried dig. stim. This only seems to work if I am at least close to having a BM...I guess thats what I'm sayin i dont know what else to try to bring on a BM i tried all the above and various meds with no luck.

The miralax does work to soften stool and i do like it. I guess what i really need is more solid options for bringing on a BM and not getting backed up all the time like i am constantly battling right now.

[SCI-Nurse]

The suppository (and dig stim) works by bringing everything down and getting it close to the rectum. Most SCI ers have slow transit time and this helps. Plus the suppository effects only that area and not the entire intestinal tract.I would add it to your program.
Magic Bullet is usually the most preferred or the regular Bisacodyl.
I would lower the Providgil by using a half dose.See how that does.

CWO

[rfbdorf]

You might want to give the Enemeez mini-enema a try.
They are expensive (we get them at a little over $2/poop), but we've had very good luck with them. We've been told they may be used over a long timescale with no deleterious effects.
- Richard

[chick]

How much is your fluid intake per day? Have you increased drinking water, with the fiber capsule and all the extra fiber you add to your drinks?

How much calcium are you taking? Calcium supps were very constipating for me, with effects being pretty immediate and significant, and throwing my bp/bm way off and my becoming irregular. I stopped after trying the calcium supps a short time, and went to taking TUMS with calcium, with no problems.

Have you tried Colace? or peri-colace? This is a stool softener. I think peri-colace is w/stimulant.

Any stimulants shouldn't be used long term, so keep an eye on that, esp. if you are using a variety of different forms per day (as it seems you are).

Also, you are taking quite a bit of meds, so if you want to identify which medication(s) may be causing/contributing to your bowel problems, change dosages or eliminate only 1 at a time (some of your meds may need to be gradually decreased), to observe changes, if any.

[fishin'guy]

Wow, that provigil is potent stuff. Took 1/2 pill before noon, didn't sleep for 2 days. I'd whack that in half right off.Good luck

[thehipcrip]

I'd also eliminate the applesauce from your diet -- it's a known constipator.