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UC and slow colon/outlet obstruction constipation- what laxatives besides miralax are safe to take

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Ulcerative Colitis
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Posted 5/22/2017 4:37 PM (GMT 0)
I would appreciate some advice. For 8 years I have had constipation and under a doctor's care, taking miralax the last 8 years but it stopped working. I had a colonoscopy 5 months ago and was diagnosed with mild/moderate colitis and told constipation is not abnormal with colitis. For some reason, with the miralax I was able to go to the bathroom these last 5 months, but now again, I can't go. I have been adding MOM for the last week to no avail. I woke up today, went to the bathroom 8 times, which is not normal for me. Just a lot of water, with a few drops of stool each time. I have no idea if this is called a flare or I am very constipated and this is from a week of miralax and MOM which is still not really working. Does anyone out there take MOM or something else and how do I know the difference between a flare and regular constipation this past week and today? Is it a flare or the laxatives trying to work? Anyone out there have a slow colon, pelvic floor issues and colitis and how do you manage? ANY ADVICE APPRECIATED..

balsalazide 750- 2 caps BID
lorazepam 1mg- anxiety, stomach and back
nortriptyline 10 mg- prn back and stomach
miralax 1 cap BID- constipation
MOM 2 tablespoons at night- just added this last week
canasa -1 nightly- I am now weaning off of this.
Posted 5/22/2017 6:45 PM (GMT 0)
Well, actually constipation IS a symptom of UC or CD that affects the rectum.
Its all about location and where it's limited.
What kind of colitis do you have?

Get on retention enemas rather than suppositories, and stop the MOM or any laxatives.
You can add fibre supplements to your meals, add a probiotic and a dtool softener for now. Oh, you mentioned a stricture...where?

q
Posted 5/22/2017 7:25 PM (GMT 0)
no stricture but I need laxatives due to pelvic floor issues. I called my GI doc who told me to go to the hospital because this was different.. Not sure I need to go to the hospital but could use a belly xray. my problem is that I can't tell if is due to the colitis or just my regular constipation. My GI doc suggested a water enema.. But I think I will start a bit of fiber once I find out what is causing this. I have proctitis (been on Canasa for two months and GI doc said to wean off of it), left sided and right sided colitis which they said is drug induced??? probably the miralax!!!! I guess that means pan colitis. I was told not to take stool softners because they are associated with causing UC. I also had irritation in my stomach when I was diagnosed and was put on zantac for 6 weeks.

thanks so much for responding to my question.
Posted 5/23/2017 5:01 AM (GMT 0)
So you don't have UC?

If your doc suggested to go to the hospital to see what's going in your abdomen, probably a good thing.
q
Posted 5/23/2017 1:44 PM (GMT 0)
yes. I also have ulcerative colitis..

the combo is difficult since I don't now if it is a colitis flare or the problems I had before I was diagnosed with colitis 5 months ago. I had an xray done, which shows no blockage but a lot of air in my colon. it is very difficult to find a GI doc for motility, never mind one that knows both colitis and motility and add in no spleen due to the colonoscopy that uncovered my colitis. The specialist who worked me up told me mag citrate was a good rescue but I have never heard anyone taking that who has colitis.
Posted 5/23/2017 2:04 PM (GMT 0)
Hi rdt,

I have ulcerative colitis, pelvic floor issues, and motility issues.

I would gradually start using acacia fiber and increase the dose slowly. Mag Citrate is also good. I would drink hot water or herbal tea with Natural Calm Mag Citrate powder mixed in at night before bed, that way it will have time to kick in for the morning, due to slow transit. You'll have to adjust the amount based on your needs. I use two tablespoons. I also mix two tablespoons of acacia fiber in my morning tea and two at night, but I worked my way up to that amount.

Continuous movement throughout the day has been extremely important for me. It doesn't really matter what activity you choose...yoga, walking, light strength training, but if I do my PT and strength training exercises each morning, take a 30-minute walk after lunch at work (I eat at my desk) and then walk my dog when I get home, I feel much better. I also fill my water bottle throughout the day and even that little bit helps.

Please ask your doctor about seeing a pelvic floor physical therapist (you will need a referral). I had 35 visits in 15 months, so I am a great resource if you have questions. The physical therapist will teach you exercises (e.g., massaging your colon, deep breathing exercises, proper form for more complete evacuation). He/she will also help you manage pelvic pain, pain with intercourse and any alignment issues, if you experience these problems also.

If you are flaring, I would start using mesalamine enemas every night.

Also, nortriptyline can exacerbate constipation, so you might want to ask your doctor for an alternative.

I hope this helps!
Posted 5/23/2017 10:02 PM (GMT 0)
thank you so much for the information. May I ask how you landed on the regimen of drugs you take? Finding a motility doctor is not so easy and so far, everyone just says to take miralax but after 8 years, it no longer works. Yes,I know nortriptyline causes constipation but I take it sparingly for neuropathic pain due to a bad back and pinched nerves. My doctor suggested I try prozac, an SSRI which supposedly increases motility but it is not ideal if you are taking a TCA. I have tried the biofeedback at the Mayo clinic in Rochester. It really did not help me but am set to travel to Augusta GA to try again. I have been all over the country for motility issues but can't find a doctor in my home state of MA. There is really only one, in Boston, who is not accepting new patients. thanks again.
Posted 5/23/2017 11:52 PM (GMT 0)
My doctor recommended Miralax, too, but it never worked for me. The combination of the soluble fiber supplement, mag citrate powder, PT exercises each morning and continuous movement throughout the day finally did the trick, but I have to do all of these things every single day. It's a lot of work, but it's much better than experiencing significant pain and discomfort.

Physical activity is extremely important to improve motility. And if you haven't tried the low-FODMAP diet, please do. That is also helping me a lot.

I started taking Delzicol because Balsalazide was no longer helping me. And I started mesalamine enemas (nightly) because GI bleeding has been a significant problem for me when flaring. I also recently started using Canasa in the A.M. when I have my period, because I struggle much more during that time of the month. And I take Xanax for PMS anxiety because it's pretty bad and keeps me from sleeping.

Please try PT again and explain in detail the problems you are experiencing. My physical therapist told me that a lot of patients don't get the full benefit of the service because they are too embarrassed to talk about their issues, don't do home exercises, etc. I know it can be awkward going to a physical therapist for pelvic floor issues, but I got so much out of it by asking a million questions, doing home exercises every day and being patient with my body.

Here are a couple of exercises I do each morning:

https://medicine.umich.edu/sites/default/files/content/downloads/abdominal-self-massage.pdf

https://medicine.umich.edu/sites/default/files/content/downloads/healthy-bowel-habits.pdf

And here is info. about magnesium and why it's helpful:

https://medicine.umich.edu/sites/default/files/content/downloads/magnesium.pdf
Posted 5/24/2017 4:39 AM (GMT 0)
thank you so much. May I ask where where you had PT? I have been to the Mayo clinic, Cleveland clinic, and Augusta GA am so open to going somewhere else except the west coast which would be tough for me. I sort of have become very inactive these past 6 months, since being diagnosed with UC. When I was diagnosed with UC, I also happened to lose my spleen from the colonoscopy, and in many ways, losing my spleen has been rather traumatic for me. I personally think the miralax induced my colitis but my doctors say no. You give me hope. I am going to begin walking again, which I did daily before the emergency operation to lose my spleen. Thank you so very much for the information and the exercises. I have pan colitis, but mostly feel it in my rectum and right side. I am going to try the acacia soluble fiber. Wonder if MOM would work instead of the mag citrate? For some reason, the GI motility doc told me only to use mag citrate as a rescue. Did you experiment in order to find the cocktail that works for you, or did a doctor suggest it? My colitis is mild to moderate and I do not bleed.
Posted 5/24/2017 5:08 AM (GMT 0)
me again. may I ask if you eat breakfast before the massage or after the massage. Is the PT training the massage or include additional types of exercises (for pelvic floor?) DO you do your weight training in the morning before or after breakfast? DO you only take the soluble fiber (insoluble fiber was listed on the sheet but I know it is not so good for slow colons or pelvic floor issues. Lastly I see you eat a paleo diet and no raw fruits or vegs. I will have to look up the paleo diet. Right now I was put on gluten free and lactose free diet (or low lactose with lactase) as well as a low sugar and low carb diet more like the SCD diet for celiac. I am so excited to try your regimen. I am assuming the exercises are from where you did PT in Michigan?

sorry for all the questions but I really appreciate it.
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