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Constipation / Slow Transit From Chronic Colitis

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Posted 7/30/2011 3:37 AM (GMT 0)
Has anyone else progressed over time from diarrhea/bloody flare-ups to more constipation/bloating/cramping from long-term chronic inflammation?

Were you able to get back to health after this type of presentation as well as you may have from diarrhea/urgency-like episodes? What do you recommend for best treatment in these cases (no urgency or diarrhea, but more severe constipation/distension/slow motility)?

I'm worried that this type of condition resulting from more chronic disease people may be more difficult to treat. But, I'd love to hear people's experiences or perspectives.
Posted 7/30/2011 4:31 AM (GMT 0)
If you've been using rectal medications, it's a progression of healing where less of the rectum is inflamed...but you'll have symptoms of constipation.

You'll still need to heal the area that's inflamed and get your colon/rectum functioning better.

Remember that many of us can suffer from IBS as well....differentiating between the both can be confusing.

Fibre supplements and probiotics, eating well, drinking enough fluids and taking meds does help.

q
Posted 7/30/2011 4:51 AM (GMT 0)
Yes, I think you're right. I first took rectal meds (steroid suppository and cortifoam), which resolved the urgency and diarrhea issues.

I had an unfortunate episode of sulfasalazine reaction once I started on an oral maintenance medication soon after. I then started on a quick taper of prednisone (to resolve both the reaction and to continue with an oral anti-inflammatory).

However, that is when this more disturbing constipation, slow transit, and more diffuse cramping started. I'm not sure if the drug reaction (and resulting systemic inflammatory reaction) or the rapid prednisone taper contributed more.

Anyway, I'm currently on prednisone 25 mg, Apriso 4/day, and mesalamine enema 1/day.

I honestly don't want to go back up on the prednisone, although in the back of my mind, I know that would probably help. I was thinking of rotating in colocort steroid enema, as I think most of my problem is still left-sided (above where the cortifoam could reach). I also may increase the Apriso to 6/day, although I know that probably won't do much.

I suppose I'm seeking hope that giving the mesalamine enema and pills more time (it's been about two weeks) would be enough to overcome a possible sub-therapeutic dose of prednisone, without the inflammation getting worse in the meantime.
Posted 7/30/2011 11:03 AM (GMT 0)
Yes I had chronic D for many years until diet started the healing process and then C became an issue.
I feel that it is both the inflammation as well as damaged vilii not being able to move things along.
It takes time to find the balance and "normalcy" whatever that is before we noticed every detail about our BM's. I rarely have C now but for a while it was D-C-C-D-C-C-D until finally neither.

Here's what worked for me to eliminate Constipation:

Fiber supplement
Fiber helps but in the beginning start very slow and gentle with fiber. I took Citrucel (still do) after experimenting with several OTC fiber types.You should try several to find one that works for your gut.

Foods with Fiber
Start slow but add foods with fiber to your diet. I can never remember which are soluble/insoluble so I just test them one by one on my gut and listen to what she says. I now eat a high-fiber diet mainly because a lot of other foods upset my gut and fiber doesn't (now). Nuts, almond flour baked goods, spinach, green beans, snow peas, yellow squash, bosc pears are friendly foods for my gut.

Don't eat foods that constipate
Hard cheese is the one thing I know will create C in my gut so it's out (for now). Your gut may be different and you'll have to figure yours out.

Drink lots of Water
Easy to say but also easy to forget to do. This one should almost be #1 (too lazy to move it).

Walk or get gentle exercise
This is to simulate the peristalsis motion. I've even found that many hours traveling in a van that has a lot of vibration is helpful lol. The bloodflow from exercise is also healthy all over your body. I've wondered whether a vibrating chair would be helpful but never bought one.

Lastly, coffee or chocolate always stimulate my gut but when inflammation is strong they can also irritate and add to the problem.Better to be proactive than use these daily.

I am an enema believer/user but they only reach so far.The upper regions need additional help (see above).
Getting back to normal BM's took 1.5 years for me and I'm still working on it but it's worth the trouble.
Good luck.
Posted 7/30/2011 3:45 PM (GMT 0)
Thanks. I agree that there is probably some damage/scarring to the mucosa that's causing the motility problems. Unfortunately, I know the constipation is not from diet, lack of fiber, and exercise, etc. in this case. I do those things pretty carefully and thoroughly. I wish those were the cause, believe me.

I suppose I'm trying to figure out the best treatment mix for someone who is not having diarrhea, urgency, or bleeding, but rather suffers from constipation and slow motility from a chronically inflamed or lazy colon. In other words, how to judge if adding medications will make a difference (when you're not otherwise having active, acute inflammation symptoms)?
Posted 7/30/2011 4:28 PM (GMT 0)
Stay on the nightly enemas until you're off the prednisone.

Regardless of it being scarring, if you have inflammation, you'll have to treat it.

If it is from scarring, that's definitely possible, and the signals from the rectum aren't being sent to the colon to get into action.

While you are on fibres, maybe choosing different ones to increase motility can work...

Regardless...it's a long process, but you need to get off the pred first before even attempting to taper the enemas.

q
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