Persistent constipation with ulcerative colitis

Hi everyone,

A little about me: I was diagnosed with left-side ulcerative colitis in 2009 after a year and a half of symptoms. I've been taking Rowasa and Asacol or Lialda since, and have been mostly asymptomatic since then. I forget that I'm sick most of the time. I've been strictly gluten-free for almost four years now and that seems to help my overall health. Tests were negative for celiac.

I spent seven weeks in Ghana over the summer, and got I Can't Believe It's Not Malaria™ around week four or five: three days of fever, chills, exhaustion, no appetite, and constipation, followed by a morning with no fever but a ton of diarrhea. (Gastroenteritis?) I was constipated for a few days after that, and took milk of magnesia as a last resort... which got things moving but brought back the blood and a bit of mucus in the stool, something I hadn't seen since 2009 or 2010. I returned to the States in August, but continued to occasional bouts of exhaustion and regular blood/mucus in the stool. No pain. Parasite tests turned up negative, and my beloved GI specialist at Kaiser said to wait it out a bit longer to see if it would stick.

After a month of doing the no FODMAPs diet, things returned to normal: blood abated and energy levels came back. I moved to the Caribbean for work, and I've been avoiding the rice, beans, and anything else that might have MSG–that gives me headaches, migraines, and exhaustion. The local diet is mostly plantains, yams, rice, beans, and meat, with the occasional iceberg lettuce salad. Not great if you're trying low FODMAPs or paleo or at least trying to keep carbs down. The local grocery store has chard, and if I'm willing to drive further I can get kale.

Last week, I started being constipated again, despite regular Rowasa enemas at night. I tried a liquid diet for a few days, starting each morning with the salt water flush (1-2 tsp of sea salt and a quart of warm water). This worked one day: vigorous bowel movements in the morning, but nothing for the other three days. I was expecting to have to be camped by a toilet, but I mostly had a headache and fantasized about steak. After that first bowel movement, nothing else happened.

I'm back to eating solid food, but I've had only one or two bowel movements that could be called as such since Monday. Salt water flushes with over a tablespoon of salt yield a few pellets. Maybe. I'm getting about 30 g of fiber a day from vegetables and fruit, as well as nuts and psyllium/flaxseed. I'm drinking lots of water and green tea. Today I took magnesium citrate; nothing's happening yet. The occasional little pellet comes out, but not more than that. Drinking apple cider vinegar diluted in water. Aloe vera juice. Yogurt. Probiotics. Nothing of significance is moving.

Weirdest thing? I'm not in pain. I don't feel particularly bloated, but going from huge bowel movements every morning (around a pound of fecal matter) to these tiny dry pellets is disconcerting.

The local grocery stores have senna tea but that sounds like not the best idea for someone with UC. Prune juice? More salt water flushes? Couldn't find Miralax at Walgreens. Any other ideas? I've yet to find a GI doctor on the island (I don't speak Spanish all that well), but I can email my GI specialist at Kaiser and he'll get back to me.

Post Edited (Asteroid) : 12/23/2012 7:07:54 AM (GMT-7)

Aaaaaaand this morning, there was a hard, well-formed movement of significant size... followed by a lot of water. Looks like the last few days of salt water flushes are catching up with me. Hopefully this means things will be back to normal soon. Glad to know I'm not the only one.

Have you tried cooked spinach to help? Really helps me avoid C and lots of people here swear by it. If you can find chard perhaps there's spinach also. I eat collards (similar to kale) and love it but spinach gives better results and is so easy to cook and add to anything such as chicken broth or just stirfry with olive oil or butter.

I also think eating more good oil keeps things moving. A spoonful of olive oil in the AM gets results but I prefer less of an attack mode by cooking with and eating it all day long.

Too much insoluble fiber causes C for me more than any other food type.

Asteroid,

Welcome to the forum.

I'm glad it finally resolved and you had a normal(ish) BM at last.

If you run into the problem again, I would suggest you keep using Magnesium powder or alternatively you could try some Vitamin C powder as well - if you use too much of either it will result in D. So it's really a matter of finding out how much you need to go from constipation to regular BMs.

 

Hi...were you on the suppository daily for the entire time with UC? Did you contact your GI to get back on the oral?

You're flaring..., and it sounds like limited in the rectum. You need to get on a higher dosage of mesalamine.
Ask to increase the oral to at least 2400mg, and for retention enemas of 4g to deal with the flare. As you heal and the inflammation improves, your constipation will improve as well.

q

Hi thank you for your responses. My Gi doctor told me I am on the max dose of mesalamine 1.2 gm . I restarted taking these again I am starting to feel better slowly. Does anyone know about the mesalamine supp. If u can take more than 3 months . Like I said I seemed to get worse with them . Is magnesium 500 mg tab good to take at night ? Maybe that’s irritating?? I think I we’ll stop . I am hearing about cooked spinach in olive oil or butter for uc with constipation helps . Do u know if it can be frozen type is ok . Anyone know of a good food ideas to help also . I know I sound rambling but I am trying to get it all in .Thank you so much

Post Edited (Lucyn) : 7/21/2022 10:46:07 AM (GMT-7)

Thank you clo that makes a lot of sense. I remember my mom had diverticulitis she would avoid skins on fruits . These doctors don’t like to tell u to avoid certain foods during flares they just give medications. Diet has a lot to do with this disease. Thank you

I’ve always had constipation my whole life. Prunes have never worked for me which is a shame because I do love them. Apple juice or an apple works sometimes.

The best thing for me is daily Metamucil. On those days that I don’t have a morning movement I take a stool softener or miralax immediately so it doesn’t get out of hand.