More bathroom issues

[codyclan]

So constipation is becoming a huge, huge issue for my dear hubby (PALS). He had previously gone almost 2 weeks without a real BM. We ended up at the ER two days ago for a soap suds enema that worked great. He felt a million times better and all seemed well, for about 12 hours. Since the ER visit he has been drinking prune juice and has had miralax each day. Today he is miserable again. Completely miserable. It seems to be affecting his breathing since he is so uncomfortable. He has not gone since we left the ER.

Called the doc but he just suggested prune juice and miralax. We're doing that but, boy, he is so not himself and is now unable to eat, AGAIN! Do we go back for another enema? I tried a fleet enema that was unsuccessful before we went to the ER last time. Suggestions please!!!!

Tracy

 

[bigbrat41]

I know that during a couple of surgeries I was given Dulcolax suppositories and have kept them in my medicine cabinet since.
Regardless of your chosen method I will pray for success.
God Bless

 

[Nikki J]

It is indeed a very severe problem and multifactorial- decreased activity, muscle weakness, possible hydration issues dietary issues.... He may need a more drastic solution but two low tech things to try- mix the prune juice 1/2 and 1/2 with hot water ( he is swallowing not eating via tube?) and try abdominal massage in a clockwise direction ( right side moving up and around then down the left side) for up to ten minutes

Also make sure when he tries to go you position his legs so he is as close as possible to a squatting position

 

[codyclan]

Thank you, Nikki. I will try the prune juice and hot water with massage. He is still swallowing by mouth.
Tracy

 

[Atsugi]

If the problem is compacted at the exit, you could do what I did. I went in and got 'em. Wear gloves, use lube. Kiss him first.

 

[KimT]

I went to a local gastro yesterday. Told him of my diagnosis. He asked me if I was OK with swallowing. Yes. He said to up my magnesium and add pure psyllium (I used Konsyl because it has no additives) once a day in 8 ounces of water followed by another 8 ounces of water (I use about two teaspoons). I had been using Miralax but it wasn't working. He said I could keep using the Miralax even with the psyllium. when it gets bad, I use a fleet enema.

So now I'm doing 1,200 mg of magnesium per day and the psyllium with lots of water. I can't do stimulating laxatives because of a heart arrhythmia so I hope this works.

My friend's mother who was bedridden had success with Dulcolax, a stimulant laxative. She was underhydrated, too so added more water.

Is there a reason you haven't tried regular magnesium? It won't hurt. It won't bulk a stool so that's the reason for the fiber being added so that it draws water into the stool.

I'm so sorry this is happening. It caused me to have burning hemorrhoids which is what got me to the gastro.

Another thought is cutting back on any dairy which can be constipating.

 

[Diane H]

Everyone gets confused by Dulcolax and Docusate Sodium. Dulcolax is indeed a stimulant laxative whose main ingredient is bisacodyl. It is a bowel irritatant that works by irritating the bowel which cause increased muscle contractions as the bowel tries to get rid of the irritant. Stimulant laxatives become less effective with repeated use, to the point of not working. They are for occasional use only. They do not prevent constipation. They are necessary when things get blocked up and you haven't gone for 4 or five days. "Natural" laxatives like prunes work the same way.

The first treatment for constipation in ALS is increased water intake. That may require a feeding tube but constipation will be a big problem regardless of what you take as long as you don't get enough water. The next step is diet changes to increase fiber. The alternative would be fiber supplements or things like Metamucil or Citracel. Again, with more water and not to be used with swallowing problems.

An excellent choice when shallow breathing makes it difficult to bear down to have a bowel movement is Docusate Sodium. It is a stool softener that works by drawing more water into the stool to keep it soft enough to pass without straining. It does not contain bisacodyl so it is not a stimulant laxative. It is a constipation preventative taken daily and is ideal for ALS patients. But it cannot work without sufficient water intake. The only option that can work with out more water, is an enema, but drug store bottled enemas may not be enough. For people beyond relief from strong laxatives, doctors used to order soap suds enemas of the "High, hot, and Helluva lot" variety! Enemas are not fun to give or receive and, with constant use, can stretch the lower bowel to the point where it can't contract.

I could have said all that by saying "Docusate Sodium and water, and if you won't get a feeding tube when you need it, constipation will happen. Badly." But I just love talking doody.

 

[BlueandGold]

I believe this happens to far more ALS patients than are willing to post about it. I have had major issues with constipation for many months. As Diane mentioned, my issue is that I no longer have the muscles to bare down. Even with soft stools, I cannot push. So my regimen for the last 5 months has been docusate stool softener twice a day every day and as much water through my tube without decreasing my appetite because I have to maintain my weight. I have a bidet with a "vortex" feature which works like an enema. If the bidet doesn't work, I use a fleet enema and 9 times out of ten it does the trick. I NEVER allow myself to go beyond two days without a bowell movement.

Constipation and subsequent remedies should be a sticky on this forum.

Vince

 

[Green Queen]

My mother in law has diverticulitis. When it flares up she has constipation issues.

Not that I'm saying all you lovelies are old, but most of us get diverticulitis as we age.

I know there is a heap of food my MIL can't eat. Strawberries, kiwi fruit, tomato seed things...

Maybe a bit of a search of stuff like that would help, it may be useful to remove some things to what I'm sure must be quite a limited diet.

All the best to everyone who has issues.

 

[KimT]

This only applies to those who can swallow and still eat by mouth. Magnesium is a natural laxative BUT if you use too much it turns the stool into water. I was using too much even though it was suggested by a doctor. I reduced from 1,200 to 800 mg of magnesium and started taking a heaping spoonful of pure psyllium fiber in 8 ounces of water followed by another 8 ounces of water. Since these two things are 100% natural, if you need other things (fleet enema, stimulant laxative, miralax) occasionally, it's ok.

It sounds like your PALS has something that needs medical intervention before trying the above. If he hasn't gone in days, he needs to get evacuated before starting something that will reduce or eliminate the problem.

 

[codyclan]

We ended up at the ER and had some professional 'intervention'. X-Rays showed that he was literally 'full of .....'. We have had a laugh about that--fortunately he has always had a great sense of humor. So he's starting fresh, so to speak. He's taking Miralax and Senacot and we have upped his fiber intake as much as possible, considering swallowing is an issue. We also have magnesium which he has only had to take once in the past week. So far it has been successful! Let's hope it keeps up!

 

[lgelb]

For those who are still eating x mouth, I (w/ a hx of diverticulitis) find graham crackers helpful, and salad every day. Can mix the crackers w/ moist foods like ice cream, applesauce if they are too dry. Re seeds and such, research has found them helpful on the whole but everyone is different.

 

[gooseberry]

Grapes, cherries, and salad have always worked for me even after major surgeries.

 

[KimT]

We ended up at the ER and had some professional 'intervention'. X-Rays showed that he was literally 'full of .....'. We have had a laugh about that--fortunately he has always had a great sense of humor. So he's starting fresh, so to speak. He's taking Miralax and Senacot and we have upped his fiber intake as much as possible, considering swallowing is an issue. We also have magnesium which he has only had to take once in the past week. So far it has been successful! Let's hope it keeps up!

Don't be afraid of the magnesium unless there are other reasons he is not taking it. It can help with cramps and sleep. Most diets are too high in calcium (contracts muscles) and not high enough in magnesium (relaxes muscles.) If he is consuming a lot of dairy, the magnesium will benefit keeping him regular and balancing the calcium.

When I went on Remeron (causes constipation) in 2003, I went from 400 to 1,200 mg of magnesium and that did the trick.

Remember to hydrate often no matter what else you are doing.

 

[patoyeah]

magnesium may also have multiple benefits for als, but at high doses may complicate heart issues, if i remeber correctly.

coconut oil makes me go like a flock of geese, ... watch out

bowel movements are more difficult to pass, if done laying in bed, if possible lay on your side and raise knees towards chest.

turd talk,

pat