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Dr hive...constipation


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DD18 just told me last night she hasn't had a bm in 3+ days.  She is worrying that it is the beginning of a gastroparesis which is common with her other condition, POTS.

 

She is not home right now, and won't be back until late tonight.  She is at her boyfriend's grandparents.

 

`She has been on iron for 2 months and takes 100mg stool softener 2x daily to help with the side effects from that. She hasn't had any issues since the first week with the stool softener.

`She drinks lots of water (50-80mls daily) and gets IV fluids daily.  

`She called me the night before it started and said her stomach hurt really bad, but then the pain stopped and didn't return.  The pain was near her appendix but she could do the basics of jumping up and down etc.  (The pain didn't last long, or I would have taken her in that night. I have had a ruptured appendix). I told her that night it was probably a bit off stool going through her system and to let me know if it got worse.

`The only thing that is different is that she took some Tums in the days following the pain.  She has been having some heartburn so she came home and picked some up.  I don't know how many she took, but I don't think it was more than 2 a day. 

`She has been having heartburn, nausea, burping lately.  (she is not pregnant)  She has gained weight this year due to her treatments, but at 5'9'' weighs 150, so she isn't overweight. 

`She is active 2-6 hours a day, but not super active due to her other health condition. She worked 8 hours on her feet yesterday.

`No fever, chills or other signs of illness/infection.

 

I told her to skip her iron, Tums and vitamins for the week, and  up the stool softener to 200mg 2x daily.  She took 10mg of bisacodyl tablets last night and I haven't heard from her this morning. The problem is something caused this to get started and aside from the Tums, I don't know what could have caused it.  She eats lots of fresh fruits/veggies, whole grains etc. so she gets natural fiber.

 

If the bisacodyl doesn't do it, what next?  Her doctor is on vacation, so the other option would be Urgent Care or ER.  Urgent care can't do xrays/scans, so that leaves the ER.  Urgent care will only be able to ask basic questions, feel her belly, and give her med suggestions.  Urgent care will be closed when she gets home tonight, so that leaves the ER.  If we need to we will, but I hate to use the ER for constipation. 

 

I didn't have mIralax to give her but we could try that tomorrow when she gets back.

If she doesn't go by tonight it will be 5 days. I could have her come home early from the grandmas, but I know she will not want to. She doesn't really live at home, so it is hard to tell her what to do. 

 

Any other ideas?  Advice? Suggestions?

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How about some magnesium? I don't know what your stool softener includes so maybe you would overdo it but we've had some good success with magnesium as a laxative.

 

Others have already suggested enema but I'll just add that I would definitely try going that route before going into emerg (assuming her other conditions don't argue against this). You can just get a big needless syringe from a pharmacy and use plain old water. It's really not that bad and it does the job. Glycerine suppositories also work quite well.

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How about some magnesium? I don't know what your stool softener includes so maybe you would overdo it but we've had some good success with magnesium as a laxative.

 

Others have already suggested enema but I'll just add that I would definitely try going that route before going into emerg (assuming her other conditions don't argue against this). You can just get a big needless syringe from a pharmacy and use plain old water. It's really not that bad and it does the job. Glycerine suppositories also work quite well.

I could pick up a bottle of liquid mag citrate from the pharmacy.  Good thought.  That should work pretty quick tonight LOL 

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Does she eat enough fats?

Low fat is a pain for my bm.

If I constipate (as in 1 bm per 1-2 weeks) a meal with lots of fats does often the trick (although I am working hard to avoid to use that trick)

Yep, a normal amount.  Nothing in her regular diet has changed.

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When my mother was still working as a nurse the staff always gave constipated patients a "colon cocktail" consisting of a drinking glass (8-10 oz.) filled with half prune juice and half apple juice heated until it was very warm, but not so hot it couldn't be drunk over a minute or two. Patients were to drink the whole glass over a couple of minutes at least 5 hours before bed, and were encouraged to go for a walk or do some other type of physical activity around an hour after drinking it.

 

If the above doesn't work I would go the pharmacy and get a Fleet enema kit.

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Aside from Miralax or other meds, watermelon is a great natural laxative. It actually worked better for my son than the Miralax. My mother-in-law always has this issue when she is traveling and drinks tap water from other locations. Don't know why - it's very strange. As long as she drinks bottled water she is fine.

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Sorry to make it sound like she was traveling....she is just gone for a day trip.   She has been home all week, she just doesn't really live at at home anymore.  She pretty much lives at her boyfriend;s house and just comes home to pick up medical supplies and clothes periodically. 

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FWIW, Tums immediately freeze everything in my system for 3-4 days. Anything for heartburn/stomach acid slows me down, but Tums is an instant and near-complete wrench in the works. I use magnesium when I need help, and if magnesium alone doesn't work, I add Dulcolax and lots and lots and lots of water. 

 

I hope she feels better very soon.

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Miralax works wonders here. Can take a few days though. Dd has taken more than the normal dose, advised by an urgent care pediatric provider. It made me very nervous, but worked. She did have to miss school to allow for time near the bathroom (pretty much went all day). Could you consult her PCP to get their opinion on higher than normal dose given her other issues? 

 

Otherwise I'd start Miralax at the recommended dose ASAP! 

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