Constipation question???

[Ihurt]

Hi everyone.

I have not been dx as of yet though I have been having some intestinal issues for the last three and half years now. I have had many tests already. I also have other health issues ( Interstitial Cystitis being one of them). Anyhow, this past Easter Sunday I started getting this odd lower left quadrant pelvic/abdominal pain. It would not go away so by Wednesday I went to the ER. They did a pelvic exam and ultrasound thinking it was a ovarian cyst but it was not. They did not think it was diverticulitis as my colonoscopy just two years ago was normal with no sign of even having diverticulosis and the doctor said you have to have diverticulosis in order to get diverticulitis.

Anyhow I have not had a normal BM since Thursday Morning . I usually go once a day. I had a BM on Monday and also on Tuesday and they were both normal. Wednesday I did not go at all. Thursday Morning I went and had a normal BM. Friday I did not go and then Today which is Saturday I also did not go as I usually do in the morning. I usually am a once a dayer, but occasionally I will skip a day but will usually always go the next day. So this morning I decided to try a glycerin suppository. It took about 40 minutes to take effect but it only produced a small poop. Not a full BM by any means.

I am wondering if something is wrong, like a fecal impaction or something??? Could I have a impaction if I had a normal BM just two days ago on Thursday Morning? I feel bloated and Blaah. I am reluctant to try any other laxatives at this point. I ate three prunes and have been drinking adequate water. I have not added any new medications either. My doctor gave me tramadol to take for my severe bladder pain I get but I have not taken that in over a month. She wants me to start taking it daily due to the awful pain my bladder gives me but now I do not want to even go there yet. Last time I took the tramadol a month ago ( and it was only 25 mg for one day) it caused me sluggish bowels for the next day or so. Now I don't even want to go there if I am having this issue.

Is two to three days without a BM mean severe constipation or impaction??? I am so worried.

 

[2thFairy]

Don't get too worked up about skipping a few days without a BM. In general, the time to worry is if you haven't had a bowel movement in 2 weeks. Try soaking in a warm bath. Being tense because of the pain you have been experiencing recently can certainly cause your skipped BM days.

 

[UnXmas]

I agree with 2thFairy. Going even as long as a week without a bowel movement is fine, and don't start worrying until it's been two weeks, unless you are in severe pain or you are vomitting. Don't start taking laxatives or suppositories or anything yet, you may just disrupt your system further.

 

[UnXmas]

Also if you did have an impacted bowel, they probably would have noticed during the pelvic/abdominal examinations. When I had a small bowel blockage the emergency doctor knew it just by looking at and feeling my abdomen. I realise a blocked small bowel and an impacted bowel aren't the same (I think impactions are usually in the large bowel). But on the other hand, if I remember correctly, you're very slim (like me) which makes it much easier to detect blockages in an abdominal exam. So if you had no signs of problems a few days ago, I don't think anything major could have built up in your bowel since then.

The frequency of bowel movements for normal, healthy people ranges from a couple of times a day to a couple of times a week. So you aren't classed as constipated yet, and certainly not severely. You're still in the normal range. I realise it's not normal for you, and I understand how, when you've had such horrible digestive problems, any change can be very unnerving. But although this isn't normal for you, your digestive system shouldn't be harmed in any way from missing bowel movements for a few days, as it's capable of going without a bowel movement for much longer than that.

As long as it's not causing you pain, try not to worry.

 

[Ihurt]

Thanks 2thfairy and Unxmas for the replies.

I did go some this morning. I feel like crap though. That left sided pain is there again somewhat. I just don't know what is going on.

I am wondering if the uribel I was taking for the bladder pain and help prevent UTI's I get caused some of this. The doctor said it was ok to take the uribel three times a day. I was only taking once a day for like maybe 4 days and then I would stop it because it was upsetting my upper gut ( gastritis and heartburn). I especially try and take it during my period as that is when I sometimes get the UTI's, right after my period. Well I had just finished my period when all that left sided pain started and I wonder if maybe the uribel inflamed my intestines and gut.

This is what the ingredinets in uribel are:

Methenamine: 118mg

sodium phosphate monobasic: 40.8mg

Phenyl Salicylate: 36mg

Methylene blue: 10mg

Hyoscyamine sulfate: 0.12 mg

The two ingredients I worry about in this are the phenyl Salicylate as it is a NSAID of some sort, I believe it is related to the aspirin family. I know it is only 36mg which is way less than a baby aspirin, but still. Also there is the hyoscyamine sulfate which is an anticholinergic which is an anti-spasmotic . I started taking it back in the end of January when I developed a Bad UTI for the severe pain I was in. It really helps my bladder so much. The doctor told me to stay on it the once a day if it was helping me. I did fine, no side effects really until about week three. Then I started getting the heartburn and bloated full feeling. I tried backing off if it some, like only taking it two days, then giving it a break for a couple days and so fourth. Except when I got my period, I stayed on it for 5 days until most of my bleeding was done in order to prevent the UTI.

I know Apsirin is contraindicted in people who have IBD right? I know I do not have a diagnosis of IBD but I honestly do not know what I have really yet. Do you think the Phenyl salicylate is what is causing all these intestinal issues? I thought about it. I tried backing off the last few days now, I have not taken any of the uribel just to see. Unfortunately my period is due in the next week and half and I have no clue what the hell I am going to do if I cannot tolerate the uribel. This sucks. I was on low dose antibiotics for years to prevent the UTI's and it worked pretty good for the most part. The antibiotic stopped working though. I am unable to take any of the other antibiotics due to the very bad reactions I get from them so I am SOL sort of speak now. The uirbel is all I have. But I don't want to be taking it if it is inflaming my intestines and gut either.

Sorry for rambling on. I am just so frustrated. I cannot win, ever it seems. My body is just so uncooperative I hate it!

My regular doctor have given me tramadol to take for bladder pain and I can only tolerate like 25mgs as it is but even that will slow my bowels up, even if I only take it once! She and my pain specialist said I should take it everyday in order to maintain pain relief but I am worried about slowing my gut up or causing even more issues.

Unxmas, I am sorry to hear you are having more pain. I hope they can come up with a plan to help get it under control. No one should have to live in awful pain.

 

[UnXmas]

Aspirin and NSIADs can irritate the stomach even in people without IBD. But try not to overthink this too much. A new symptom isn't necessarily a side effect, it could be unrelated to your medications. And some side effects will ease over time.

Are you sure the Tramadol caused constipation? As was already said, it's fine to go several days without a bowel movement. How long did you go without having a bowel movement when you took Tramadol? There are many options of laxatives to try, if you were constipated for so long that it caused stomach pain, and if the bowel movement is hard and painful to pass, you can try stool softeners.

If pain is your worst symptom, I would continue taking whatever gets that under control. Then if you get side effects of heartburn and constipation, there are plenty of things to treat both those conditions.

 

[Ihurt]

Unxmas,

Well. when I last took the tramadol I only take 1/2 a pill ( 25mg) If I take the whole pill I get super nausea. I did not get constipation where my stool was super hard. just that I did not go like I normally do, I think I skipped a day or so and that was with only taking the 25mg of tramadol once. I am sure if I start taking it daily I may have more of an issue.

I guess you are right, I could always take some sort of stool softener or maybe even drink prune juice or eat prunes if they wont bother my bladder too much or my gut.

Yeah. I am not sure on the Uribel. I know I cannot tolerate the PPI type meds like ( nexium, Prilosec etc..). They never agreed with me. I tried taking zantac when I was taking the uribel but it really irritated my bladder as did Tagamet. My next step would be to try Pepcid. I have stuff like gaviscon and tums but I have to wait hours to take those type ant-acids as they interfere with the uribel from what the pharmacist said.

I guess I am just going to have to try and work with it. I just am worried to keep taking it if it is actually inflaming my intestines and gut. Couldn't that even cause crohns or UC or trigger it rather?

Anyhow, thanks so much for you advice and support. I know you have your hands full with not feeling great from the pain you are having too. I hope your doctor can find something to help relieve your pain or at least up your medication your on.

 

[2thFairy]

I guess I am just going to have to try and work with it. I just am worried to keep taking it if it is actually inflaming my intestines and gut. Couldn't that even cause crohns or UC or trigger it rather?

It wouldn't trigger Crohn's or UC unless you are destined to have Crohn's or UC. High doses (REALLY high doses) of NSAIDs like ibuprofen can create a pseudo UC, but will disappear once the NSAID is discontinued. NSAIDs do not cause IBD, but can trigger a flare up if the patient has IBD.

 

[UnXmas]

If I were you I'd give Tramadol a proper try. Side effects often ease off as you continue taking the medication, not get worse. Is a delayed bowel movement and bloating worse than the pain? If you really can't stand the bloating, then try various laxatives until you find what suits you. I spent four weeks on Tramadol (including trying it at different doses and with and without other painkillers) before I concluded it wasn't helping me.

I'd take the Uribel too. On your pain thread ( http://www.crohnsforum.com/showthread.php?t=71436 ) you said it helped but was giving you digestive problems. Again, I'd continue with it to see if the digestive problems are unrelated or if they ease over time. Or see if your doctor can provide something to counter them.

So really I think you need to ask yourself:

Are you sure that both Uribel and Tramadol are responsible for your current/new digestive symptoms?
Have you stayed on them long enough to see if the side effects ease off?
Have you asked your doctors for medications to treat the side effects?
Are the side effects from Tramadol and Uribel worse than the pain?

I know pain has been a massive issue for you, and you've suffered an awful lot because of IC. Which is why I think if you've found something that helps you shouldn't give up on it because it causes your digestive system to slow down. If you will only take medications that cause you no side effects, you'll never get anywhere.

I really hope you can find a solution. You've had to put up with all this for too long and you really deserve a break.

 

[Ihurt]

Unxmas,

I read your advice and you are right. I do not have a lot of options in terms of treating my bladder. I am at the end point as far as that is concerned. I am not going to give up on the uribel or tramadol yet. I am going to try and work with them like you said and see if my doctor can offer me anything to counter the effects of it. I have not taken the uribel in a few days now since I got that left sided abdominal pain that has calmed down a lot now. I am going to see if the pain comes back once I take the uribel again. That would at least tell me if the uribel is responsible for that pain. My biggest worry is not so much the left sided pain it "may" be causing, more so if some ingredient in it is actually causing inflammation( or damage to the intestines).

Thanks so much for all the support Unxmas, I appreciate it. It is so hard living with such awful pain ( as I know you know this first hand). I will keep you posted on how it goes. I hope your doctor will be able to get your pain down as well and soon. You also have suffered WAY to long as well and deserve to be pain free.

 

[jamilea]

I work in a hospital. You need to talk to your doctor if you haven't had a bowel movement in five days. Longer than that should be cause for concern. A fecal impaction could happen. I'm just being honest.

Get some prune juice. Warm it in the microwave for 30 seconds. That will do the trick! I would advice against taking laxatives. If prune juice doesn't work, use miralax (gets your bowels moving) and ducolex (softens them). Also, any opiate or synthetic opiate causes constipation for me. It's a common side effect.

 

[Ihurt]

Jamilea,

Thanks for the response. I was able to go thankfully. I was wondering,, what can I take besides miralax? I am allergic to that. I did take it a few years back and it worked great at the time but I ended up developing hives from it so now I am allergic to it. I have been eating like three prunes daily right now hoping that will help.

I am going to taking tramadol regularly and it does slow me up for sure. What would be a good thing to take while being on tramadol since I cannot take miralax?

 

[jamilea]

Yay, you went!!!!

Try warm prune juice. You can get it at the store and put it in the microwave for 30-45 seconds.

 

[2thFairy]

Magnesium tablets will help you go and it is gentle.

 

[UnXmas]

I'd try not taking any laxatives at first. Don't pay attention to how many days you go between bowel movements, just concentrate on how bloated and uncomfortable you feel. If you go once every few days or so but you're not in pain, and when you do go it's not painful to strain, you probably don't need laxatives.