# Firming up stool?



## mey2614 (Feb 25, 2011)

Does anyone have any idea on what I can use to firm up my stool? I am currently using tegibs (and amitiza when needed). Although my stool is very soft and loose it seems I am still very constipated and bloated because of it. I had five days last week where they were firmer and had no issues at all with using the bathroom. I would appreciate any idea any one has!! This flare has been going on forever and I'm really at my wits end. No one seems to understand around me how frustrating and debilitating this can be!


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## Kathleen M. (Nov 16, 1999)

Most of the stool firming things (other than fiber) can be constipating so I don't know how many of those are going to be useful if you tend to the constipated end of things.You can look at how much fiber and water you get and see if there is some amount of fiber (and how much water you need with it) to keep things in the firm range rather than too loose or too hard and dry.You might also look at dietary things that tend to loosen up stools, and it may be now with the medications you'd do better with less of them, even if you really needed them before. Alcohol, caffeine and stimulants like nicotine can all loosen things up for some people. Also sorbitol containing fruits (raw, dried or juices). So apples, pears, cherries, peaches plums/prunes may be better if you eat them cooked or canned rather than raw.


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## mey2614 (Feb 25, 2011)

I've heard about caffeine and alcohol causing loose stools but for some reason that seems to always be the opposite for me. I usually have a firmer movement especially after drinking alcohol. What fiber brand or supplement would you recommend in order to bulk things up?


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## tourist (Feb 19, 2011)

Yes, it is becoming clear that softer stools don't always mean better evacuation. I too have found that if they get too soft, they move LESS, not more. It kind of throws a monkey wrench in the conventional wisdom. Maybe there needs to be a certain amount of solidity to the stool or the colon doesn't get stimulated to contract. I think the beginning of the idea that stools need to be softened had to do with seeing folks whose constipation that was caused by hard dry stools, But constipation can also result from a lazy colon and soft stools just lay there.For this reason, I had so much trouble getting help from doctors who were not gastros. They seemed sure that softer stools will solve everyone's problem. Even my gastro started with that idea. When I told him that I had trouble evacuating the colonoscopy prep, that got his attention. A bowel full of water and laxative, but it still didn't move. In any case I found that Miralax made things worse because it not only caused hellish gas, but also created a stool that was so soft it never moved. It also seems a mistake, when you have an atonic colon, to take your meds twice a day. That leaves no clear signal ot stiumulation to the bowel. Taking all meds before bed seems to work better.But for me nothing works as well as cascara or senna. I do have melanosis after taking them for so long but nothing else works without bad side effects. And there still is no study that demonstrates undisputable harm in melanosis. I'm still looking for an alternative, but so far, nothing.


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## Kathleen M. (Nov 16, 1999)

If you don't have problems with gasiness psyllium based fibers (like metamucil or bulk psyllium) can do a good job.If you tend to get pain when you have more gas you may want to try something like citrucel. You can also look at higher fiber foods, whole grains, fruits and veggies, and see if those help. Fruits tend to be more soluble fiber, whole grains generally tend to be more insoluble fiber. Most fiber supplements tend to have more soluble fiber. (everything is a mix of both, but tend to have more of one or the other).


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## tourist (Feb 19, 2011)

Kathleen M. said:


> If you don't have problems with gasiness psyllium based fibers (like metamucil or bulk psyllium) can do a good job.If you tend to get pain when you have more gas you may want to try something like citrucel. You can also look at higher fiber foods, whole grains, fruits and veggies, and see if those help. Fruits tend to be more soluble fiber, whole grains generally tend to be more insoluble fiber. Most fiber supplements tend to have more soluble fiber. (everything is a mix of both, but tend to have more of one or the other).


So you are saying that these forms of fiber will firm up the stool for mey2614? But wouldn't that depend on how much fluid was ingested? Increasing fiber only makes things worse for me because the slow transit time gives them all too much time to ferment and turn to gas.


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## Kathleen M. (Nov 16, 1999)

Fiber and water makes up the stool. Getting the right balance will get the stool the right consistency to move.Slow transit usually doesn't have people getting too soft stools, and for that particular kind of constipation too much fiber is a problem as the stool is inside for more than 3 days. Usually if people can get too loose that isn't the issues, and it isn't the issue for most people with IBS.If you have slow transit constipation (based on a sitz marker test, not how backed up you feel) then the recommendation is less fiber and a lot of osmotics, even amounts that might make anyone else have watery diarrhea all the time.If you are too soft and loose you don't want to add more osmotics as that makes you even softer and looser, but sometimes with too soft stools a bit more fiber can give them enough bulk to stay formed.


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## mey2614 (Feb 25, 2011)

There are a few things I planned on trying for this. Do you think that calcium would be constipating for me? I will try the psyllium based powders and see if that does anything. I take miralax usually daily, is that the same thing as adding bulk fiber?


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## Kathleen M. (Nov 16, 1999)

Miralax is an osmotic laxative, not a bulk fiber.Probably better to either play with the level of that or the level of fiber rather than try to balance things by using a constipating side effect to balance out the stool wetting/softening/loosening of miralax.Now if you need calcium and don't get it in the diet you could take that, but you might need one combined with magnesium so it isn't as constipating.


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