# IBS-C Story & Dulcolax + Lactulose Query?



## Kate Smith (Aug 4, 2014)

I have had IBS for about 15 years now. I have IBS-C which means I don't go at all for a week to 10 days and then when I do go I pass very large, painful BM's followed by overflow which is basically diarrhea and leakage for the following 24 hours (horrible). I also suffer from episodic severe abdominal pain which only strong pain killers help all of which I am sure is familer to many of you.

I was origionally diagnosed with IBS in 2000 with no follow up treatment (during this time I never used laxatives just peppermint tea). My condition fluctuated but eventually I was refered to see a gastroenterologist last year and after some tests to rule out any major bowel disease they diagnosed IBS-C and began treating me with Movicol (Miralax). I continued with the Movicol for about 8 months with not a lot of success. It made my BM's easier to pass but it didn't do anything to speed up my slow digestion.

Today I went back and my medication was changed to Biscodyl (Dulcolax) 10mg and Lactulose 10 ml daily. The doctor told me there is not really anything else they can do for me. He said that my bowel is very lazy and totally relient on gravity and food pushing food and waste though my system and when it reaches a kind of critical mass then I have a BM. He hopes that the compination of stool softener and stimulant laxative will help me have a BM maybe every 2nd or 3rd day. This would be a good improvment for me and he feels it would largely eliminate my leakage issue and abdominal pain.

He has discharged me from his clinic saying I could asked to be refered back if things didn't improve in a few months with the new treatment plan. I get a bit nervous at hospitals and didn't ask some important questions. Mainly if this new treatment works do I stay on it forever? Most of what I have read about stimulanting laxatives say you shouldn't take them long term?

Is anyone else taking the above combination of Lactulose and Dulcolax? Has it been helpful and if so have you been able to stay on it long term? What side effects have you experianced?

Overall I feel a bit disappointed with the treatment I have recieved from the NHS for my IBS. I feel like once they ruled out anything life threatening they lost interest in me regardless of the the fact the symptoms which so concerned them haven't really changed is this common in the UK?

Thank you in advance for reading my post and answering my query!


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## annie7 (Aug 16, 2002)

Hi

so sorry for all your problems.yes it's miserable living with chronic constipation, isn't it.

i have slow transit constipation as diagnosed by the sitz marker test (colonic transit study) i also have pelvic floor dysfunction and some other problems as well. i've been having constipation problems for about fifty years (i'm old--lol)

very long story short after trying everything--diets, herbs, meds---about five years ago i started taking 15 mg dulcolax nightly along with 3-4 TBL of milk of magnesia (lactulose never worked for me) both my gastro docs as well as my surgeons have told me to "take what i need to go" since i develop impactions very easily. and all these docs have told me and i've read many studies that say this as well that the stimulant laxatives currently on the market are safe to take at recommended dosages. the dangerous stimulant laxatives that used to damage the colon have been removed from the market. i actually remember when they pulled the old-style ex-lax and replaced it with the newer type that is safer.

so, yes, this laxative combination has helped me a lot.

stimulant laxatives i feel are kind of a last resort to use only if you've tried everything else (like i have)--diet changes, exercise, etc etc...and of course, with your doctor's approval, which you have.

have you tried any of the newer meds available for constipation? there is linzess (prucalopride) (constella it's called in some countries) it's available in the uk. also available in the uk but not in the usa is resolor (prucalopride) ask you doc for a script so you can try these (separately, of course) there is also amitiza. the drugs have been effective for many people in helping tpo relieve constipation. you can google them for more info..

and of course if you haven't already done so, you should try experimenting with different diets to see any dietary changes will help relieve your constipation. there's a lot of diet info here on the board.

sorry your doc hasn't been too helpful. if this continues, i would get a new gastro doc, if i were you. you deserve to have a knowledgeable, caring gastro doc who will be proactive in your treatment.

please do take good care. wishing you all the best.


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## Kate Smith (Aug 4, 2014)

Hello Annie,

Thank you for your reply, sorry to hear that you have to suffer with this too. it is indeed a miserable existance.

I appreciate the reassurance about the long term use of dulcolax. I guess what they say is that your bowel may become lazy and dependent if you over use simulate laxatives but seeing as mine doesn't work properly anyway then perhaps their is no real harm.

I haven't heard of the new medications you mention when I first saw the gastro doctor he did mention other drugs that we could try (antidepressents I think) but today he said that due to other medications I am on (I take quite a few prescription drugs for Chronic Migraine) that I was unsuitable for treatment with anything other than the laxitives due to contrindications with the other drugs. I will speak to my GP about the medications you mention though if I don't have any success with the laxitives.

I will look into the diet side of things, I am a vegetarian and my gastro says I should not give up milk as I am very deficent in Vitamin D but I am willing to play around within those boundries to see if anything helps.

It is a bit dissapointing about the help I have had but I think this is somewhat common with the NHS in the UK chronic conditions are to some extent over looked. Not that I am knocking the NHS it is brilliant if you are acutely ill.

Thank you again for your response, take care 

Kate


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## annie7 (Aug 16, 2002)

Kate--oh you're more than welcome.







we're all in this together...

you're right--our bowels don't work properly by themselves so, yes, we do need help--whatever it takes to get them working again--like my gastro docs told me..


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## Aidara (May 9, 2014)

Kate Smith, I am from UK too and I am struggling so much even to get the right diagnosis on the NHS. It's been almost 3 years and only a week ago I managed to get referral for some testing. Sadly, it is very difficult to get the right treatment and even diagnosis in my case. However, I believe that you have to be very persistent. That is what I am doing now. If you are not happy with the treatment ask for a second opinion. Don't give up. I do understand why they don't want to prescribe you prescription medicines mentioned on Annie's post, but I can't understand why they haven't prescribed them to you before offering Dulcolax?? It must be something to do with NHS savings, I don't see any other explanation. Wish you the best luck.


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## Aidara (May 9, 2014)

Also, have you tried lactulose yet? Does it make you bloated? It works quite well for me, but I can't stand the pain and gas with it, so I had to stop it. I wouldn't worry about Dulcolax in your case, your symptoms are quite severe. For the last 4 months I keep telling my doctors that Movicol and Fybogel are not working for me anymore, but they don't want to offer me anything else. I don't want to take stimulant laxatives without my doctor's approval, but I am taking them, because I simply don't have any other choice.

How did you get your diagnosis? Was it difficult to get referral to see a specialist? What tests have you had? I believe that there is no other condition taken less seriously as constipation in NHS, so your experience is very interesting to me.


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## trudyj (Apr 5, 2014)

Hi, Kate,

As to medication conflicts, there are various medication interaction checker things on the web that you can tell all the medications you are taking or might take and see if they really conflict. (When I do this with mine, I get some conflicts that I can disregard because my doctor has told me they are minor.) Usually the conflicts are labeled something like minor, major, severe.

As to milk and vitamin D, at leats in the US you can buy vitamin D-3 supplements. I do that and hardly ever drink milk. I know that is enough to keep my vitamin D levels normal because my doctor has me have a blood test for those about once a year.

I've had IBS-C for about a year. Like yours, everything accumulates but in my case for 3-4 days. I do think mine has been slowly worsening. So far I have been using Miralax plus a stool softener (anything that contains Docusate Sodium 100 mg) every twelve hours. I am still trying various things like modifying diet and I see a new GI doctor in about six weeks.


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## trudyj (Apr 5, 2014)

p.s. Could the medications you are already taking be causing constipation?


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## Kate Smith (Aug 4, 2014)

Hello all,

Many thanks for your replies and advice.

Aidara, I have looked into it more today and it turns out that the drug Annie mentions "linzess (prucalopride)" is serotonergic which is contraindicated with the medications I use for migraine. Also it appears the NHS guidelines here in Scotland only allow for it to be used in exceptional cases when all other options have been exhausted. I'm not sure why this is but it is probably financial.

I haven't used the Lactulose yet I should be able to start on it tomorrow. I am prepared to give it a go although my concerns about long term use of laxitives remain. I am determined not to over use them in any case.

As for your question on getting a diagnosis I was initially diagnosed with IBS about 15 years ago when I presented with symptoms of colitis which runs in my family. I was whipped in for a colonoscopy but no ulceration was found. I was told I had IBS and that was it no mention of further help or treatment. I did my best in the next decade to help myself with diet, peppermint tea etc. Over the past two years I have been under the care of a neurologist for my migraine and he was the one who requested I was refered back to the gastro doctor when my IBS was becoming much worse. It was then I was diagnosed with IBS-C and began treatment with laxitives.

I think on the NHS there is like a treatment protocal you need to comply with to progress to hospital referal. Obviously for things like suspected cancer and the like referal is much faster but for chronic conditions your GP will usually have a few first line treatments to offer for example with IBS these might be diet and lifestyle advice and fibre supplements. You need to comply with these treatments and give them a fair try and if the GP exhausts all his approches and your still not improving then he needs to refer you. Sometines depending on your GP you need to be quite assertive to get a referal. When I sought a referal for my migraine I took in information detailing the medications I had already tried, a diary of my migrianes and symptoms. Even then I had to push to get my referal and at the migraine clinic I attend I am considered one of the more severe cases they see. If you are unhappy with your treatment then see another doctor who will refer you. As a caveat to the above I would say that realistic expectations of what the NHS can offer is important I don't expect to be completely cured of my migraine or digestive issues but I do want help to make these conditions more managable. I doubt that a lot of the treatments you hear about online such as biofeedback are available here in the UK on the NHS, I wish they were but treatment seems pretty basic. I have had two colonoscopies and a lot of blood tests that is all.

Trudyj thank you for your post. Yes I do think that some of the medications I take for migraine are making my constipation worse however Migraine itself causes gastroparesis which doesn't help either. Infact I believe both Migraine and IBS are linked to a lack of serotonin but for me migraine is my most disabling condition so I give precedence to my migraine treatment over by IBS treatment.


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