# Orlistat (Alli)



## Mary5 (Apr 17, 2006)

A gastroenterologist from abroad suggested taking Orlistat (Alli) with each major meal -just make sure you have fat in the meal. She said they were using it successfully for constipation problems.I haven't dared yet...Have slow transit and pelvic floor disorder (in therapy).Anyone trying? Comments ?


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## em_t (Jun 8, 2010)

Hi Mary,I read a study where they used Orlistat in patients who were taking large doses of opiate painkillers and who had severe constipation as a result. The results from the study showed that it was indeed very effective in reducing symptoms of constipation and reduction of laxatives for those patients. However it was only used in overweight patients with a BMI of 30 or above. If you are overweight you could ask your GI about a trial of it. Btw for slow transit constipation have you tried a trial of a low fibre diet, I've heard it can be effective in some people. I have recently had a transit test done, during which I passed none of the markers, so suspecting to be diagnosed with slow transit constipation. I also have some rectal problems too and wondering if there is anything that you have found effective?


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## Mary5 (Apr 17, 2006)

The colorectal surgeon confirmed that with pelvic floor outlet disorder, he would not do surgery for slow transit and sent me to therapy.At therapy they apply deep heat, do massage and instructed me on pelvic floor excercises.The first couple of months were wonderful ! Suddenly everything worked!However, as usual, the effect started to slow down and now I am back to "almost square one".I am definitely not overweight so I am not sure about the orlistat.It does seem like there is no solution in sight, only the possibility of decreasing the pain and the physical discomfort.To answer your question:-If you are diagnosed with pelvic floor disorder, I urge you to go to therapy, this has made a huge difference.-Yes, I definitely find a lower fibre diet better. Otherwise, I can feel the rocks stuck along the way.-Drink water and stay away from starches completely, and little meat.-Back to taking OTC laxatives as needed (mostly senna), although less than I used to before starting therapy.-Taking hyoscin before meals makes it easier for food to start going down.


em_t said:


> Hi Mary,I read a study where they used Orlistat in patients who were taking large doses of opiate painkillers and who had severe constipation as a result. The results from the study showed that it was indeed very effective in reducing symptoms of constipation and reduction of laxatives for those patients. However it was only used in overweight patients with a BMI of 30 or above. If you are overweight you could ask your GI about a trial of it. Btw for slow transit constipation have you tried a trial of a low fibre diet, I've heard it can be effective in some people. I have recently had a transit test done, during which I passed none of the markers, so suspecting to be diagnosed with slow transit constipation. I also have some rectal problems too and wondering if there is anything that you have found effective?


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## em_t (Jun 8, 2010)

Hi Mary,Its interesting to hear how any people have both slow transit and pelvic floor problems - I wonder whether sometimes the slow transit has caused the pelvic floor problems. I have had such bad constipation that I ended up with faecal impaction once because my doctors would not take my constipation seriously and now I have a suspected mucosal prolapse - still need to have investigations done for it but have all the symptoms. Because of my pelvic floor problems I physically cannot push any pressure on the area, I have to use powerful laxatives everyday to go (sodium picosulphate) and sometimes suppositories because I have incomplete emptying. I also have persistant nausea due to all this which is resistant to any treatment. I know they offer biofeedback in some hospitals in the UK, but I am not sure about Northern Ireland, plus if its caused by a prolapse I'm not sure how successful it would be. I'm also worried that if I have the surgery for a prolapse that I will still continue to suffer since I also have slow transit. Just wondering what you eat in a typical day - if you have no starches, very little meat and low fibre - what can you tolerate?Sorry to bombard you with questions but its just good being able to talk to someone else who has the same problems!Em


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## Mary5 (Apr 17, 2006)

Yes, slow transit + pelvic floor (prolapse)seems to be quite common. I believe it is a combination of Age + the pushing. And also at some point you start NOT to evacuate properly and your muscles get into that pattern.The defecaphropy test is the one that showed the prolapse and how the rectal muscles were not working properly.If that is your case (and it does sound like it,the incomplete emptying is TYPICAL) I highly recommend you go to biofeedback or therapy, it really does make a difference. If you can't get to a therapy center right away, there is lots of stuff online including videos so you could check that out at any time. Search for Pelvic Floor therapy.If you have a prolapse, it will not make the prolapse worse. On the contrary, strengthening the pelvic floor muscles should help to prevent it getting worse.Personally I would not get surgery for a prolapse unless it was absolutely and vitally necessary. Plus it won't fix the slow transit. In the end slow transit appears to be a chronic condition for which there is no cure or medication at this time. All the medications that were out there (like Zoloft) have been banned because they caused rapid heartbeat etc.The only hope out there for now /for slow transit constipation/ is Resolor (prucalopride) approved by the European commission, it is out in Germany, UK, Belgium. It is not available here in the US. If you are in Northern Ireland perhaps you can get a script for it.Well I try to eat small portions (which is easy to do since I tend to think of all food as pieces of glass).For breakfst typically applesauce and coffee. After much experimenting this combo seems to work for me as the best trigger. However, several gastros have advised that all contipation sufferers would benefit from eating fiber at breakfast time and one suggested the following breakfast each day: a piece of stewed fruit, half a yogurt, 2 pieces of toast with butter and coffee.At midmorning sometimes some crackers with butter/margerine.For lunch: vegetable soup, depending on how I feel, whole or pureed and strained. Or: a small piece of roasted chicken with cooked zucchini. Or fish with peas. Or a lean cuisine meal. Midafternoon: coffee and toastFor dinner: same as lunch.With slow transit it seems like it doesn't really matter since stuff doesn't move along usually and I end up taking a laxative cause I can't breathe! but I have found over the years that I feel better if I stick to mostly cooked vegetables.Hope this helps.


em_t said:


> Hi Mary,Its interesting to hear how any people have both slow transit and pelvic floor problems - I wonder whether sometimes the slow transit has caused the pelvic floor problems. I have had such bad constipation that I ended up with faecal impaction once because my doctors would not take my constipation seriously and now I have a suspected mucosal prolapse - still need to have investigations done for it but have all the symptoms. Because of my pelvic floor problems I physically cannot push any pressure on the area, I have to use powerful laxatives everyday to go (sodium picosulphate) and sometimes suppositories because I have incomplete emptying. I also have persistant nausea due to all this which is resistant to any treatment. I know they offer biofeedback in some hospitals in the UK, but I am not sure about Northern Ireland, plus if its caused by a prolapse I'm not sure how successful it would be. I'm also worried that if I have the surgery for a prolapse that I will still continue to suffer since I also have slow transit. Just wondering what you eat in a typical day - if you have no starches, very little meat and low fibre - what can you tolerate?Sorry to bombard you with questions but its just good being able to talk to someone else who has the same problems!Em


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## em_t (Jun 8, 2010)

Hi Mary,For me age shouldn't really be an issue, I'm only 24! The slow transit constipation was very sudden onset for me - I had a stomach bug almost 2 years ago and since then I have really struggled with severe constipation and poor appetite, no doubt exacerbated by the slow transit! At this point in time, I would actually prefer to have my bowel taken out because I am in so much pain. I am also having difficulty urinating, presumably from the pressure of my bowels on my bladder. I've resigned myself to eating once a day because I'm in so much pain and because my appetite is bad, however once the pain settles down I will try and get back on track and eating more often. I have had to abandon my job as a teacher because of all of this and am practically housebound at the minute. Although I had quite a bit of nausea and bloating during the Sitz marker test, at least I didn't have the pain from taking laxatives!I actually had a script filled for Prucalopride but because my constipation has been so severe of late I haven't been able to take it because I haven't been able to come off laxatives. When you say that surgery doesn't fix slow transit constipation is that for subtotal colectomy with ileorectal anastamosis or for coletomy with an ileostomy. To be honest, if I was going for surgery I think I would go for a stoma because at least there would be less bowel for it to go through to get stuck.Just wondering as well, when you eat toast is it white bread or wholegrain?


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## Mary5 (Apr 17, 2006)

Yes, you are very young so that your metabolism should be quite high still. Sorry to hear you are suffering from this condition so young, they say it is not "life-threatening"...I beg to disagree, it is definitely life threatening!I don't understand why you don't take the Prucalopride instead of the laxatives ????As for the colectomy, if you do not have pelvic floor problems, then it should help the slow transit.In my case, because I do have the outlet issue, then the operation won't help because I still cannot get things out at the exit.As for bread, I will eat both, white or wholegrain. I just do not eat a lot of fibre because with the slow transit it makes for lumps that DON'T MOVE ALONG. In normal people the fibre will move along just fine, but with Slow Transit AND pelvic outlet I find a low to medium fibre diet best. People say that X is healthy and X isn't...it doesn't matter, it is what works for you, for your condition.


em_t said:


> Hi Mary,For me age shouldn't really be an issue, I'm only 24! The slow transit constipation was very sudden onset for me - I had a stomach bug almost 2 years ago and since then I have really struggled with severe constipation and poor appetite, no doubt exacerbated by the slow transit! At this point in time, I would actually prefer to have my bowel taken out because I am in so much pain. I am also having difficulty urinating, presumably from the pressure of my bowels on my bladder. I've resigned myself to eating once a day because I'm in so much pain and because my appetite is bad, however once the pain settles down I will try and get back on track and eating more often. I have had to abandon my job as a teacher because of all of this and am practically housebound at the minute. Although I had quite a bit of nausea and bloating during the Sitz marker test, at least I didn't have the pain from taking laxatives!I actually had a script filled for Prucalopride but because my constipation has been so severe of late I haven't been able to take it because I haven't been able to come off laxatives. When you say that surgery doesn't fix slow transit constipation is that for subtotal colectomy with ileorectal anastamosis or for coletomy with an ileostomy. To be honest, if I was going for surgery I think I would go for a stoma because at least there would be less bowel for it to go through to get stuck.Just wondering as well, when you eat toast is it white bread or wholegrain?


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## Mary5 (Apr 17, 2006)

I also wanted to ask you if you have had a Defecagrophy, this test is to see if your pelvic floor muscles are working correctly (to push things out the anus) because my understanding is that subtotal colectomy will NOT work if these muscles don't work properly.


em_t said:


> Hi Mary,For me age shouldn't really be an issue, I'm only 24! The slow transit constipation was very sudden onset for me - I had a stomach bug almost 2 years ago and since then I have really struggled with severe constipation and poor appetite, no doubt exacerbated by the slow transit! At this point in time, I would actually prefer to have my bowel taken out because I am in so much pain. I am also having difficulty urinating, presumably from the pressure of my bowels on my bladder. I've resigned myself to eating once a day because I'm in so much pain and because my appetite is bad, however once the pain settles down I will try and get back on track and eating more often. I have had to abandon my job as a teacher because of all of this and am practically housebound at the minute. Although I had quite a bit of nausea and bloating during the Sitz marker test, at least I didn't have the pain from taking laxatives!I actually had a script filled for Prucalopride but because my constipation has been so severe of late I haven't been able to take it because I haven't been able to come off laxatives. When you say that surgery doesn't fix slow transit constipation is that for subtotal colectomy with ileorectal anastamosis or for coletomy with an ileostomy. To be honest, if I was going for surgery I think I would go for a stoma because at least there would be less bowel for it to go through to get stuck.Just wondering as well, when you eat toast is it white bread or wholegrain?


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## em_t (Jun 8, 2010)

No I haven't yet. My gastroenterologist is trialling me on Resolor and wants to repeat the transit test to see if it made any difference. From my understanding the first one was particularly bad but he wants to see if the Resolor speeds it up or not. I think I do have defecation problems as well but haven't undergone the tests for it yet. To be honest, I doubt they will do a subtotal colectomy because I am so young (24) and they will want to exhaust all other measures before doing that. I know they won't do a subtotal colectomy if you have outlet problems but I wouldn't mind having an ileostomy instead because my quality of life is so poor at the minute. The stigma and embarrassment of wearing a bag would be worth it to feel like myself again!


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## Mary5 (Apr 17, 2006)

I think you and your gastro are on the right path!I am very anxious to know how you do on the Resolor, how you feel, if and when you notice a difference...Have you started it yet?Please keep us posted. I would really appreciate it if you wouldn't mind corresponding also one on one through email.


em_t said:


> No I haven't yet. My gastroenterologist is trialling me on Resolor and wants to repeat the transit test to see if it made any difference. From my understanding the first one was particularly bad but he wants to see if the Resolor speeds it up or not. I think I do have defecation problems as well but haven't undergone the tests for it yet. To be honest, I doubt they will do a subtotal colectomy because I am so young (24) and they will want to exhaust all other measures before doing that. I know they won't do a subtotal colectomy if you have outlet problems but I wouldn't mind having an ileostomy instead because my quality of life is so poor at the minute. The stigma and embarrassment of wearing a bag would be worth it to feel like myself again!


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