# Regular use of laxatives, unknown reason chronic constipation.



## Aidara (May 9, 2014)

Hello everyone, I am new on this forum. First of all, sorry for any mistakes as English is not my first language.

I am so glad to find this forum, I thought I am going crazy with my symptoms, cause none of my friends or family members are suffering from chronic constipation. Since I've found this forum, I don't feel alone anymore with this embarrassing condition.

I've had mild constipation issues for all my life, but it got so much worse after I gave birth to my daughter 2.5 years ago. Since then I've been taking laxatives on the daily basis. I am a very healthy eater. I cook everything from scratch, I always make sure that my diet is full of fruits&veg. I had been eating tons of fiber before I realised that my constipation has nothing to do with my diet and I feel worse with high fiber diet, cause on top of my constipation I am suffering from extreme bloating. I've also tried dairy and gluten free diet for 6 weeks. No improvement at all.  I couldn't live with this chronic constipation, so I started laxatives as my gp recommended. To be honest, my doctor doesn't seem to be concerned about my unexplained constipation, even though I already have complications - advanced haemorrhoids and anal fissure. I could accept the discomfort of chronic constipation and stay away from laxatives, but without medications my stools are dry, that is why my fissure retears and I get worse symptoms of haemorrhoids. I have bm almost every day, but I have either dry stools or incomplete bm. I am taking a glass of prune juice, 1 sachet of movicol (miralax in US) everyday, 400mg magnesium citrate, strong probiotics on the daily basis. Couple of times per week I have 2 glasses of prune juice and 1,5 sachet of movicol. I am extremely concerned about taking movicol long term, cause I noticed that my body builds up tolerance to the medication and I am scared that I will end up with 10 sachets per day in 10 years time. I am concerned about prune juice as well. Do you guys believe it is safe to take them on regular basis? There is so much information about it and some sources says that it can damage your gut if used long term, cause it contains a mild stimulant. My doctor strictly refuses refer me to see gastroenterologist, he is happy that I am responding to movicol and I have a feeling that as long as my medication works, he won't be taking me seriously. But I need higher doses of it recently, I have been having soft stools, but no urge to go, when I increased movicol amount, I got better. Obviously, I am building tolerance to it and I so scared that eventually I will be taking strong stimulant laxatives and damage my gut, because without medications I can't have normal bm. Also, is it possible that piles are making constipation worse, cause my stools are very narrow. I also suspect pelvic floor dysfunction, because if I don't have constipation, I usually have bm up to 6-7 times in the morning, which


----------



## appleorchard (Oct 14, 2013)

Hi Aidara, I have been suffering with IBS-C for six years now (5 of which I was un-diagnosed). I too suffer from severe constipation (have gone for up to two weeks without going to the loo) and have to take two sachets of movicol every day. The hospital consultant advised that he was not aware of any long term effects of using a laxative such as movicol every day - I was very concerned about this as I had heard that you can end up with "lazy bowels" - the consultant advised that this was just a myth.

My GP referred me to a dietician which helped immensely. She advised that with constipation you need to avoid insoluble fibre but eat plenty of soluble fibre. I too used to eat lots of fruit and veg, but you have to be really careful as to what you eat and the combinations of food which can make the constipation and other side effects worse. The main things to avoid are fruit/veg skins and seeds/pips. For example, when I eat an apple I remove the skin beforehand. Tomatoes should be peeled and de-seeded (processed/tinned tomatoes are ok). The dietician explained that the skins/pips contain insoluble fibre, but the flesh of the fruit/veg contain soluble fibre which is what your body needs.

Also avoid brown foods such as brown bread/rice/pasta and eat everything white. Another tip is to try porridge for breakfast, almost everyday and to have a pro-biotic yogurt drink such as Yakult or Activia- but avoid the yoghurts which are not drinkable - the amount of bacteria in the yoghurt alone is not sufficient to reach your gut, where as the drinks have so many and it passes through your stomach more quickly ensuring that the bacteria reaches your gut where it is needed the most.

It's not an easy road - but good luck!


----------



## annie7 (Aug 16, 2002)

Aidara--so sorry for all your problems--dealing with chronic constipation is miserable isn't it.

like Appleorchard said i've also read and been told by my gastro doc, primary care doc and surgeon that movicol (or miralax as it's called here in the usa) is safe to take and that you can take as much as you need to go. it is not a stimulant laxative but an osmotic laxative and helps keep the stool soft and easy to pass.

and yes if you eat a diet low in insoluble fiber, etc --like Appleorchard said--good diet tips there







--that will also help keep your stools soft and easier to pass.

if you think you may have pelvic floor dysfunction or some type of outlet obstruction like a rectocele or rectal prolapse you can ask to be tested for that. sometimes pregnancy and/or childbirth can bring on pelvic floor/outlet problems. a defecating proctogram will diagnose all this. not sure exactly what they call that test in the UK but it's a similar name. it's a very good test to have. a program of biofeedback and physical therapy taught by a specially trained therapist can help with all that.

and yes, plies can complicate things. not too long ago someone here on the board posted that they got relief from their constipation problems by getting their piles treated--may have been they had surgery for them--can't remember.

good luck to you. hope you can find some relief.


----------



## Dreamcatcher32 (Nov 12, 2013)

I have PFD and find my stools are almost always pretty watery since changing my diet. Absolutely stay away from insoluble fibers. These will constipate you like crazy!! Be sure you are eating soluble and eating good fats and protein to increase peristalsis. Be sure to take 2 tbs olive oil or 3tbs coconut oil and this should aid things in 'slipping through.' Also try chia seeds mixed into coconut water in the morning.

I don't know if you have PFD. If you're going THAT many times when you have looser stool, this sounds almost 100% diet related. Though the fissures signal PFD for sure. Hmmm.. tough to say! I would take Mag Citrate for awhile. Get Bluebonnet liquid magnesium citrate from Whole Foods and take 1-2 tbs a day. This should soften those stubborn stools unitl you can work out your diet.

Btw, to change your diet over I would keep a journal of the foods that work for you and make things 'looser' and those that bind you up. Everyone is difference. For instance, dairy helps me go and binds lost of other people up. Meat or eggs tends to help me 'go' and that isn't the case for most. I find I can't eat rice or really thick breads. (though most are fine) You have to find what works for you and it's a long journey. Guarantee that diet is what is causing your hard stools though.


----------



## Dreamcatcher32 (Nov 12, 2013)

Also be sure that you're drinking enough water. I suffered from constipation for months until specifically being told by my GP to drink water DIRECTLY after eating. Make sure it's a full glass of water each time, otherwise the food/fiber will sit in you like a brick. You also need to drink at least 64 oz a day of water at least. Good luck! Let us know if these things help.


----------



## Aidara (May 9, 2014)

Thank you so much for your replies. I posted two similar topics, because I thought I have deleted this one. I am so grateful for your advice. I have never tried eating soluble fibre only, I am definitely going to try that. I noticed that bran, wholemeal bread or pasta makes things worse, so I am staying away from it, but I am eating loads of fruits and veg but with skins on them, so I will make sure that I am peeling them. Hopefully, that will help. I know that movicol is considered to be safe long term, but I am worrying that I need more of it to be effective. What about prune juice? It works very well for me, but Is it safe to take 2-3 glasses of prune juice daily? Also, I have a strong feeling that my problem could be related with PFD, but I have no idea how to convince my doctor to test it. I had 3rd degree tear during my labour so it is very likely that it contributes to my constipation.


----------



## annie7 (Aug 16, 2002)

yes insoluble fiber can really make things worse if you're constipated. it just slow things down even more and also causes a lot of bloating. soluble fiber is much easier to digest and helps keep stools softer, looser and easier to pass.

about testing for pfd. tell your doctor all about your problems, symptoms and concerns--all the details, explain why you have a strong feeling you think you might have pfd etc-- and tell he/she that you want to be tested for pfd. if for some reason he/she refuses without an extremely good explanation that makes sense to you--i would find another doctor or a gastro specialist.


----------



## Dreamcatcher32 (Nov 12, 2013)

Yep, pasta, brands and oats bind most people up. Fiber one bars even bind me up! Too much insoluble fiber. Soluble fiber will definitely make your stools looser. The problem is that people want to 'cheat' here and there. Once you do that, you're just going to get constipated again. To replace pasta, you can get some type of 'spinner' and use zucchini or try quinoa. Even quinoa can kinda constipate me though. I have to be sure to get my fats in my diet. I eat a lot of organic sausage - can't complain about that. Yum! I would do almost a 100% veg/fruit diet and keep a diary for a good month of what works and what doesn't for your own body. Just be sure not to eat your fruits with anything - makes them harder to digest. Eat them all inbetween meals. Do lots of stir frys with chicken (if you can tolerate that) and be sure to only use veggies and eat zero rice. If you're going to eat something binding then use the Magnesium Citrate over the Miralax. I also make avocado pudding for a sweet treat (you can google it) and it's full of wonderful healthy fats and it's to die for delicious!

You can drink prune juice as much as you want and it's safe. I would 'rotate' it out with other things, though. Your body gets used to certain things. And honestly, if you change your diet you won't need 'helpers' every single day. I went so long refusing to change my diet until I got totally desperate! I also forgot to mention fish oil - that's really going to help things out. Oils make things 'slippery' for you. You can also drink coffee in the morning and this will help get things moving along.

I'd say yeah, definitely go to a gastro specialist. Maybe one that specializes in motility disorders? I find regular gastros are super hesitant to test for PFD. I have no idea why! It's so frustrating! None would test me until I went to Mayo Clinic. (though I still don't think they did enough testing and are missing something) An anorectal manometry or defography is supposed to diagnosis this condition. Though my manometry came back normal, I was diagnosed by their biofeedback specialists. A lot of people have PFD and are able to 'get by' and don't struggle too much. But what about those who DO struggle!? For now, just be sure that you're pooching out your belly when having a bowel movement and 'relaxing' your sphincter entirely when having a bowel movement and bearing down. Annie posts this video a lot and it is SO helpful! This prevents straining, thus preventing further tension in the pelvic floor.


----------



## Aidara (May 9, 2014)

Thank you so much for your advice. When I am feeling worse, I've been eating more and more of insoluble fibre, because that is what on every health article they say helping constipation. In fact, the more insoluble fibre I ate, the worse I felt, despite of drinking loads of water. I have never thought about cutting this kind of fibre. I was only increasing it, because I thought that is what is helping constipation. Eventually, I stopped eating wholemeal bread and pasta, cause I didn't have any relief and it caused me a lot of bloating. I've been still constipated since then, but at least it stopped the bloating. You all gave me hope. I was just about to give up and be taking laxatives for the rest of my life, but now I have something else to try. I will let you know how I am doing, thanks again to all of you.


----------



## annie7 (Aug 16, 2002)

oh yes please do keep us posted--thanks! hope the diet change works well for you--it should help quite a bit.

years ago my primary care docs keep telling me to eat lots and lots of insoluble fiber because way way back then it was thought that insoluble fiber was good for constipation. and it just plugged me up even more of course--lol... dropping my fiber intake and switching to insoluble fiber like everyone has said has help me a bit. at least i don't get plugged up so badly now. and it's a bit easier to get it all out.

thank goodness there is more information out there now about soluble and insoluble fiber and the thinking about which is best for chronic constipation has changed. insoluble fiber can help some people with C if indeed low fiber is their problem but for many of us it just makes us worse. as my gastros are both telling me now: "fiber is not your friend".

good luck!


----------



## Dreamcatcher32 (Nov 12, 2013)

Same thing happened to me! My dad just kept telling me to eat insoluble and it completely backed me up! I also wasn't drinking a full glass of water with each meal and that was the kiss of death. Once I started eating soluble and added smoothies (Spinach, yogurt, coconut milk and oodles of berries) and was shocked that my stools were loose! I was also eating lots of soups and salads. I thought I'd never have looser more manageable stools but diet is key. My dad has to literally write down everything he eats day in and day out and rotate foods in order to not get backed up. He also measures his water, which is a little kooky. But it's funny how if I drink a full glass of water after every meal, I have loose stool. If I drink half a glass, I have firmer stool.

Another tip would be to use lubricant before you know you'll have a BM. That way things can just 'slip out.' Also be sure that the urge you have is strong and persistent, otherwise you won't get much out anyway.

You can use laxatives now and then but they aren't necessary if you don't have Inertia. (which is quite rare) Even with a slower colon, your body can do the job just fine on it's own. You just have to be kind to it and put the right foods in it. You'll get there!!


----------



## Aidara (May 9, 2014)

Well.. I am impressed how many of you got relief just switching to soluble fibre instead of insoluble. That is really encouraging. However, I found a little problem to find sources of soluble fibre. For example - beans, nuts, dried fruits, broccoli, spinach . Some sites states that it is source of insoluble fibre and some that it is a great source of soluble. I presume, they have both. But should I eat them or should I avoid insoluble fibre at any price? Typical diet I have been following by now is:

Breakfast: citrus fruits, banana, youghurt or porridge with raisins.

Lunch: lean meat with vegetables, pasta, brown rice sometimes potatoes

Dinner: raw vegetable salad with loads of olive oil and lemon, some cheese or walnuts

I usually had dried fruits or fresh fruits for snacks, but with skins on them.

I decided to leave the same breakfast, the same lunch, but change my dinner to vegetable soup instead of raw veg salad. Also to make sure that I don't eat fruits with skins on them and in general avoid any wholemeal food. Should I avoid dried fruits as well?

I have been thinking about fibre supplements as well. That is so strange, that it is recommended to eat insoluble fibre for constipation, but so many fibre supplements sometimes called laxatives are based on soluble fibre. I took fybogel yesterday and reduced movicol to half sachet and so far so good. I think it is safer to take fybogel then movicol, but of of course, my biggest dream to be laxatives and supplements free.


----------



## annie7 (Aug 16, 2002)

here's a good soluble/insoluble fiber chart that i've been using--shows different foods and how much of each type of fiber they have:

http://www.digestivehealthconsultants.org/patient_education/fiberchart.html

and yes there is conflicting information out there. what i do when i find information that conflicts is experiment and see what works best for me.

personally i found that just experimenting with different foods worked best for me and helped me figure out a diet plan. i don't avoid insoluble fiber at all costs--i just don't eat a lot of it. for me, well cooked vegetables work better than salads or stir fry but that's me. i eat a sort of soft "squishy" foods diet. but i am older, too--62, lol--and i've read and been told that as we age our digestive system tends to not need as much fiber.

and yes--healthy oils like olive oil etc are in general good for constipation..

i also eat a diet lower in FODMAP to help prevent gas--been doing that for many years. but again, everybody is different . not all fodmaps bother me but some do.


----------



## Dreamcatcher32 (Nov 12, 2013)

Thank you Annie! I'm going to use this chart for sure. I've been looking for something like this. I also wasn't aware that as you age your digestive system doesn't need as much fiber. Definitely a good thing to note. I find soft and squishy foods to be really helpful also. Fodmap foods are strange for me. Some foods will make me bloated and gassy (I'm never very gassy though) at some points in time and then at other points, they don't bother me. I think the volume of food is what makes me feel bloated and gassy. I eat about 5-6 meals a day versus 3.


----------



## annie7 (Aug 16, 2002)

the recommendations for the amount of fiber that you should eat get lower as we age because the digestive tract tends to slow down with age. at least that's what i've read and been told. and experienced.









http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/fiber/art-20043983


----------



## Aidara (May 9, 2014)

Annie7 thank you very much for your link. It's been very helpful. I realised that there is very few foods containing one type of fibre only. Since yesterday I've been eating the ones, which contain the highest amount of soluble fibre. I am also taking fybogel (ispaghula husk) it is based on soluble fibre, I want to replace Movicol with it gradually, cause I don't want to take higher doses of it, hopefully some break helps to get back it's effectiveness.

My doctor keeps telling me that I have this chronic constipation problems, because I am aging, but it sounds ridiculous as I am only 30 years old. What my body will be like in 30 years time then? I guess I still need high amounts of fibre. Annie7 do you know at what age people should decrease their fibre intake?


----------



## annie7 (Aug 16, 2002)

for decreasing fiber the mayo clinic link i posted above said age 51 for women and i've read that elsewhere too. but i imagine--like they say--"your mileage may vary"...

for me constipation problems seemed to get worse when perimenopause started around age 45 or so and that's when i really noticed that less fiber was better.


----------

