# Long term Miralax use?



## sjw596 (Feb 19, 2014)

I'm a 64-year-old male and have suffered CIC for many years. Otherwise, I'm in great shape and eat a very healthy diet: fruits, vegetable, whole grains, etc. I drink at least a gallon of water daily, plus Metamucil 3xDay. I've been through bouts of hemorrhoids over the past 40 years, but no surgery. My doctors really are of little help. Recently, I visited a PA for a gastroenterologist. She suggested Colace 2x day. She also said that I should take Miralax daily and indefinitely. Well, the Miralax helps a lot, though it sometimes gives me some minor cramps. I can live with that, but I'm concerned about whether using it every day from now on is wise. The PA said to ignore the label warnings. We talked about Amitiza, but I haven't started it yet. I'd rather avoid it if possible, given some of the possible side effect (and the cost). Thanks for your thoughts.


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## annie7 (Aug 16, 2002)

Hi SJW

i'm 61 and, like you, have had chronic constipation problems for many years--from childhood, actually.

both of my gastros, my surgeon and my primary care doc have told me that miralax is very safe to take indefinitely (as long as you don't have kidney disease) and that it is even safe to take several doses a day--to take whatever works. i've heard other people say their gastros have told them the same thing and that they've been on it for years with varying doses. if your doctor/PA has examined you, knows your health history and has cleared you to take it, then it's safe to take under his/her supervision.

that's great that it works for you.


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## sjw596 (Feb 19, 2014)

Thanks very much for your comments! I've used it only a few times, and it does have a tendency to make me feel a little crampy for the rest of the day, after it's "done its thing." I'm going to try to adjust the dose (I've added a teaspoon or two to Citrucel). I have 8 days' worth of Amitiza to try, and I may try it if the Miralax causes too much discomfort. The cost of Amitiza is very high, but I'll pay just about anything for a cure, after the past 30+ years! The insurance company considers Amitiza "ineffective for the cost," and suggests a daily colonoscopy prep!


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## annie7 (Aug 16, 2002)

yes, hopefully adjusting the miralax dose will help.

and hopefully amitiza will help if miralax just gets too crampy. there are two different doses for amitiza 8 mcg and 24 mcg. if one doesn't work for you the other might. interestingly a number of people have said the lower dose worked better for them than the higher one.

Takeda, the manufacturer of amitiza, does have a patient savings program to help people save money on the cost of the script--i think it might just help with the copay though--not sure.. maybe, if the samples work for you, your doc can submit paperwork about that--a prior authorization--to persuade your insurance company to pay for it. a daily colonsocopy prep indeed! what a terrible idea!!! i wonder how the insurance guy who made this brilliant suggestion would like to have to endure a daily colonoscopy prep! outrageous!

anyway--if it helps any, here's the link to the savings program:

https://www.amitiza.com/dual/fullform/default.aspx?from=hsc

also there's a newer med out--maybe you've heard of it--linzess (linaclotide) it works on the same principle as amitiza --increases fluid in the colon--but it does it a little differently. and it's real expensive too. my insurance wouldn't pay for it until the gastro submitted a prior auth. there's also a patient savings program in place for linzess:

https://www.linzesshcp.com/patient-resources-and-information.aspx

good luck to you! wishing you all the best (colonoscopy prep indeed!! oh don't get me started....)


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## sjw596 (Feb 19, 2014)

I'm bumping this thread as I now have another question related to my initial post. First, I've been taking Miralax once daily for about the past six months. It's been working well, and I haven't felt this good in many years. However, it does seem to be losing a little of its effectiveness. My urges and "output" have diminished somewhat. Is this to be expected? If so, is it likely that I'll have to switch to a prescription med at some point?

I still have the samples of Amitiza, but have not tried it, as I rather live on Miralax. The nurse practitioner also offered to give me a trial of Linzess, and I guess it's a toss-up as to which one to try. I also take Metamucil 2xday and consume a high-fiber diet. Thanks!


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## annie7 (Aug 16, 2002)

Hi sjw--sorry i really can't answer your questions because i don't use miralax very often but hopefully someone here who does use it regularly can help you.

the only thing i can think of is maybe if you reduce your fiber intake a bit, the miralax might go back to working like it did before--there would be a bit less bulky stool for it to work on. or you could increase your dose of miralax a bit instead to see if that helps. just play around with the mix, so to speak--tweak things...

or try the meds of course...take care.


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## Aidara (May 9, 2014)

Sjw596 That's exactly what has happened to me when taking Miralax! I had been taking it for 8 months and it was a miracle, but it stopped working.  Stools are still soft, but I have no urge to go. It's been a nightmare for the last couple of months, cause I can't control my constipation with diet or other mild laxatives. To get an urge,I keep taking fibre. But my body gets used to fibre in a couple of days and it looses effectiveness. I keep searching for an answer what else to take instead of Miralax. Also, I hope that I will get my diagnosis soon and the right treatment. Sorry, my post is no help to you. I really hope, that someone can give us a good advice how to get Miralax working again. By the way, I have been giving this medicine to my 2,7 year daughter for almost 2 years (miralax pediatric) and it is still very effective on her.


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## Dreamcatcher32 (Nov 12, 2013)

Miralax eventually looses it's effectiveness for some. Your body tends to get 'used' to a certain thing. Though I've heard stories of some who have taken Dulcolax for 20 years and it still works as great as ever. I would try Magnesium Citrate (Lifetime or Bluebonnet - liquid kind), Aloe Vera Inner Filler (NOT whole leaf), Fiber gummies and use Dulcolax suppositories when necessary. My mom does use Amitiza and it works fine for her. Though I tried it and it gave me breathing problems. I don't think it's very safe.

Be sure you're getting enough oils (fish oil, coconut oil) and fats/protein in your diet. That's important. Trying a Caffeinated beverage in the morning along with a good walk helps quite a few. Mollasses and olive oil can also get things 'moving' in the morning. The colon is MOST active in the morning and after large meals. Might be a good idea to sit on the toilet after a large breakfast and try to 'relax down' for a good 20 minutes or so.

I would get tested for motility and also pelvic floor dyssynergia, as both can be very problematic. If you have motility problems, laxatives will most-likely be prescribed and if you have pelvic floor problems (50% of those with constipation do) then they can do biofeedback along with balloon expulsion, which seems to be more effective than laxatives for most.


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## Aidara (May 9, 2014)

Thanks a lot, Dreamcatcher. I was looking for molasses this morning in my local health food store. I heard that black strap molasses are good for constipation. Would any other kind of Molasses do the same thing? Is it safe to take Aloe vera inner filler? So many people say aloe vera isn't safe for everyday use, so I am afraid even to try aloe vera.

I checked Bluebonnet brand on the internet. It must be really good as there supplements are so expensive. I don't mind to spend a fortune if it helps though. So I am going to get this company's magnesium from Amazon as I don't think that we have it in UK shops.

I also ordered some triphala and a squatty potty.

However, before I find something natural, I need to take something chemical in the meantime. I bought some Dulcoease tablets as well. It must be equivalent to Colace in US. The main ingredient is docusate sodium 100mg. But I am so confused about this medicine. On some webs they say that docusate sodium softens the stools and stimulates the bowel. This can lead to dependency. I thought that docusate sodium is completely safe ingredient to take on the daily basis. Could someone shed some light on this? Many thanks.


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## Dreamcatcher32 (Nov 12, 2013)

It doesn't necessarily have to be black strap, thought that might be more effective. I haven't used it! I use the Wholesome Fair Trade brand and I believe it's on Amazon. You can also get the Magnesium there also. Again, the body can get used to certain things fairly quickly, so switch things around as much as you can. You may need to try different 'types' of magnesium or molasses or even olive oil. I know my mom pushed regular Magnesium Citrate vitamins on me and they did nothing - the liquid stuff is amazing though! Yes, it is safe to take Aloe Vera Inner Filler but NOT safe to take the Whole Leaf. I would consider the Aloe Vera something to take only 1x every 3 days. That's what Mayo Clinic recommended to me - same goes for laxatives of any kind. (Honestly though, I think it's no good to go 2 days without a BM, so I would switch these things around every 2 days personally)

Squatty potty will do you a world of good in getting 'more' out. Just be sure when you 'go' that you're only belly 'pooching' and making a 'mmmm' sound while your rectum goes slack. It's also imperative to 'relax' down on the toilet as much as humanly possible. Literally get so relaxed you almost fall asleep on the thing! lol! Also be sure you have a STRONG urge before a belly pooch. Don't feel an urge and go crazy - trying to push it all out yourself. I will say that if it's a pelvic floor problem (so often it is) and it's severe enough, even laxatives won't work very well at times. So maybe the best thing to do for now is after a big meal and drinking a full glass of water, relax down on that squatty potty for a good 20 min or so. See if that helps you.

I really can't speak to the Colace. Though Mayo Clinic assured me that laxatives are not chemically addictive. They didn't comment on whether it's addictive in sense that your 'brain' gets used to not going on it's own. I just would stay away from Ex-Lax, as I've heard bad things about that one. I'm sure the rest is fine. Do you have Milk of Magnesia over there? Might want to order some of that from Amazon. It is extremely potent, though. I have also heard of Oxypowder (haven't tried it) and Constipation Stop! by Renew. Triphala works great for some.


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## Aidara (May 9, 2014)

I tried molasses yesterday. The taste reminds me liquorice and I hate it so much. However, I am so desperate to get relief, that would had been able to eat a whole jar of Molasses if necessary.  I don't know whether it is molasses or something else (I had been taking loads of fibre, smooothies and etc), but I had a bm in the evening (I usually go in the mornings). This never happens to me. I was so glad yesterday!  It must be working.  I will make sure I rotate molasses with something else as I really don't want it to loose its effectiveness.

Dreamcatcher, if I go every day, some days more some days less, how do I know when is it the right time to take a laxative? Sometimes I go, but very little and I feel as didn't go at all. Sometimes I go more, but I still feel that I didn't have complete bm. When should I consider a laxative? Thanks a lot.


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## idkwia (Feb 26, 2009)

Dreamcatcher32, you can sit on the squatty potty for several weeks and nothing will come out if stool doesn't move into the rectum. You advise people to wait for a strong urge but numerous amounts of people here don't get a strong urge, in fact they get no urge at all!

A lot of your advice maybe based on good intentions but you go too far in my opinion. To say that it is no good to go more than 2 days without a bowel movement is wrong as for some people once every three days is normal.

Can you tell us how many bowel movements and how often you have a week and do you fully evacuate?


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## annie7 (Aug 16, 2002)

what Idkwia says about the urge---

yes, that's me to a "T" unfortunately. in addition to pfd, i have rectal hyposensitivity and megarectum...i get little or no urge without the help of laxatives. back when i didn't take laxatives, if i did get the urge and ignored it, then it would just go away and not come back. because of this, my gastros have all told me not to ignore an urge.so that's me--and of course, we're all different--but for those of us with this particular problem, ignoring an urge, even a slight one, is not a good thing.

and i have slow transit so i need help in getting stool to move through my colon because my colon just doesn't work by itself, probably due, at least in part, to my having mitochondrial disease.now i have adhesions as well, due to my open abdominal surgery last summer, which are further slowing my transit. and my rectum is abnormally large, so, given the chance, stool really builds up in there which is not good and could worsen the situation so it's best that i have a bm daily. my PT and i were discussing this just yesterday.

yes, there are those of us here who have complex situations... which is why finding a good gastro doc to work with is of the utmost importance--having all the necessary tests, getting a correct diagnosis..


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## sjw596 (Feb 19, 2014)

Thanks to everyone for the posts! Perhaps I should add that, when I had a colonoscopy five years ago, I was fine, but the gastro-ent found that I had a "tortuous and redundant" colon. According to his PA, that likely is one of the root causes of my problem and also results in less of a stool diameter than whatever is "normal." I eat a very high fiber, low fat diet with good proteins and am in excellent health and condition for my age. I do take fish oil and a host of other supplements. Overall, the Miralax is working very well after these six months, and I haven't felt this good in 30 years! The mere fact that I haven't had regular bouts of hemorrhoids all this time is extremely welcome. Per the PA's advice, I'm still taking Metamucil 2xday as well, and I drink a good gallon of water daily. Nothing helped before Miralax. A number of years ago I tried Zelnorm, but it caused diarrhea for me. My sense is that going to Amitiza or Linzess is a lifetime proposition, too, assuming that one or the other work. I'm pretty well resigned to having to take some extraordinary measures to keep feeling this well.


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## Aidara (May 9, 2014)

sjw596 as I understood you are taking Miralax longer then 6 months. How much Miralax are you taking? Have you had to increase the dosage? Thank you.


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## sjw596 (Feb 19, 2014)

I always have taken the standard dose: the bottle cap to the top of the white insert. At this point, I don't see a need to increase it, and I think I'd consult the PA before I did.


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