# How many years on laxatives?



## Aidara (May 9, 2014)

I've been taking osmotic and all other gentle laxatives for almost 3 years now. And it really makes me sad, that I can't live without them anymore. I can't find what is wrong with my diet, although I keep looking for answers. I am wondering - what is your experience? How many years have you been taking laxatives longest? Has anybody started with gentle laxatives and then end up with strong stimulant ones? Do gentle laxatives tend to stop working even though they are rotated? I am only 30 years old and I can't imagine myself 50 or more. My colon already doesn't work on its own. Thank you for your replies.


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## annie7 (Aug 16, 2002)

Hi Aidara. oh please don't be sad. in the C (constipation) world, we do what we have to do to go. that's what my gastros and surgeons have told me. and yes of course it is regrettable that we do have to take these things in order to go but at least they work--that's the good part.

we all start with diet of course and all the more natural ways of dealing with C but if those things don't work then we have to move on to other things like enemas, prescription meds, OTC meds --first osmotics and then stimulants if necessary. as all my docs have told me--you have to take what you need to go because it is far more harmful to let things back up and develop an impaction.. i develop impactions quite easily and i know they are something to be avoided.

i'm 62. i've had constipation problems since childhood. . my colon doesn't work on it's own either. tests show i have slow transit as well as pelvic floor dysfunction and a rectocele, rectal hyposensitivity and megarectum. so i guess with all that it's somewhat of a miracle if i can get anything out at all--lol...

i tried all the natural stuff, diet etc and all the meds that have been out over the years to no avail. although these things do work for a lot of people. and i'm still working with biofeedback for the pfd. i've been taking milk of magnesia for the last 7 years. it worked on it's own for about a year but as my body became more used to it, it didn't work by itself so well anymore so i started --on the advice of my gastro--taking stimulants with it--i use either dulcolax or cascara sagrada. for me the stimulants work best when taken with MOM. but that's me. and i eat a low fiber diet. and exercise etc.

have you tried any of the prescription meds for C like resolor (prucalopride), amitiza or constella (linaclotide). they have helped many people.

hope you can find some relief. take care.


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## annie7 (Aug 16, 2002)

another thing that comes to mind---i wouldn't worry about being on laxatives for a lifetime. i keep reading and hearing that the pharmaceutical companies finally realized that there is a large unmet need for drugs treating constipation. there are meds for C in the pipeline right now that sound promising. and there's an intriguing new non-medication device in development in irsael--a vibrating pill for constipation:

http://www.vibrantgastro.com/index.php?pid=3

there are constipation meds already out in the uk that can help you too. prucalopride (resolor) and constella (linaclotide). ask your doc for a script. they have helped lots of people and are really worth a try.

so you have options...there's always hope, i say


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## Aidara (May 9, 2014)

Thank you Annie for your reply. I really appreciate your lifelong experience with constipation. That must be awful to be living with this condition so long. You said, you have these problems since your childhood. Have you been on medication since then? I have a daughter, she is only 2.5 years old and already suffering from constipation, she's been on Movicol for over a year now. That makes me so sad. I know how difficult it is to live with chronic constipation, but at least my problems started lately and she might be even worse then me when she grows up.  Could you tell me please, how many years exactly since you started daily laxative regime? I presume, it's been quite a while. That gives me hope that laxatives never stops working completely and there is lots of new things to try. Just my biggest fear is - that one day I wake up and nothing works, cause I will have my colon damaged due to prolong laxative use. On the other hand, there is nothing I can do about it now to prevent it. My colon doesn't work properly on its own anyway. The good thing is that most products are working on me, I have only had problems with lactulose it causes me severe bloating and pain, so I stopped it. Movicol gives me the best results, but I am building tolerance to it. Hopefully, after a while I will be able to get back to it. Is there any people taking osmotic laxatives for a long time and they are still effective on them or prolonged use of osmotic will certainly lead to stimulant laxative use?


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## Aidara (May 9, 2014)

Annie, as I understood, you were taking MOM and then you had to add some stimulant laxative. What did you take all these years before you started MOM? Do you think you had to add some stimulant because your constipation got worse or because you had built tolerance to it? Does it mean that people like me eventually end up taking stimulant laxatives?


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## annie7 (Aug 16, 2002)

no i haven't been on meds for C since childhood. i just struggled along without meds for quite a long time til my early 20's when i started trying different natural things like i mentioned above to relieve it.

then when zelnorm came out (a script) i tried it. and later started up with the MOM.

i've been taking MOM for the past 7 years and a year later added stimulants. i had to add the stimulants because my C got worse and yes i think i also developed a bit of a tolerance to MOM meaning that it no longer kicked everything out by itself. but it still works to add water (liquid) to my stools. so i would say it still works for me somewhat.

my docs have all told me and i've read studies etc that say that the dangerous stimulants 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.

i have mitochondrial disease ( a mild form of it). it's a very rare disease and basically means my cells don't make enough energy--and that has contributed to the slowing of my colon. and i also have pfd. so i'm a complicated case as all my docs and surgeons say.

i do know of people who have taken only osmotics for many many years for their C and did not develop a tolerance to it. so i really don't think people always eventually end up having to use stimulants. definitely not.

i am so sorry about your young daughter having problems. hopefully she has a good doctor to help her through all this and hopefully the movicol will continue working well for her.


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## Dreamcatcher32 (Nov 12, 2013)

Annie's posts are so wonderful! I'm glad pharmaceutical companies realize the problem and are working on more and more medications. It's funny how most prescriptions (linzess, amitiza) that an MD prescribes you won't work very well. Then you use something you grab at Target and are amazed by the results!!

I also just wanted to send hugs your way. I'm also close to your age (33) and have dealt with this on and off since I was 10 years old or so. I just recently went to Mayo Clinic in Rochester, MN and got a proper diagnosis, though I honestly feel like they still might be missing part of the puzzle. I have a fully functioning system from stomach to large intestine, so they believe 100% of my problem is Pelvic Floor Dyssnergia, which is basically just pelvic floor tension. What happens is that when your pelvic floor is relaxed and your rectum is full enough, peristalsis will kick in and your internal sphincter will relax. The feces then moves down to push against the external sphincter, sending signals to your brain to go poop. Once this action begins, your golden and the urge will keep coming in waves. If put off long enough, it will stop and then come back later even stronger. My problem is that I wasn't relaxed enough for any of these things to occur. I'm still not relaxed enough at times. PFD is far more common than simply a 'slow' colon, as far as I am aware. In fact, about 50% of people over the age of 50 have some sort of pelvic floor problem that can cause constipation or urination problems. I do believe PFD can 'slow' the colon down quite a bit. But once you've got the pelvic floor relaxed and the muscles functioning optimally, the colon goes right back to normal. This is also rare though. I have yet to meet anyone who was 'fixed' by biofeedback, balloon expulsion, Valium suppositories or Botox for PFD. Most will improve but it can take years.

I'm not saying you definitely have PFD but 50% of people with constipation have this. It is a serious and overlooked condition. If you never rule it out, your basically chasing your own tail. Because NOTHING will seem to help your situation when your muscles won't relax. It's very difficult to 'tell' if they are relaxed without a biofeedback device to tell you that. When I was 'tested' for PFD it did not appear but when assessed by biofeedback nurses at Mayo Clinic, I showed clear symptoms. Even before they tested me, I noticed it was difficult to pass gas unless I spent a long time 'relaxing' things down there. There is also a huge psychological component when it comes ot these issues. Almost 100% of those with IBS have some sort of anxiety or mental disorder in combination. My constipation problems started EXACTLY when my mental problems ramped up as a kid. Getting Cognitive Behavioral Therapy can be quite helpful.

What I have found works for me at this point is:

1) a 'routine' in the morning. To establish it, I used suppositories and enemas to work out the timing. Peristalsis is strongest in the morning! I take molasses or olive oil and have 1 large 8 oz glass of water. I then make warm tea or coffee. After that, I sit down in a relaxed position and check my emails, browse the internet, etc. If this doesn't work, I get up and take a walk or stay on my feet a lot, this gets things 'moving.' I also have the squatty potty and it's wonderful. It's SO important not to push when going to the bathroom. Because of my PFD, I always have to push. But I only 'belly pooch' with my diaphragm very gently.

2) If I don't have a BM today, tomorrow know things 'might' be getting rough. (tough to say) So I generally will take 1 tbs liquid Magnesium Citrate by Bluebonnet at bed time. This is the only Magnesium Citrate that works for me. Some say Magnesium Calm helps them - that does nothing for me. Might work for you. Magnesium is a MIRACLE. It has the same effect as Miralax, pulls water into the colon. But it definitely works better, if you ask me.

3) If I get to day 3, I then will take MOM. I have to take about 5 tbs in order for it to work and drink LOTS of water. I believe this is the safest laxative. Senna is quite addictive and stopped working for me. Same with Dulcolax. Though I believe Annie takes these things and they work great for her. I felt I had to keep going 'up' on the dose. I do find they stop working! Your body gets used to them. You need to keep rotating and try to use them infrequently if you can. I avoid ex-lax, as my old GP told me this one can 'kill' cells in the colon. Mayo Clinic refutes this.

4) I sometimes use suppositories or enemas to help. I use fleet enemas and supps when I am desperate. But I like to use Carlson Vitamin E suppositories. I'll use 2 at a time and they feel less irritating and sometimes work fairly well. You can do at-home salt water enemas or all kinds of enemas. I found these to be HORRIBLE. Mainly because of the PFD - water would stay stuck inside of me and slosh around all day. I have heard of Enemeez for those with colonic inertia or spinal problems. I haven't tried them but probably will.

5) Diet is super important in that it's a balance. Eating all soluble fiber (smoothies, salads, soups) can work great for me. But it can be majorly bloating and also difficult to get that 'loose' stool out. With a larger stool, you'll get more of an urge and have an easier evacuation. I almost find it's easier for me to eat constipating food for 2 days and then take 2 tbs Magnesium Citrate! lol. Not saying I enjoy not going for 2 days. Though I feel just as bad not going for 1 day. You can also try flax seed, chia seeds, Hemp seeds, etc. All of these bloat me, so I avoid them. Keep in mind too much insoluble fiber is the cause of hard stool and constipation!

6) WATER! It is imperative that you drink 64oz of water every single day. After every meal, you must drink at least 1 8 oz glass of water.

Okay, I've rambled on long enough. Can you tell I go through the ringer? It really is a daily struggle for me, so helping people on here makes me feel so much better. I hope I gave you some ideas or things you haven't looked into before. I would definitely recommend looking into having both your pelvic floor and colon checked, though. Some are prone to constipation and when you combine that with pelvic floor problems, you really feel like you're beating your head against a brick wall. Another piece of advice is to NOT look up all the 'scary' things on the internet. You'll only find negative experiences, not positive ones. Anyone who actually corrects their problem isn't bound to go posting it all over the web.


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## Aidara (May 9, 2014)

Thank so much Dreamceacher for such a long and informative post. It's been so helpful. My gp refuses to test my colon. I was begging him so many times to do colonoscopy for me, but he even refuses to send me to gastroenterologist. The only test he did for me is called shapes study, but nobody mentioned me (in fact it wasn't written on my referral letter either) that I can't take laxatives when having this test. I asked my gp after the test, he said it is all right to take laxatives, which I believe is nonsense. Anyway, I am waiting for the results now, I will try to ask him to send me for shapes study once again and I am going to stay away from laxatives this time. If he refuses, I am going to go privately. I know that it will cost me a fortune, but I also have a feeling, that there must be something related with my pelvic floor. I had 3rd degree tear during childbirth - could this have had any effect on the problems I am having now? I am straining a lot, even if my stools are soft. So, I am definitely going to get checked, even if I have to go privately.

I stopped Movicol recently and tried Magnesium. It works! I have been taking 1000mg, but I think I need less. Do you think it is more natural then Movicol? I hope when Magnesium stops working I would be able to get back to Movicol.

You are so right with insoluble fibre. I remember I was in a vicious circle for a while. I felt horrible when consuming insoluble fibre, that is what every doctor and article says, but it made me only feel worse constipated. Now I know for sure that insoluble fibre is my enemy.

I also have routine. The reason I suspect pelvic floor is that I go number of times to the toilet in the morning. I take lemon honey water first thing in the morning, then strong coffee and breakfast. I have to have at least 3 bowel movements (after each drink and breakfast) to be finished, but mostly 5-8. I don't have diarrhoea, it is just that I can't have it done in one go. If I have less then 2-3 bm and have no laxatives at bedtime, next morning haemorrhoids and anal fissure is back. That is why I can't take laxatives every other day or when needed.

This forum is God send. I believe that people like you Annie and other people with long term constipation problems know so much more then most doctors. Thank you for your time and sharing your experiences.


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## annie7 (Aug 16, 2002)

Aidara---i'm sorry your gp refuses to give you more tests. sounds like going private --even though so expensive--is a good idea. you really do want to see a good gastro doc to get this all figured out so you can get successful treatment for it and get on with your life.

i looked up the shapes study and that is a transit test--sounds a lot like our sitz marker test (colonic transit study) here in the usa. although our sitz involves 25 markers. the general protocol for that test is NOT to take laxatives or anything at all that will help you go because it is usually done to see how your colon functions without laxatives. sometimes the gastro doc will tell patients to take it with laxatives because he/she wants to see how your transit is with what you normally take to go. your doc should have at least explained all this to you, though.

so yes, i would def ask to take it without laxatives. i specifically asked my gastro if i could take this test because i suspected i had slow transit problems. and it showed i did plus the placement of the markers showed i also had outlet problems--a lot of them were in the rectum and sigmoid colon..and then my gastro had me take the defecography.

if you suspect pelvic floor or other outlet problems, ask your doc--or private doc --sounds like you'll have to go that route--for a defecography--defecating proctogram--not sure what they call it in the uk. it is such a useful test to have, it will show if you have pfd as well as any other outlet problems--rectal prolapse, rectocele etc.

an anorectal manometry is useful in further investigating pfd problems etc if the defecography indicates pfd..

so sorry you had such a difficult and painful childbirth. yes i would imagine the tear could have something to do with your problems. you've probably seen a gyn about that? i know some people whose gyn recommended they have a defecography because of problems like this.

good luck!!! i do hope you can find a doc who will be proactive about all this and help you!!


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## Sean (Feb 8, 1999)

I have been taking laxatives more or less continuously for 24 years. My doctor first prescribed them when I was 16 (I had them on an as-needed basis before that) and I have just turned 40. I was diagnosed with colonic inertia (slow-transit constipation) at 25. I have used and been prescribed every laxative under the sun. The osmotic and saline laxatives no longer work. I "graduated" to stimulant laxatives a few years ago. My situation is bad enough that I cannot have a bowel movement at all without a laxative (or sometimes an enema).

I use Dulcolax. It seems to be the most effective of the stimulants for me. It still works, thank goodness. I don't seem to have developed a tolerance. I have to take 3 or 4 tablets, and the cramping, urgency and uncertainty are unpleasant to say the least. I used to take it twice a week. However, because it is so uncomfortable and disruptive to my routine, I am now taking it just once a week - usually on a weekend night. That way, I know that I can choose to be at home the next day when I am dealing with the results. If I feel too backed up during the week, I use a Dulcolax suppository or Fleet enema. Those work to provide a little relief, but do not empty you out by any means.

I have resigned myself to the fact that I will have to take something the rest of my life. At some point, everything may stop working, and I will be faced with surgery to remove my colon. The weird thing about all of this is that I am otherwise extremely healthy. I work out regularly and still participate in competitive athletics. I have normal weight, blood pressure, etc. and take no meds other than for my colon.


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## Dreamcatcher32 (Nov 12, 2013)

Aidara, It really is a huge struggle! I've found to take every suggestion I have ever heard and run with it. lol. What is great is that you're getting urges to go to the bathroom. That's fantastic! It does sound like you are having incomplete evacuations, though. The nurses at Mayo Clinic said having to go more than once over and over again is a sign of it. If you're straining with even looser stools then yes, that is a clear sign of pelvic floor tension! I think it is exactly the problem you are dealing with. Though I am no doctor. I would find a physical therapist that deals specifically in women's pelvic floor dysfunction. When you call them be sure to ask if they do biofeedback for pelvic floor tension! Your GP might be able to refer you if they are good. Otherwise, you might need to head to Mayo Clinic in Rochester, MN.

Btw - my anorectall manometry came back normal. The only way I knew I had PFD is because of the nurses who do biofeedback there. They could see that I had paradoxical contraction of the muscles and my tension was also too high. I have very little faith in the anorectal manometry or defography being 100% accurate. That's why I say going to a PT is important also.

1,000mg Magnesium is too much for daily use, yeah. Movical works great for some and not so great for others. It all depends on your body. I'd swap these two here and there, switch it up. It also depends on the TYPE of magnesium you're using. Magnesium Citrate and Oxide will get you going. I think Citrate is safer. If regular Chelated Magnesium works for you then stick to that. Eventually Movical lost it's effectiveness with me. It was always irritating to me though. It would tend to 'liquify' everything or just liquify half of it and I'd still have a difficult evacuation. Magnesium always gives me BM's with great consistency - soft and easy to pass. Also, water is going to be your new best friend. Make sure you're drinking tons of water. IF I lay off of my water routine, my stools immediately harden.


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## Aidara (May 9, 2014)

I am so grateful for your replies. Many thanks to you all. Dreamcather, you really encouraged me to get some help and get the right diagnosis, thank you. While reading this forum, I realised that there is a big possibility of me having a pfd. It is so expensive to be checked privately, but I think it is worth doing that. Does anybody know if children could have the same problem? My daughter is 2.5 years old and she is having very similar symptoms to mine. Also, if 1000mg of magnesium daily is unsafe, HOW MUCH IS SAFE THEN? Yesterday, I took only 750mg of magnesium, this morning I was bleeding during bm.  What else can I take instead of Miralax? I know the best is to find solution with diet, but I need something in the meantime. Thank you.


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## annie7 (Aug 16, 2002)

Aidara--

yes children can also have pelvic floor dysfunction. i've read studies about treating pfd in children. apparently they use interactive computer games and also biofeedback to help these children learn how to relax and coordinate their pelvic muscles. not sure at how young an age they start this at but a knowledgeable gastro doc/specialist would know and be able to help with that. for your daughter you may need to find a pediatric specialist who is trained in all this. if you have problems finding a specialist who can help, try a university hospital. often doctors affiliated with university hospitals are more knowledgeable and up-to-date about these problems. i do hope you can find a doctor(s) who can help both you and your daughter.

http://www.ncbi.nlm.nih.gov/pubmed/10458431

i don't know where in the UK you live but i've heard several times on this board that St Mark's hospital has an excellent biofeedback and treatment program for pfd.

http://www.stmarkshospital.org.uk/biofeedback-for-bowel-control


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## Aidara (May 9, 2014)

Annie thanks a lot for the links. I am going to do my best to find a good doctor for my daughter. St. Marks hospital isn't far from the place I live, the problem is that this hospital won't accept me without a referral form my gp. I don't think it is going to be easy to get it from him. However, if he agrees to send me for pelvic floor test, Ill ask him specifically for that hospital. I really appreciate your recommendations, thank you.


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## annie7 (Aug 16, 2002)

oh i do hope and pray you can get that referral! i don't understand why your GP is being so difficult to work with. if he doesn't give you one, i'd try another GP--although of course i don't know if it's easy to switch doctors in the UK...

i know GPs often don't know much about pfd. if he doesn't know or understand much about pelvic floor dysfunction maybe printing out some information about it and/or also printing the info from St Mark's website and their treatment program would help? if he could even just refer you to a good gastro specialist then you'd probably have a better chance of the gastro doc understanding and giving you a referral to St Mark's.

is it any easier to get an appointment with a colorectal surgeon? i went to one and when he saw my test results he concurred with my gastro that i had pfd and advised me to go to my local university hospital for their biofeedback and physical therapy program.

good luck! wishing you all the best.


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## Dreamcatcher32 (Nov 12, 2013)

Aidara said:


> I am so grateful for your replies. Many thanks to you all. Dreamcather, you really encouraged me to get some help and get the right diagnosis, thank you. While reading this forum, I realised that there is a big possibility of me having a pfd. It is so expensive to be checked privately, but I think it is worth doing that. Does anybody know if children could have the same problem? My daughter is 2.5 years old and she is having very similar symptoms to mine. Also, if 1000mg of magnesium daily is unsafe, HOW MUCH IS SAFE THEN? Yesterday, I took only 750mg of magnesium, this morning I was bleeding during bm.
> 
> 
> 
> ...


No problem, I think you're on the right track to figuring out what the 'real' issue is. Though that's not to say that you don't also have a 'sensitive' system. Mayo told me I have PFD but I'm also convinced I'm either DO have a sensitive system or something else could be going on. I would say 750 mg is perfectly safe, it wouldn't make you bleed during a BM. Have you had a colonoscopy? That's one thing you might want to do to get 'big' things ruled out. Most-likely you have hemorrhoids or a fissure, which is causing bleeding. Yes, children can have PFD. I believe I had it as a 10 year old. Though I will say it is quite common. It could be that your daughters system is just a bit more fragile and will require a different diet. Getting the right pediatrician should help with this. I'm not sure what is safe to give kids but I am thinking diet and water intake could really help her out.

Miralax won't harm you and I would take it if you need it and it helps you. But just try to be a wee bit sparing with it so it doesn't stop working for you. Also try some Metamucil or Citrucel, these might work better for you. For a LONG time, they worked for me. I'd say a good 5 years, if not more. They WILL cause some bloat. I would also give enemas and suppositories a chance, if I were you. Suppositories will definitely help you out in a pinch. I'd say using these once a week or once every two weeks is perfectly fine. You can even get natural ones with vitamin e in them, it's the Carlson brand. Having a bowel movement once a week is just awfully uncomfortable. I hope you find some help and your struggles ease a bit. *HUGS* Sounds like your positive attitude is really helping matters.


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## Aidara (May 9, 2014)

Thank you Annie and Dreamcatcher for your support. To be honest, I had been very pessimistic before I found this forum. All of you inspired me to look for the root cause of the constipation. In UK it is extremely difficult to get referrals to see specialist, especially in non urgent cases like constipation. I think as long as medications work, my gp won't take me seriously. I was begging him a year ago to give me referral for colonoscopy, but he completely refused, saying that in my case there is no need.  I can't have it privately as it would cost me thousands without insurance. However, I do agree that my systems is sensitive, but there is definitely something going on with my pelvic floor. I am going to see my gp on Thursday, we are going to discuss shapes study results and then I am going to request a referral for pdf. If I won't get it, I will go to see another gp. Honestly, I am going to see gp every week till he gets fed up with me and refers me to have my pelvic floor tested. As a last resort I will go privately and hopefully I won't have to stay on laxatives for the rest of my life. I am just wondering what o we have similar to Metamucil or Citrucel in UK, are they soluble or insoluble fibre based?


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## Aidara (May 9, 2014)

I miss Movicol so much, it works wonders! I had to stop it, cause I don't want it to loose effectiveness on me for good, that's why I decided to do some break. I haven't been using it for 2 weeks now and I am struggling. 750mg magnesium doesn't work for me unfortunately, 1000mg unsafe. Enemas and suppositories I can't use everyday, so this is not a solution for me. What about stool softener sodium docusate 100mg, is it as gentle as Movicol? Shall I try it? Thank you for your responses.


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## annie7 (Aug 16, 2002)

the stool softener you mentioned is safe to take. it just softens the stools. all my docs recommended it to me years ago and i took it daily for quite a while and it did help a bit. i'm not sure if it's quite as effective as movicol --we're all so different in how our bodies react to things--but it's worth a try! and fingers crossed it will work for you.

i do know people who have taken miralax (movicol) for many many years and it did not lose effectiveness for them...

and yes--good for you for staying positive and being persistent about getting checked for pfd! persistence is what it takes to get the ball rolling!!


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## annie7 (Aug 16, 2002)

i wanted to add--i've personally never had an osmotic laxative like miralax (movicol) or milk of mag lose or fade in it's effect on me. i just went from miralax to milk of mag because i found MOM worked better for me.


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## songbird (Dec 21, 2009)

Hi Annie: your story sounds similar to mine. When I found this site over 12 years ago I was weaning myself off MOM- it just made me feel sick and sometimes dizzy. On this site I found people with intractable constipation recommended magnesium pills. I started out with 500 mg and my body developed a tolerance to that amount. after awhile it hardly did anything. by the way this all started 30 years ago when I was 40. anyway, I now require 1600 mg but I take it every other day because it is not healthy to take that amount on a daily basis. I also require the use of magnesium citrate liquid every 5 or 6 weeks because for some odd reason my colon backs up and I get so uncomfortable I cant stand it. This is really a horrible problem and while I am grateful to have something that I can manage my problem with, the fact is that I know I will never be rid of this problem. On the day off from Magnesium I am able to squeeze out enough ( very little) from the anus so I can get through the day. It is very bizarre. No matter what I eat or drink (fiber and water) I can never go more than a teeny weeny bit on my own. I think people have to find a way to manage whatever problem they have but I would tell people who are young to try not to get hooked on any type of laxative, including osmotic.


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## annie7 (Aug 16, 2002)

Hi Songbird--yes, i remember you from previous posts--and your beautiful name--songbird.









so sorry you're still have problems but yes like you said it's a relief to be able to somehow manage--or try to manage-- it all ..

i imagine if you've read this thread you've read we've also been discussing pelvic floor dysfunction in addition to other things. when you mentioned having trouble getting things out and squeezing things out i thought of pfd--have you been tested for that. a lot of time those of us with constipation problems or slow transit also develop pfd. or sometimes people develop pfd and then more constipation problems follow because things start to back up from the rectum. biofeedback and physical therapy can often help with that. i've also found that putting my feet on a shoe box while sitting on the toilet helps. elevating the feet helps straighten out the anorectal angle and allows for a more complete evacuation. or you can use a footstool etc or even a squatty potty or something like that.

good luck with everything.wishing you all the best..


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## Aidara (May 9, 2014)

Well.. I wish I could live without osmotics and skip at least one day, I could live with the discomfort of not going. But in fact, I think I would still go, but this would be painful dry stools, which gives me very bad haemorrhoids and opens the fissure. So, I have no choice, but to take laxatives and keep looking for root cause of my constipation. I can't wait to see my gp tomorrow, hopefully he will give referral for pfd testing.


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## Aidara (May 9, 2014)

The most upsetting thing is that nobody posted on this forum who has 40 - 50 years experience of taking laxatives, which suggests that it is impossible to live the rest of your life on laxatives. Does it mean those people end up with bags?  What about chemicals in laxatives, they must be affecting human body as well, especially with prolonged use. I doubt there has been any study done.


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## annie7 (Aug 16, 2002)

Aidara--please don't get upset--really--i wouldn't jump to conclusions--the people who post on health boards are those of us who are having problems and who are searching for solutions. those with a treatment plan that works--such as taking laxatives long term--or taking medications that work--are happy that they have a plan that works and don't feel the need to post on the boards--they are out living their lives.

besides--like i mentioned earlier--the pharmaceutical companies have finally realized that there is a large unmet need for medication to relieve constipation and there are several drugs for C in the pipeline right now. so chances are there will be a med developed that will help you (if there isn't one already) and you won't have to take laxatives for the rest of your life.

have you tried any of the meds currently available for C--amitiza, constella (linaclotide or linzess in the usa) or resolor (prucalopride) ? they have helped many people.

the few people who eventually do require surgery to remove the colon because they have severe refractory colonic inertia (and this is not a particularly common surgery--more like a last resort) can have a total colectomy with ileorectal anastomsis which does not involve a bag. the surgeon removes the colon and hooks the small intestine up with the rectum. because i have read so many success stories about this surgery i desperately wanted to have it but because i have pfd my surgeon and both my gastros told me i do not qualify for it.

that one of the reasons why i have been working so hard on biofeedback. i am hoping to get my pfd resolved to the point where i don't have to take laxatives--or as many laxatives--any more. or--failing that--hopefully it will help at least to the point where i can have a colectomy if the docs and i feel i need one. i know people who have been successful in doing these things. biofeedback/physical therapy for pfd is a wonderful thing. and it's also another reason why many people don't have to take laxatives for the rest of their lives--because they had pfd and biofeedback helped them to the point where they no longer needed laxatives to go.

please try not to worry







it never helps. worrying about the future robs us of the energy we need to deal with today....and it totally sucks the joy right out of our lives.

good luck with your GP appointment. hope it goes well for you.


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## Aidara (May 9, 2014)

Annie thank you for your post. It is very encouraging. It is a horrible problem we have - you cannot discuss with anybody, people who don't have digestive issues, doesn't understand that. It is also embarrassing and leaves people feeling lonely yet I don't feel lonely anymore since I found this board. I am doing my best do not loose a hope and keep in a good mood.  However, as expected, things are not going well with my gp. I saw him this morning, he said that shapes study confirmed once again that it is functional constipation. I told him my concerns about my pelvic floor muscles, but he completely refused to refer me for defecography test. He adviced me to see another gp for a second opinion. That is what I am going to do. But I am worrying he won't be taken me seriously as well, but who knows. Also, I got a quote from private gastroenterology clinic and I that was a complete shock for me. £950 for defecography test and £250 consultation with gastroenteorologist, not mention biofeedback treatment or other possible tests. It is literally thousands. However, before I pay these money Ill make sure I've tried all options to be tested under nhs. Hopefully, Ill have better luck next week seeing another gp.


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## Aidara (May 9, 2014)

I forgot to mention, that I got referral (this is a third one) to see colorectal surgeon instead. I said that I have fissure which fails to heal that is why I want to see him again. This is not true. My fissure usually heals after some time, but I was desperate to see some other doctor and get some help. The only problem is that my referral is regarding my fissure not bowel problems, so it is not the same as going to see gastroenterologist. I just simply don't know what else to do. Colorectal surgeon will recommend surgery, but I don't see any point having that surgery (considering all the risks) when I can't keep my constipation under control. Does anybody know if colorectal surgeons are familiar with pelvic floor diseases?


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## Aidara (May 9, 2014)

One more thing, my gp said it is ok to have shapes study when taking laxatives. What a nonsense is that!


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## annie7 (Aug 16, 2002)

so sorry your appt with your GP did not go well. yes--do get a second opinion--good idea. and keep trying til you find someone who will listen and care and refer you if necessary. it's so frustrating going from doc to doc but it's worth it once you finally find a good proactive doc who listens,who is knowledgeable and who cares. i am so fortunate my gastros are like that.

and sorry about the expense and the NHS not covering that particular clinic. hopefully you can find a doc and /or clinic near to you that they will cover. will they cover St Mark's docs, tests etc if you get a proper referral? i'm thinking maybe St Mark's would be covered because it is a hospital? don't know how the NHS works...

yes you're right about it not being wise to have fissure surgery until your C is under control.

oh yes colorectal surgeons do know all about pfd and other pelvic floor problems. you could mention to your colorectal surgeon that your fissure is caused by your C problems and that you think your C problems could very well be happening because you have pelvic floor problems. and hopefully he will refer you for tests for pfd or to a good gastro doc so you can have get tested for pfd etc.

when my colorectal surgeon saw all my test results he concurred with my gastro that i had pfd and advised me to go to my local university hospital for their biofeedback and physical therapy program. he wanted me to try this first.

good luck to you, especially in finding a good GP and getting a referral to a good gastro doc.


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## Dreamcatcher32 (Nov 12, 2013)

I do want to mention that there is some concern about whether laxatives cause dependency in the wiring of the brain, not necessarily physical or chemical dependency. I am concerned about this as well, so I avoid laxatives as much as I can. I'll wait 2 days to have a BM naturally and use things to 'help' things (liquid magnesium, aloe, diet ) rather than jump to laxatives. I think it's important to allow your body to have those natural BM's, even if it means waiting it out. I prefer nudging things, vs pushing them. Aidara, maybe you can give this a shot?


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## Aidara (May 9, 2014)

if I had referral, that would cover my treatment in St. Marks hospital. It is nhs hospital, I don't think I would be able to have access to it without a referral from my gp. I knew it won't be easy to get it, I have an impression that general practioners don't have a good knowledge about pelvic floor. But hopefully my surgeon will be able to help me, fingers crossed.

Dreamcatcher, I would love to have natural bm. And I am sure I would be even able (I usually go everyday), but that would be most likely incomplete bm which will cause me dry stools next morning and then I am in a severe pain.  I can't take a risk, cause one day my fissure won't heal and it could lead to even more complications. That is why I am so dependant on laxatives. Thank god that I found some alternative to Movicol. I am taking 2 sachets of Fybogel (ispaghula husk), 750 magnesium, 2 glasses of prune juices and I am fine. At least so far, who knows when it stops working.

I strongly agree that there is a psychological dependency on laxatives. it is so difficult to reduce dosage only because of fear what happens tomorrow. I think it is also important to believe that something works for you, because then it usually does.


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## annie7 (Aug 16, 2002)

Aidara--so glad you found an alternative to movicol that is working! that is such good news! isn't it great when we find something that works.

i think you're right about GPs. none of my GPs knew much about pelvic floor problems although they all had heard of them. but thankfully one of the GPs i talked to about my C problems did give me a referral to a great gastro clinic and where the gastro doc --i love him--he's knowedgeable and really listens--had me tested.

good luck to you. fingers crossed you are able to get your referral.


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## Aidara (May 9, 2014)

Thank you, Annie!  I will keep pushing them.


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## annie7 (Aug 16, 2002)

there's also the Oxford Pelvic Floor Centre. i don't know if this would be any closer to where you are or not.

http://www.oxfordpelvicfloor.co.uk/


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## Aidara (May 9, 2014)

Annie thank you sooooo much! It is an amazing site, so much useful information. I am going to print it out and bring it to my gp for my second opinion appointment. It also says that I should have had colonoscopy to make sure that something serious is excluded. Thank you very much for your link!


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## annie7 (Aug 16, 2002)

oh so happy you found it useful!







yes , printing it out and taking it to your next GP appointment is a terrific idea.

i really like that site too with all the information it has. it really explains anismus (another word for pelvic floor dyssynergia--pelvic floor dysfunction) it sounds like the doctors there really are experts in all this. they do the pelvic floor retraining and they also have had success with the botox treatments for pfd. i imagine other places, like St Mark's, do botox too. if biofeedback doesn't end up helping me enough i'm definitely going to ask my colorectal surgeon about botox.

good luck!


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## Aidara (May 9, 2014)

Thanks Annie, I am sure this information will help me a lot during my next battle with GP. Many thanks to you, I am very grateful for your help. You and Dreamcatcher encouraged me to stand for myself and find the answers. I feel so much better these days cause I made a plan how to get diagnosis. I will do the same with my daughter. As I understand, you been diagnosed with pdf recently if you are having biofeedback treatment. it probably taken years to you to get diagnosed. I can't believe you spend your life not knowing that you have pdf. Let's say biofeedback works for you (and I pray for that), do you think you could stop laxatives or take less of them?


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## annie7 (Aug 16, 2002)

i did suspect i had pfd years ago when i started reading about it here on the board. it's a long story--lol..

the reason why i didn't get tested right away for it and start biofeedback was because at that time my insurance company would not cover biofeedback. i had called them about it and they said no coverage because (at that time) it was still considered (in their words) experimental.and no way could i afford to pay out of pocket for it. i didn't see the point of getting diagnosed at that time since i could not afford the treatment for it so instead i just kept reading the board and thanks to all the helpful people on here who posted info about their experiences with biofeedback and more importantly the information their physical therapists gave them about the proper way to have a BM, using a footstool while on the toilet to elevate the feet, the belly pooching etc etc i was at least able to pick up some info on what i should be doing since i already had learned that straining not only did not work but was not good for the rectum.

when i found out that my insurance finally now does cover it (if coded correctly--lol--it's all the the coding) i went for testing and then biofeedback/physical therapy last summer. and fingers crossed if insurance agrees to cover it again i will be going back for more this summer since last summer's sessions got interrupted by my needing emergency surgery, long hospital stay and even longer recovery period.

so yes the goal is to get biofeedback working for me so i won't have to take as many laxatives. i also very slow transit problems which of course biofeedback will not, in my case, correct, both my gastros and my surgeons agree that because of the slow transit i'll probably have to take laxatives of some sort forever.

so glad the information helped!


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## annie7 (Aug 16, 2002)

this u-tube video by physical therapist Michelle Kenway about how to move your bowels without straining is excellent at explaining the proper way to have a BM. maybe you've already seen it. i've posted it a few times and Dreamcatcher recently posted it also:


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## annie7 (Aug 16, 2002)

here's a post i finally managed to find by a member who posted in 2009 the St Mark's biofeedback programme instructions . i found these really helpful too:

http://www.ibsgroup.org/forums/topic/113788-biofeedback-aiding-in-a-bowel-movement/#entry771206


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## Aidara (May 9, 2014)

Thank you, Annie! That is so kind of you. I found it really helpful.


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