# My doctor says constipation is in my head.. :(



## Aidara (May 9, 2014)

Hi guys, I feel so sad after yesterday's appointment with my gp. I've tried to explain him that I suspect that the reason for my constipation is pelvic floor dysfunction. Then I mentioned that I have to go to the toilet number of times to have a proper bowel movement and.. that's it! He thinks that I am not constipated at all and abusing laxatives. Then he scared me to death that this can cause something called bowel rupture. I have a little daughter who suffers chronic constipation since she was six months old, now he thinks that I am giving her laxatives just because of my own anxiety. I am only taking 2 sachets of fybogel and 2 movicol, he thinks this is way too much.


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## Aidara (May 9, 2014)

I tried to explain him, that I can't stay away from laxatives, because I tried to manage this condition naturally in the past and as a result I had to take painkillers for anal fissure pain thus getting more constipated. However I am waiting for my colorectal surgeon appointment and I am praying he will do some tests, especially for my pelvic floor.

Yesterday I got upset with my husband too, he thinks that I have no problems, but this is only my imagination. How annoying is that! You suffer from this terrible condition and others around you think that you are going crazy..  Thanks for reading this, I believe so many of you been blamed pretending to be sick. I am sure nobody can understand unless they've been in our shoes.


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## annie7 (Aug 16, 2002)

Hi Aidara--NO it is NOT in your head! i am SO sorry your gp said this as well as all the other terrible things he said too . wrong wrong wrong. (i'm getting upset with him too) you are not abusing laxatives either. he clearly sounds like he know very little about constipation and has a very bad unhelpful attitude in general. i'd find a different gp ASAP.

and i am SO sorry about your husband not understanding either. it's really hard when you don't have support from your spouse. i do hope and pray that changes. and i imagine he will understand once you get a proper diagnosis from a knowledgeable doctor like your colorectal surgeon.

you need a good gastro doctor. if you need to get a referral to one from a gp then first you need to find a better gp. but hopefully your appointment with your colorectal surgeon will go well and he will give you the tests and the care you need.

i've had constipation problems since childhood. when i was in my mid twenties my family thought it was my fault because i "didn't eat right". way back then there wasn't all the help and knowledge about constipation problems that we have now. my doc (gp) just told me to eat more fiber. when i found this board in 2000 and finally started reading about people with problems just like me and that it was not my fault and not in my head, i started to cry. such a relief to know i'd been right all along! and then i started researching everything, got a gastro doc and finally got the tests i needed and my diagnoses.

hopefully your colorectal surgeon appointment is soon. hugs, annie


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## Aidara (May 9, 2014)

Thank you, Annie! You are always so supportive. Your message made me so emotional, because I feel exactly the same as you did some time ago. Since I found this forum, I am sure I haven't gone mad and there is an explanation to my symptoms, thanks to you and other members. I can't wait to get tests done to prove that I am not making up my symptoms, but in the meantime is difficult to stay positive, but I am trying my best. The more I pay attention to my symptoms, the more I am convinced that something is going on with my pelvic muscles, but it is so frustrating that it is such a difficulty to get it tested.

I just wonder, why doctors doesn't say to people who have a flu or some other common illness that it is in their head? This must be because they don't know how to treat you, I can't find any other explanation.


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## annie7 (Aug 16, 2002)

you're right--it's because your GP doesn't know how to treat you and instead of being a decent human being about it all and acknowledging that (at least to himself if not to you) and referring you to a gastro doc, he's letting his ego get in the way and is instead choosing to blame it all on you. and he's the one at fault here!! inexcusable behavior!!! and oh don't get me started because i could just rant and rave forever on this subject--doctors like that.. they really get me going....

at least the GP i started up with a few years ago, after trying all of her ideas to help me, never once gave me the "all in your head" thing--she simply told me she would refer me to a good gastro doc and she did. and then i got started on my tests etc. i hope and pray you will find someone like her. and i'm sure your colorectal sugeon will be knowledgeable and helpful. mine sure was.

fingers crossed for you and hugs, annie


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## annie7 (Aug 16, 2002)

another thing that just occurred to me is that i really wish your husband was supportive of you in all this because sometimes it helps to bring someone supportive along with you to your doctor appointment . i've heard people say that this can really help--especially with some docs like the GP you have--because having someone else there with you puts them on their "better" behavior and sometimes makes them more cooperative and helpful. or at least, less blaming. do you have any supportive friends or relatives who could help like this? and in some cases it especially helps to bring a man with you especially with some of these docs who sadly look down on us women and think we're all a bunch of emotional hypochondriacs.... we should not have to do this at all of course but i've heard it can help.....


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## annie7 (Aug 16, 2002)

oh and one more thing--i keep wracking my poor ol brain here trying to come up with ideas. is ealing hospital close to you? here is a post from some from the uk who found a very understanding colorectal surgeon at ealing. this poster's constipation problems were maybe not quite like yours he had slow transit/colonic inertia--but this surgeon was willing to do surgery to help him. and i know you're NOT looking for surgery--you just want help and to get checked for pelvic floor problems but i was thinking if your current colorectal surgeon isn't helpful (although he should be) you could maybe go to this other surgeon---abhay chopada is his name , at ealing hospital. and he would help you get tested for pfd and refer you to biofeedback.

here's the link to that thread:

http://www.ibsgroup.org/forums/topic/167892-surgery-booked-for-constipation-total-colectomy/?hl=colectomy


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## Aidara (May 9, 2014)

That's good idea, you are so right, I have to take someone with me, so the doctor doesn't think I am mad. I even started to cry in his room, which was the worst think I could had done. I am so tired these days of this constant constipation and when your doctor says it is all psychological I just couldn't control myself anymore. For sure it made things worse, he was convinced that he is right with his diagnosis.

You must had gone through the same in the past. Annie, I am so grateful for your responses, I will post as soon as I see my colorectal surgeon, but to be honest I am so sceptical about him as well. I lost hope someone will ever takes me seriously. However, I will pay a fortune then and go privately. Thanks a lot Annie, I really appreciate every piece of advice you give me, thank you.


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## Dreamcatcher32 (Nov 12, 2013)

This doesn't surprise me. Most gastro's completely suck. They always avoided testing me for PFD and gave me Miralax. If you have a fissure that's another sign of outlet dysfunction. I think it's time to take a trip to Mayo Clinic or Cleveland Clinic. Though Mayo Clinic diagnosed my PFD even after an anorectal manometry turned up no signs of dysfunction. They did say that if it was nerves or anything like that, they had no other treatment options besides their bowel retraining program. It has been the most helpful for me of anything I have tried, though.

He is probably saying you aren't constipated because you feel you should be going every day, correct? Technically he is right, you don't need to go every day. You can go every 1-2 days and be fine. Mayo also pushed this. And YES, some of this can be psychological. But only in the sense that it's exacerbating a physical problem. Mine is very much psychological because I 'tense' my pelvic floor when stressed or upset. For now, try to relax your pelvic floor (like you need to pee) as much as possible. This can be done more easily when standing up or sitting on the toilet. You should feel a 'drop' and try to stay there as much as possible. Also relax your tummy muscles.

Good luck to you! Someone will be able to help you, it's just a pain in the butt (literally!!) to locate them. You also have the option of Stanford Motility Clinic in CA. If you look for a woman's pelvic floor specialist in your area that does biofeedback for the bowels, they will also be able to help you. A good GP can do a referral to something like that too.


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## annie7 (Aug 16, 2002)

Aidara--oh there are good doctors out there who do take us seriously. and i don't blame you one bit for feeling like you are losing hope, though--you've had such a terribly bad experience all because of your horrid GP. but never give up hope or trying , either. i know you won't. we develop a certain strength from all this, truly we do....

i am so thankful i have found two terrific gastro docs who care and understand and listen to me and are knowledgeable. often doctors who are working in hospitals--particularly university hospitals--are more knowledgeable and proactive about treating constipation--as well as other health problems--than the other docs.

wishing you all the best always!!! and thank you for the thank you







hugs....annie xx


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## annie7 (Aug 16, 2002)

ps--Aidara. i do hope that someone who is in the UK like you are will read this or some of your other posts and will be able to help you find a good gastro doc in the UK ...someone close to you.


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## Aidara (May 9, 2014)

Thanks, Annie. Ealing is quite far, but it is possible for me to travel there, so Ill keep in mind that there is a good doctor over there. Thanks a lot. Ill do my best to stay positive and I will keep pushing my doctors to test me no matter what they think about me. If I ever get better, I promise to keep posting on this forum, so I could help or support other people, as you do. Thank you!!!!


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## Aidara (May 9, 2014)

I just noticed your post Dremcatcher. Thanks a lot for your response. Is there any Mayo clinic in UK? Where is Stanford motility Clinic?

Could I make things worse by keeping my tummy muscles tight. Especially when I am bloated, I don't want to look like pregnant, so I keep them as tight as possible. Could this make things worse? Is it something to do with my pelvic floor?

I know that it is completely normal to go even only 3 times per week. Firstly, before I got these problems, I used to go everyday at least once and that was normal for me. I was not taking any laxatives, although I used to have some constipation occasionally , but it was easy to manage with diet only. Secondly, if I feel that I had incomplete evacuation for 2-3 days in a row, this usually leads to no bowel movement for a day or two and once I have bm it causes me severe anal fissure pain not mention bloating discomfort. That is why I make sure I go everyday and ideally as many times as I need to feel empty. Before I started taking laxatives, there used to be some good days as well, but that would be exactly the same scenario. When I go number of times it is not diarrhea. It is normal soft consistency stools, but for some reason I can't push them at once, so I have to go many times. Although incomplete evacuation makes me really uncomfortable, I could definitely live with that, since I hate taking laxatives. But the fissure pain is just killing me. I would go for surgery, but if I keep on having dry stools, it makes no sense. That is why I am taking laxatives and making sure I have complete bowel movements as much as I can. I honestly wish it was in my head. I can't understand why my stools get dry or maybe they are not. Maybe it's haemorrhoids and fissure making normal stools difficult to pass? I don't want to go for major surgery just to find out whether it is a reason for my endless constipation. Also, please reassure me, that laxatives doesn't cause bowel rupture. It sounds so scary, I am sure it can't happen with osmotic laxatives, even in high dose, can it?


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## annie7 (Aug 16, 2002)

Aidara. i've never read or heard anything that laxative use--osmotic at high doses or any laxative use other wise --can cause bowel rupture.

a severe bowel obstruction --which can be caused by very severe constipation if it's allowed to go on for too long--can --although it's rare--cause the bowel to rupture if it's not taken care of. it is very rare because people with a severe obstruction usually go to the ER and get help long before a bowel perforation can actually happen. an ER doc told me about all this when i because obstructed during my sitz marker test--the test where you have to refrain from using laxatives for 7 days or so.( i didn't go at all during the test.)

causes of bowel rupture (just one link--there are more if you google):

http://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/acute_perforation.html

your GP is either hopelessly ignorant or just plain mean and trying to scare you.


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## tummyrumbles (Aug 14, 2005)

Don't doctors read up on IBS, SIBO, the FODMAP theory etc? There should be a register for IBS friendly doctors.

I'm hoping testing improves for SIBO because at the moment it's very hit and miss. If testing could prove conclusively that IBS was caused by SIBO then IBS would stop being a "functional" disorder. I'm certain that day isn't far away.

There's a very strong link between constipation and methane production. The problem foods causing the excess gasses are mainly grain starches, high FODMAP vegetables and too much fibre. The question is if carbohydrates causes IBS then why doesn't everyone have IBS. Maybe IBS people also have a genetic weakness, probably related to neurotransmitters in the gut. I doubt you can cure a defective gene but you can do a lot to reduce symptoms. I'm resigned to taking a long time in the loo now and maybe some of us just have to accept this. Fibre is tricky because too much causes hypermotility with the wrong type of peristalsis but I think it helps to eat mainly veges, even if mashed, pureed etc rather than breads, crackers etc which definitely have a constipating effect on me.


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## annie7 (Aug 16, 2002)

Aidara---concerning your question about keeping your tummy muscles tight because of your bloating etc. i can really relate to that. when i don't go completely i bloat out hugely and painfully. and oh yes i have that pregnant look too. not a good look when you're grey haired, thin and 62--lol...but because of the pain and discomfort i cannot keep my tummy muscles tucked in and tight because that all just hurts too much. so i have the belly bulge. had to stop wearing tight jeans etc years ago because it just hurts too much to have anything tight across my sore belly.

i would think it would be really hard to keep your belly muscles tight (to avoid the pregnant look) and also at the same time keep your pelvic floor muscles fully relaxed. but that's just my opinion. seems to me that tightening the tummy muscles would also result in you tightening all the muscles in that region including the pelvic floor muscles. although i think if a person were really sensitive to which muscles were where, they could do it. you just would have to have good muscle control and an accurate sense of which muscles were which. practice with a biofeedback machine is so helpful in identifying the pelvic floor muscles. and it would be helpful in aiding to tighten the belly muscles while keeping the pelvic floor muscles relaxed.


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## Aidara (May 9, 2014)

I am also thin, I am very tiny around my waist, but this bloating makes me look funny. I don't wear anything tight either, unless I have good days, then I definitely put on something skin tight to celebrate that day. On my bad days I have to hide my huge belly under oversized clothing.  How sad is that, but I guess most female members on this board have the same issues.

I can't keep my tummy muscles tight all the time, sometimes bloating gets so bad, that I have no other choice, but to relax them and then I feel awful and embarrassed. I am stay at home mum these days. If I don't feel good, I can always choose to stay at home, but I am dreading to go back to work, because it will definitely mess up my routine and I won't be able to hide from people on my bad days. Annie, why are you bloated? Are you bloated everyday? I am bloated only when I have constipation or incomplete evacuation. If my laxatives are working, I have no bloating at all. What about you?

Thanks for your reassurance regarding laxatives and bowel rupture. I knew my doctor is wrong about that and about other things he told me.


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## annie7 (Aug 16, 2002)

Aidara--like you, i am only bloated when i am constipated or still have more to get out which i suppose you could call incomplete evacuation although nothing is backed up in the rectum--it all feels higher up in the transverse colon. i then have a lot of pain and discomfort around the splenic flexure area (that bend on the left where the transverse colon turns into the descending colon. i have slow transit constipation as well as pfd. because of the slow transit my colon just doesn't move stool down on it's own--it needs laxative help..

and yes like you, when my laxatives are working properly i have no bloating at all. none. and then i feel terrific









i wear loose clothing when i'm all bloated and pregnant looking. you're right--other women here have the same problems with bloating and clothes. we've had threads here on the board about that...

and yes, like you i found work very difficult on my bad days. i always feel so miserable and sick then. my job was a customer service job so it involved working with the public all day long. i managed the best i could but it got so wearing having to put on the "happy face" all day long no matter what, handling difficult, rude people etc etc. finally being able to retire after 34 years of this was such a huge relief! i do hope you can get some relief from your constipation problems before you go back to work.


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## Aidara (May 9, 2014)

Annie, it must be so difficult to handle slow transit and pdf. At least you also have good days as I do. What a relief that you could take an early retirement. It is so much easier to handle this condition when there is no work commitments.

Every flare up for me is a challenge - pain, physical discomfort, irritability, no appetite and etc. I am so grateful for good days when I feel good as normal people do on the daily basis. My biggest dream is to handle this condition naturally, who knows, maybe one day I will be able to. I know that people with slow transit have to take laxatives indefinitely. I wish they always worked for you, all the best.


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## annie7 (Aug 16, 2002)

Thanks, Aidara









and yes, wishing you all the best as well. especially in finding a good doctor--hopefully your colorectal surgeon-- who will listen to you, taking your problems seriously and get you the tests and treatment you need. biofeedback teaches you how to relax those muscles and go naturally and that will help your dream come true. take care.


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## Freud (Mar 22, 2012)

This may be a lousy suggestion and I haven't read all the posts so I could be repeating or suggesting something that definitly isn't right for you. But how does your constipation issue correlate with food intake? Have you tried fasting? Do you get better or worse when not eating?

I read what tummyrumbles wrote and the link between constipation and methane production is perfectly correct. And don't take my word on this but I think the methane production is specifically high when eating (mainly carbohydrate rich foods). It could be something worth thinking about. Not that you should stop eating. That's of course a very bad idea! But one can try occasional fasting, and see if it gives some relief or not.


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## Aidara (May 9, 2014)

Freud, I don't know if fasting would help, because I have never tried it. But I wish I could not eat on the days I am constipated, cause eting makes me feel even worse. I just don't understand how fasting works. Should I stop eating once I get constipated? What if I am constipated for weeks sometimes. What if I am fine for 2 days and then constipated another two. This pattern can last as long as 2 months or longer. I am worrying that I might be loosing some important nutrients when fasting so often, but I have been thinking about that a lot, just never had courage to try. I really don't want to make things worse.


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## Freud (Mar 22, 2012)

You can do it at any time. It doesn't have to be when you're constipated but it may be more benifical during those periods to not further aggravate your symptoms. Fasting is pretty hard. I know people who do week long fasts, but I have never been able to pull that off. I feel like one or two days is somewhat easy, and easy on your body and mind. You are worried to loose nutrients, that's not an issue with occational fasting. And you should definitely not fast as long as for 2 months. That could be harmful. Take one or two days when having a bad period and just see if you get any relief at all. Do it when your free from work, during a weekend. When I fast I drink organic nettle tea with lemon along the day. Nettle tea, if organic, is full of nutrients, so that should to some degree make up for having no food, and make you feel stronger. And lemon is cleansing. I'm sure at least that it won't make your constipation issues worse. And this may be a little clichée, but just listen to your body.

Oh, and if possible I would consider to reduce your carbohydrate intake in general. Gluten products like pasta and bread is the worst culprit. tummyrumbles recommended the FODMAP diet, that can also be worth checking out.


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## Dreamcatcher32 (Nov 12, 2013)

Aidara said:


> I just noticed your post Dremcatcher. Thanks a lot for your response. Is there any Mayo clinic in UK? Where is Stanford motility Clinic?
> 
> Could I make things worse by keeping my tummy muscles tight. Especially when I am bloated, I don't want to look like pregnant, so I keep them as tight as possible. Could this make things worse? Is it something to do with my pelvic floor?
> 
> I know that it is completely normal to go even only 3 times per week. Firstly, before I got these problems, I used to go everyday at least once and that was normal for me. I was not taking any laxatives, although I used to have some constipation occasionally , but it was easy to manage with diet only. Secondly, if I feel that I had incomplete evacuation for 2-3 days in a row, this usually leads to no bowel movement for a day or two and once I have bm it causes me severe anal fissure pain not mention bloating discomfort. That is why I make sure I go everyday and ideally as many times as I need to feel empty. Before I started taking laxatives, there used to be some good days as well, but that would be exactly the same scenario. When I go number of times it is not diarrhea. It is normal soft consistency stools, but for some reason I can't push them at once, so I have to go many times. Although incomplete evacuation makes me really uncomfortable, I could definitely live with that, since I hate taking laxatives. But the fissure pain is just killing me. I would go for surgery, but if I keep on having dry stools, it makes no sense. That is why I am taking laxatives and making sure I have complete bowel movements as much as I can. I honestly wish it was in my head. I can't understand why my stools get dry or maybe they are not. Maybe it's haemorrhoids and fissure making normal stools difficult to pass? I don't want to go for major surgery just to find out whether it is a reason for my endless constipation. Also, please reassure me, that laxatives doesn't cause bowel rupture. It sounds so scary, I am sure it can't happen with osmotic laxatives, even in high dose, can it?


Sorry I took awhile to respond to this.  Mayo Clinic is only in the US as far as I know. I would do some heavy research on good GI clinics there in the UK. There may be one but I am not sure. You may just have to make a trip to the states, though...

Yes, keeping your tummy muscles tight can be a problem for those with pelvic floor dysfunction. Doing this can cause the pelvic floor muscles to tighten up. You need to let your belly loose and be quite careful about the tummy exercises. With the u-control device you could 'practice' tightening your tummy muscles and letting go of the pelvic floor. It will always cause some tension, though.

Fissure pain seems to be a huge problem for you right now so that needs to be cleared up. You can get medication from your doc for this, to heal it up. Also use Tinactin. I know it sounds bizarre but it works! Not sure they sell it there, you might have to order it online. You need to keep the area as 'dry' as possible and try to sit infrequently. This needs to be healed up before you go to work on the pelvic floor. Also try sitz baths or regular baths with salt as much as possible.

For now, try to get Baclofen suppositories from your regular GP or GI doc. These will help to relax your sphincter muscles to have a bowel movement. Also be sure that your in a 'squat' position (there are seats you can buy for this) when going. When pushing ONLY use your upper stomach muscles to push OUT. This should make bowel movements far easier for you.


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## Dreamcatcher32 (Nov 12, 2013)

Dreamcatcher32 said:


> Sorry I took awhile to respond to this.
> 
> 
> 
> ...


Also forgot to say that NO - laxatives will not cause bowel rupture! They really won't do you any harm. For the bloating, try a digestive enzyme in the morning and before big meals. The bloating is probably muscle spasms, not so much gas or anything like that. I would also try acupuncture and possibly massage.


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## Aidara (May 9, 2014)

Freud, thanks very much for your advice. I am going to consider fasting as one of the options. I have nothing to loose at the end of the day.

Dreamcatcher, thanks a lot for your post. I am going to ask for those suppositories next time I go to see my gp. As long as I take my laxatives my fissure is fine, so it should be all right once I have biofeedback treatment. Many thanks for all the other information.


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## Dreamcatcher32 (Nov 12, 2013)




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## Jinky (May 23, 2014)

Baclofen suppositories are the BOMB! They help me so much with both vaginal and rectal pain....20mg. And they help make easier, much less painful bowel movements (I have a puborectalius in constant spasm).


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## Aidara (May 9, 2014)

Can't believe none of my doctors never mentioned about those suppositories. Does anybody know if they are available in UK?


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## annie7 (Aug 16, 2002)

i searched medicines on the netdoctor.co.uk website. it shows baclofen available as an oral medicine but doesn't mention suppositories. but it might still be available as a suppository.

http://www.netdoctor.co.uk/aches-and-pains/medicines/baclofen.html

ask your doc about it.. if it turns out they are not available in the uk perhaps your doc could order them for you from the usa or another country that has them...just guessing. would be worth it to ask though.

hopefully someone else--possibly in the uk-- can answer "yes" to your question ....

good luck!


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## Jinky (May 23, 2014)

I get mine through a compounding pharmacy. Do they have those in the UK? Oral baclofen is formulated into glycerin suppositories. Glycerin suppositories are very heat sensitive (they are meant to be inserted and melt) so they are tricky to ship. The pharmacy I use is 50 miles from where I live, it takes 2 days to ship and need to be surrounded by cold packs. Not sure how long they can survive in the post, maximum lifespan.


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## annie7 (Aug 16, 2002)

thanks, Jinky. from what i've read i thought they might be only available through a compounding pharmacy.


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