Constipation in a World without Zelnorm
Published by tummyblogger May 1st, 2007 in Medical, general, IBS, Irritable Bowel Syndrome, IBS-CThere are some standard medical responses to the report of constipation, that do not involve prescribing Zelnorm. Note that the following is a discussion of these standard responses particularly aimed at constipation. They do not address bloating or cramps or other problems, although making some diet and over-the-counter changes aimed at controlling constipation may ease some other troubles as well. The following discussion is aimed at clarifying some of the questions and hesitations involved in putting the standard recommendations into effect. I am not an MD, although I do have a couple of Ph.D.s, one in a clinical field. The following, where indented and in italics, represents quoted material from the Heather van Vorous website:
Constipation affects almost everyone at one time or another.
What is constipation? I’m pretty sure you know. In any case, the usual definition describes passing hard, dry bowel movements in small amounts, and not very often–generally less often than three times in a week. Bowel movements may be painful, may leave you feeling that you haven’t completely emptied your bowel. In addition, you may observe that you are bloated, and feel slowed down and not very comfortable overall.
If you have Irritable Bowel Syndrome, or IBS-C, constipation is an ongoing problem, and many people took prescription Zelnorm, a medicine designed to ease IBS-C. Zelnorm has now been taken off the market by the Federal Drug Administration. See this post.
The most common causes of constipation are poor diet, insufficient water intake, and lack of exercise.
So the simple-minded solution is to eat well, drink lots of water, and exercise a lot. If it were so simple, of course, none of us would have constipation! Eating well is particularly difficult when you have IBS, and various symptoms that are triggered by eating a wide variety of foods. See the page on IBS triggers on this blog, or go to the IBS TummyChow site.
Additional causes of constipation include medications, Irritable Bowel Syndrome, abuse of laxatives, and specific diseases.
Some medications are constipating: these include some anti-depressants and calcium tablets. Abuse of laxatives means that you have gotten to the point of desperation and beyond–you take a laxative every day, and have tended to take more and more of the laxative to get the same effect. All of which gives you not-very-satisfactory results. Probably you have talked about constipation with your doctor, who has ruled out the “specific diseases” mentioned above.
A medical history and physical examination may be the only diagnostic tests needed before the doctor suggests treatment.In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation:
*Eat a soluble fiber-based diet with the careful incorporation of insoluble fiber.
Eating a soluble-fiber based diet is a puzzling instruction. There is also some misinformation at major IBS web sites about soluble fiber. The reason, though, that every source on IBS-C mentions soluble fiber is that fiber acts in the digestive system in particularly helpful ways. Soluble fiber interacts with the remnants of food that will be excreted in a bowel movement. Soluble fiber (SF) gathers water and forms a gel with remains of food. The gel smoothes the passage of the combined gel and food remains through the large colon. Regular dialy intake of enough souble fiber help correct disorders of the large colon (=large bowel) such as IBS, either IBS-C or IBS-D. Not only does soluble fiber help correct disorders of the large colon, an adequate fiber intake keeps the large bowel functioning normally (Jackson-Siegelbaum Gastroenterology website, accessed 5/1/2007).
Feeling better with fiber is not an instant process. You need to find a baseline daily amount of fiber that is something you take every day, and then eat a variety of foods that have some fiber, and are, well, “IBS-safe.” By IBS-safe I only mean foods that do not contain triggers for IBS symptoms. Embedded in the concept of “IBS-safe” foods is the caution that “Your Mileage May Vary;” that is, you may not be able to tolerate some foods on a list. The standard advice is to get 20 to 35 mg of fiber per day. Twenty mg. would be for someone small and thin; 35 mg. would for be someone tall and/or heavy.
My own solution is to take a combination of acacia tummy fiber and a meal-replacement beverage, which adds up to about 30 mg. per day. My doctor would be much happier if I were to use a commercial FDA approved over-the-counter (OTC) product rather than the acacia tummy fiber, which is a food supplement rather than an over-the-counter medical product. For the FDA-approved OTC products that are compatible with IBS–that is, they don’t have triggers like artificial sweeteners or citric acid–try FiberSure or Benefiber. For times when I think I might be at a tipping point between constipation and diarrhea, I will take Equalactin. All three are free of IBS triggers, and provide soluble fiber in your diet.
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*Drink plenty of liquids.
You may need to make rules for yourself to do this. For example: Never pass a drinking fountain without taking a drink; Get a drink of water with every bathroom break; Don’t end a meal without drinking something. Or make up your own rules.
Soda and alcohol are triggers for IBS, so of course you would not include those in your drink rules.
*Exercise regularly.
I will try to fulfill this. I did take a good walk yesterday. Will try again today.
*Set aside time after breakfast or dinner for undisturbed visits to the toilet.
Eating triggers some impulse to move your bowels; it helps to have a week or so where you can time the process from full meal to bowel movement. Tug McGraw would have said “You gotta believe!” Believe that it will happen. I found that a regular activity, like using a hand-operated game for solitaire or sudoku in the bathroom and associating the game with the biological impulse was a mild psychological trigger to get the process going. If you don’t live alone, negotiate for a fairly long quiet time in the bathroom.
*Do not ignore the urge to have a bowel movement.
Yes. You learned in childhood that there were proper places and times. Any other time you had to stop the process. Now you stop the process automatically. If you can, start to notice the mild clues that something is ready to happen, so that many times you can find a bathroom, and other times you consciously wait until you can obey the urge.
*Understand that normal bowel habits vary.
It is not necessarily normal to have exactly one bowel movement at one specific time of the day. You might regularize to three, one after each meal, or one every day and a half. Or that famous proviso, “your mileage may vary.” You may notice day-to-day differences.
*Whenever a significant change in bowel habits occurs, check with a doctor.
Ah. What is a significant change? If you have soft(er) bowel movements that come out easily, day-to-day variation does not need to be reported. If you have five to six bowel movements in a day, or revert to constipation, of course let your doctor know.
On the other hand, as you get to be an old hand at managing IBS, write some notes for your doctor to discuss at your next regular visit.
The italicized material comes from this page on constipation, accessed 5/1/07.
I have mentioned a restricted number of choices for soluble fiber, the ones that have nothing added to the powder or tablet base. Metamucil without additives to its psyllium fiber base also works for some. Another choice, that is mixed soluble and insoluble fiber in tummy-happy form, is oatmeal. Cheerios and soy or rice beverage (soy milk, rice milk) would also work. Probably several other dry cereals would be okay, as well. Basically, read the label. No sweeteners, no citric acid, no whole wheat or other whole grains.
Fruits and vegetables: take them slowly, try the baby or junior foods versions first, to see what you can tolerate. Don’t eat fruits and vegetables when you are hungry–except bananas or plantain–without eating soluble fiber first.
And let me and the readers know what your solutions are, and how the change from Zelnorm is working for you.
One Response to “Constipation in a World without Zelnorm”
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