Hello Mr. XXXXXXX XXXXXXX

ATT medications ( both Rcinex and Combutol ) are known to cause chronic constipation and uneasiness.
You have already completed 7 months of therapy, and hence have a few months more to go, and the side effects you mentioned are definitely due to these medicines.
It is not a serious issue, and can be overcome by appropriate dietary and lifestyle modifications.
The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.

Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people.

If you are indeed constipated, undertake the following measures :

Increase your fiber intake: Adult men should eat at least 30 grams a day;
adult women should eat at least 20 grams a day. Whole grain foods, wheat and oat XXXXXXX fresh fruits and vegetables, legumes, and nuts are considered the best sources. The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. You could add a fibre supplement in your diet like Psyllium seed , Isabgol etc.
Increase your exercise and activity level.
Drink more fluids: It is recommended that adults consume atleast 8 - 10 medium sized glasses of water per day, maybe more, depending on the activity level.
Don’t ignore the urge to use the bathroom: Set up a regular to time to
use the toilet.

Certain medications are used to treat constipation, although you must use them only when other measures fail, because they can be habit forming. These include oil based laxatives, stool softeners ( Docusate ), hyperosmolar laxatives, stimulant laxatives ( Dulcolax ), suppositories and enemas.

Do not expect the dietary and lifestyle changes to work overnight. It might take a few weeks for you to experience their benefit.

Some of these are prescription medications, hence you can consult your treating physician to prescribe them if non drug therapy fails to improve your constipation.

Take care, and please feel free to ask for further clarifications.

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Hello Mr. XXXXXXX

I do not necessarily see a major problem if you are only going to drink a single alcoholic beverage on a weekly basis. As you know there can be some effect of alcohol on liver enzymes which are used to process the medication which she is taking for the tuberculosis.

It is not necessarily an effect of the medication interacting with the alcohol. It is more of an effect that alcohol affects some of the liver enzymes which process the medication and if these enzymes are affected significantly it can raise or lower the drug level.

I would like to caution you on any drinking more than that as it may significantly affect the level of medication in her body.

Yes, alcohol does aggravate constipation, if you stop drinking altogether, it would benefit you.

Chronic constipation can cause piles. Also, as I mentioned, laxatives are habit forming and hence I would not encourage you to use it on a regular basis.

The complete cure as I delineated lies in dietary changes . It may not show overnight relief, but will definitely be better in the long run.

Once your ATT medications are completed, you will automatically feel improvement in constipation, as long as you do not build up addiction to laxatives like Dulcolax.

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