Suggest treatment for severe constipation

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Posted on Mon, 7 Sep 2015 in Abdominal Pain
Question: CONSTIPATION
After a hernia operation on July 25, this seems to be healing well.
However shortly after, in hospital my urine stopped ( not a drop) from 10am-7pm, and a catheter was fitted in hospital . Catheter was removed after 16 days- clerical error at hospital!
Two days later, urine stopped again and catheter inserted by district nurse, painful this time probably due to an infection.

I am concerned about constipation, which I NEVER get, having been a wholefood vegetarian from age 17 to no, age 80, in good health.I take no regular medicines. Previously I would get one or two soft motions daily without fail.
Medicines prescribed by hospital.
Pain;
paracetamol-take less than maximum daily
ibuprofen- since infection, which caused pain along urethra, reduced from 3 to 2 per day (400 mg)
Omeprazole prescribed to stop damage to stomach etc!Trimethoprim-200mg. antibiotic for infection. When I took urine sample after 3 days, doctor said urine infection had cleared, but I wonder whether the infection between catheter tube and urethra will clear so quickly, as, if I reduce painkillers urethra stings badly.
Tamsulosin to relax musculature around urethra and prostate. Having read the information leaflet, I guess it relaxes arteries etc and (probably) digestive tube and colon. I normally do not feel my body, and I get the impression that my normal peristalsis is not operation. I'm drinking plenty, producing over 2.5 litres of urine (recorded accurately !) daily.
Last time I recollect getting constipated was age 7, when I left parents and arrived at boarding school!
I MAY have had laxatives as a child as I come from a medical family.
Have never taken a laxative or had an enema as an adult.
I look forward top your help, please.
doctor
Answered by Dr. Rishi 1 hour later
Brief Answer:
You should be fine with some medications. All the best.

Detailed Answer:
Hello XXXXXXX
Please help me with a few details.
1. What type of hernia did you have and which side?
2. What was the type of Surgery done?
3. Since when is the constipation in relation to the Surgery?
4. Any diet changes since the Surgery?
5. Are you passing gas normally or is there a problem with that as well?
6. What medicines or treatment have you tried for the constipation and any relief from them?
I usually advice my post-operative patients to take Syp Lactulose or Isabgol husk or Senna at night and this usually resolves their constipation until they return back to their normal lifestyle.
Please do let me know and you can try the above.
Take care,
Will look forward to hearing from you.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 4 hours later
Dear Dr. XXXXXXX

Thank you for the answer and clear interest in my welfare.

(I am pleased that you are from XXXXXXX because it was Yoga, at age 14, which helped me to change my lifestyle, becoming a wholefood vegetarian, from a family of doctors of three generations. Instead I opened 9 natural Health Stores locally in Portsmouth, on the South Coast of England in twelve years in the 1960's. The only surgical intervention was about 24 years when 2 skin cysts were excised, and some warts cut off- in a ring around my anus!-misdiagnosed 10 years earlier as "pressure spots"- I did not sit much, as I was always dancing and obviously could not look down there in detail, but just accepted the diagnosis!)
Now to your questions:

1. Hospital Queen XXXXXXX in Portsmouth- surgeon Wattas.
Operation (from notes): Lap mesh repair bi-lateral incisional and temoral hernia and stitch repair umbilical hernia. Date 25/7 .

2. Keyhole surgery. As far as I can see three entry points repaired by stitches. The lower two were dressed awhile by district nurses-they never appeared inflamed- (aren't we lucky in U K ! )
I was advised, until now, to continue dressing the umbilical stitch because it was discharging a little and, later, might otherwise catch on clothing.

3.Operation on Saturday- kept in hospital Sunday and discharged at 3 pm. on Monday after traumatic need for catheter mentioned in my original.
I was HOME at last, and able to eat good food(hospital food was bad!)
In hospital bowels were not opened at all- I'm surprised they did not encourage me- (a) first effort was impacted hard motion (which I never get), but later that night a further (firmer than usual) motion about 12" long!
Next day at 6.30 in the morning another 12 motion, fairly firm, but at 1.30 a normal ( for me) motion, requiring no effort, and soft and normal shape.
(My own interpretation was that the engorgement -from the operation- which caused black and blue colouring like the front of small underpant briefs, including the scrotum and also enlarged the left testicle to a small pear size- the right one was only slightly enlarged.)

2. My motion remained normal for me, once or twice each day with no effort required, until Thursday, 13th at 2 am, when motion would not pass and was clearly very hard. This followed starting Trimethoprim antibiotic 200mg. twice daily as prescribed by my doctor on Tuesday 11th at 3 pm. Also I re-started taking Tamsulosin (400 mcg once daily) having telephoned for an appointment with doctor. I had previously stopped this after leaving hospital on 31th July, four days after discharge from hospital, after a helpful discussion with my G P , who listened to my concerns. I have previously controlled any prostate symptoms for many years with a very low dose of "Doctor's Best -Comprehensive Prostate Formula (Google for details because it is "alternative"- from United States). The doctor emphasized that it MIGHT reduce my chances of having to be re-catheterized. In fact it appeared to me that it was more likely to be the infection and irritation of the urethra that stopped my urine after the catheter was taken out on Sunday August 9th.at 10 am. By 8 pm I noticed sticky dribble around tip and cloudy urine, so I saw my G P on Tuesday, 11th, who prescribed the antibiotic 4 pm.
Urine turned red from 10 am till 3 pm, but was clear by 9 pm. then urine stopped for the second time.
Catheter was re-fitted (painfully !) at 8 am.
Constipation, in my case seems to be linked with one or both of the two medicines listed above.
Even though constipated and hard, by being persistant, using a little oil at anus with gloved hand my does just manage a montion on most days, so I have not needed the Bicarbonate of Soda balanced remedy so far.
4. I always eat whole natural foods-vegetarian- (lack of appetite for two days after return home, but I ate sparse meals), and have from then on, added ground flax-seed three times a day with yoghourts hopefully to prevent constipation. I'm also consciously adding more vegetables than usual.
5.My usual habit of passing gas for some time appears to be when I stand and relax to urinate, that I pass wind. Since the constipation I find more gas, and often , when I feel the urge to defecate there is only wind and stool feels had and remains inside.
I appear to have exerted a little control and help for my intestines, by increasing roughage and lots of water (average 3 litres of water) but I feel (with my amateur knowledge) that my peristalsis movement is not working, perhaps flaccid. Not scientific, I know, because all that is unconscious.

As my hernia appears to be healing, due to rest, sleep and gentle movements, I have tried mild straining ( a thing I NEVER need to do), but this does not move the motion.

I HOPE that it is the antibiotic that is mainly the cause of the constipation, because the course will finish tonight. If it is the Tamulosin , it will continue, I've worked out; correct?

6. As an adult ( from age 17 -80) I have never had to use a laxative, not even a herbal one! Doctor has prescribed Laxido (basically bicarbonate of soda),
but I only wanted to use it if I went past 24 hours of clearly hard motion with nothing coming out.

Thank you for the recommendations in your final large paragraph. I have Googled Syp Lactulose and understand its action. the other two are traditional rmeedies, which I tend to prefer.

My lifestyle is only super hygienic and walking slowly around the house and outside (2 hours daily) at half my usual speed, because the catheter can easily cause pain on movement! I use only the pain killers when necessary, now in lower dosage, as I don't like stinging or pain! I'm not used to it!
I don't expect to beck to full speed normal living until the catheter is removed, hopefully safely this time!

Thank you, Dr. XXXXXXX for your great help so far.

I apologize for giving so much information, but feel that, if you have the time to read it, it will assist diagnosis and recommendations. Normally I do not have to worry about my health at all, just eating well and exercising (walking and a few exercises in the home and XXXXXXX bouncer (trampoline) ) . The last thing I am not doing as the catheter will make it too uncomfortable, and I want to be gently on the internal wounds left by surgery.

Do you have any advice about this? I do it because it should stir up the lymph for 5 minutes a day, giving us oldies exercise that kids get naturally every day!

I look forward top any further advice. I'm interested to know whether you ever use the traditional Ayurvedic medicine mixed with modern medicine. I have never studied it, keeping to mainly Western natural ideas.

Best wishes,
XXXXXXX XXXX














doctor
Answered by Dr. Rishi 6 hours later
Brief Answer:
Constipation mostly due to medicines.

Detailed Answer:
Hello XXXXXXX
Good to hear from you.
Your reply is definitely more descriptive than your initial question and very informative. Thank you for that.
I must congratulate on your near perfect lifestyle. Keep it up.
Now that I know what surgery has been done I can understand that constipation is a natural sequelae of this surgery. Therefore, you need not worry about that. Also the antibiotics and urinary medicines you are taking are all adding to the constipation.
I suggest you start the medicines as I suggested. Whichever you prefer and whichever works for you.
We routinely use Ayurvedic medicines with modern medicines and usually get the best effect out of both of them. But one should consult a practitioner before embarking upon something like this.
As for exercise, I do feel that you should be exercising daily. It is extremely important to keep you fit. It will also help in bowel movement. You do not need to do any rigorous exercise. Just slow walking as you are doing and you could do it twice or thrice a day and slowly increase the distance you walk and you would see the bowels also normalizing slowly.
Please do let me know if I can be of further help with this issue.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Rishi

General Surgeon

Practicing since :1999

Answered : 1312 Questions

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