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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Suggest treatment for severe constipation

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Answered by

Internal Medicine Specialist
Practicing since : 2004
Answered : 1455 Questions
Question
I'm a C-6 quadriplegic (complete) and am experiencing severe constipation issues. The only medication that helps me is "Magnesium Citrates". Currently, with the mag citrate drink, I can have one BM per week and am extremely bloated and uncomfortable all week. What can I do to get on a more "Regular" schedule / regimen?
Wed, 6 Jun 2018 in Digestion and Bowels
 
 
Answered by Dr. Salah Saad Shoman 3 hours later
Brief Answer:
Dietary changes

Detailed Answer:
Dear sir, I have gone through your question and I understand your concerns, but chronic constiaption needs a dietary modification in order to be improved.. You need to increase the fiber content
of your diet by consuming two servings per day of green leaved vegetables daily ( as lettuce and broccoli).. Also you need to take two servings of whole wheat products as XXXXXXX , oats, brown bread and whole wheat biscuits.. Adding a daily portion of high fiber fruits as oranges or cantaloupe.. it is important as well to be adequately hydrated with at least eight cups of fluids daily with one of them orange juice.. You can add lactulose syrup three times daily that can be decreased gradually when your bowel habits are improved.. Also passive Physiotherapy on your legs could be an option to improve intestinal movement.. I hope you find this helpful..
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for severe constipation 1 hour later
Thank you for your response. Are you familiar with the complications of bowel care management when the patient is paralyzed (quadriplegia, 25yrs. post-injury)? What is a good target as far as BM frequency (1x per day / 3x per week / 4x per week)? I'm 6' and 140 pounds (I've lost about 40lbs over the past year) in addition to the surgery I mentioned.

I've listed the different G/I meds I've tried with very poor success, except for the mag citrates which seems to be my only hope for a BM. I'm VERY frustrated and in a lot of pain in my gut area (no feeling due to the C-6 injury but much referred pain from the autonomic nervous system).

Am I best served by seeing a G/I Surgeon or a G/I Physician or a nutritionist? All the above?

Are there other causation factors that I should be tested for? What would be a prudent medical plan looking forward? I will try the lactulose again, but given the excessive bloating it causes, what other meds / foods / OTC supplements should I incorporate into a daily / weekly regimen? Are PROBIOTICS of use in a regimen (if yes, what type are best)???

I hope you can come up with some additional recommendations as this is turning into something far more than an inconvenience. Awaiting your response.

-Robert
 
 
Answered by Dr. Salah Saad Shoman 31 hours later
Brief Answer:
Not less than once every three days

Detailed Answer:
Dear sir, hello again.. the bowel movements in a paralyzed person should not be less than once every three days.. to help regulate the bowel movements an intestinal massage that consists of circular, clockwise movements along the line of the colon by using the hands, permeating the ascending, transverse, and descending colon, for a period of 5–10 minutes, preferably 30 minutes after a meal.. Also An abdominal press assists in the expulsion of fecal matter, and it should be performed concurrently with an intestinal massage, by pressing the legs flexed on the abdomen.. Also it is important to increase the Consumption of laxative foods as fruits, vegetables especially leafy vegetables; addition of vegetable oils (olive, soybean, corn, and canola) to the main meals; increase in the intake of fluids; and decrease in the intake of constipating starchy foods..
If all these measures failed to regulate the bowel movements then fingering with anal massage in circular manner is indicated and it might also be used to introduce a suppository or removing impacted stool pieces.. Also probiotics might help with the constipation.. it will bet better to consult a nutritionist or a gastroenterologist.. I hope you find this helpful
Above answer was peer-reviewed by
 
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