From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition,sci.med,sci.med.pharmacy
Subject: Re: Best way to aleviate constipation?
Date: Wed, 2 Apr 2003 08:53:33 -0800
Message-ID: <b6f4ei$31u$1@slb9.atl.mindspring.net>

"Al Hephy" <ahephy@freewweb.invalid> wrote in message
news:1049293589.854141@savina...

>I have the problem due to long term use of prescription pain medication
>-- apparently it affects function of the large intestine.  Mainly
>oxycodone or hydrocodone compounds.  A known side-effect.
>
>I prefer milk of magnesia because it seems more predictable -- 2
>tablespoons at bedtime gets results next morning.  But getting it
>swallowed is a problem.  Have to use Phillips; store brands taste so bad
>I can't use them.  Tried the tablet form and found it much less effective
>(not reliable) but tasted better.
>
>Sure wish there were something I could take on a routine (daily) basis.
>Yes, I take supplementary fiber (Metamucil).  And that can be hazardous,
>because it sometimes packs up to make a brick-like stool.  Might ever
>clog the toilet.  Honest.  I have to keep a plunger in the bathroom!
>
>Thanks to all who are sharing their experience/ knowledge.
>
>Al


===============

COMMENT

I'll give you the tip on oral narcotics and bowel I learned
in chronic pain management and hospice.

Here's the main thing to remember-- these drugs work mainly
by slowing the bowel down so that stuff stays in longer, and
more water is absorbed so the result is very hard, like
concrete.

Fiber (bulking agents) work by retaining water, so the stool
cannot get TOO hard. Generally real problems with them are
NOT caused by them per se, but rather by misuse of them in
which you have one or more meals in which they are not
taken, with fiber meals before and after. This results in
one small concrete plug from the normal meal, which then
sticks to and gums up everything on either side, so you have
one giant mass which doesn't want to move. You've seen the
result.

Thus, the important thing with bulk laxatives is that you
must have some with each and every meal you eat. On
narcotics and fiber, even ONE meal low residue meal will get
you in the end, so to speak, a couple of days later. The
result is worse than no fiber at all, because at least with
no fiber you reduce all meals to a series of rabbit or deer
pellets. With fiber you have to go all the way, or not at
all.

That said, by far the best bulk laxative I know if is
natural banana. This has not only fiber for bulk, but also
other stuff for lubrication and even some serotonin which is
a mild stimulant. We humans are deluxe model chimps, and
we're built to eat bananas! If you can stand to eat three
large bananas a day, you'll be well served. If not, banana
as frequently as you can, and some fiber with meals you
don't get banana.

If you don't like Metamucil (made from psyllium seed hulls),
try citrus fiber (Citrucel) which holds a little more water.
Don't forget an extra glass of water with the meal.

Finally, you may find that bulking agents aren't enough, and
you have to resort to magnesium. Here the same rules apply
as to frequency. A little with each meal works better than
one big blast each day, since that can result in cramps and
water behind one harder bit of residue. Magnesium is
harmless unless you have kidney disease (which you'd know
about if you had it that bad) so generally you can
experiment to see how much magnesium it takes per meal. If
you really get to hating the cherry flavored Phillips, there
are also magnesium oxide tablets and milk of magnesia
tablets which are equivalent. They absorb enough water to
work from the meal you take them with, if you remember the
extra glass.

There is new on the laxative market a slightly different
kind of osmotic laxative which can be used in place of
magnesium, and is more pleasant tasting than Phillips. It's
called MiraLax, and is the same polyethylene glycol (a
soluble plastic) which has long been used for colonoscopy
prep. It's about as inert as fiber, and long term studies
show it's probably safe for the long term (although the
packaging recommends 2 weeks). I think it's still by
prescription only, but that's because it's relatively new
for this use.

Stay away from bisacodyl/Dulcolax and other stimulant laxati
ves-- they work but your body adapts to them and becomes
dependent. Bulk and osmotic agents such as are discussed
above don't have so much of a problem that way. Lastly,
there are "stool softeners" (docusate, PeriColase, etc)
which are supposed to soften stool but actually probably
work partly by irritation, since your body adapts rapidly to
them also. Again, not a good idea for long term use.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition,sci.med,sci.med.pharmacy
Subject: Re: Best way to aleviate constipation?
Date: Sat, 5 Apr 2003 17:28:08 -0800
Message-ID: <b6nvou$ras$1@slb5.atl.mindspring.net>

"Señora Moment" <sendspam@spamreceipt.biz.au> wrote in
message news:dlot8vgln7q6qi8mb3i92l0a0fgq34g5qt@4ax.com...
>
> Thanks for that Steve, most helpful, not for me, personally, but my
> constipated relatives. Just curious about the last group. Is the
> inadvisability of using docusate long term due to its irritant effect. I
> used to think that it was purely a softener by its surfactant
> properties. Interesting that they are rapidly adapted to. I thought they
> were one of the best for long term use.
>
>
> Moosh:)


So does everybody else in geriatrics, since it's one of the
more common meds I see in nursing homes. However, it's a
fact that bisacodyl's effects rapidly wear off (so says the
PDR, the texts and my own experience in practise using it),
and if it was a mere stool softener by means of surfactant
properties, this would hardly be true.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition,sci.med,sci.med.pharmacy
Subject: Re: Best way to aleviate constipation?
Date: Tue, 8 Apr 2003 02:19:14 -0700
Message-ID: <b6u42k$2i8$1@slb6.atl.mindspring.net>

"Seora Momenta" <sendspam@spamreceipt.biz.au> wrote in
message news:e8l49vgvl22i2skn1g8aup35rahj5denbh@4ax.com...
> >> Thanks for that Steve, most helpful, not for me, personally, but my
> >> constipated relatives.


<grin>.  Doesn't everybody have constipated relatives?



> >So does everybody else in geriatrics, since it's one of the more common
> >meds I see in nursing homes. However, it's a fact that bisacodyl's
> >effects rapidly wear off (so says the PDR, the texts and my own
> >experience in practise using it), and if it was a mere stool softener
> >by means of surfactant properties, this would hardly be true.
>
>
> Do you mean bisacodyl or docusate. Different groups, No?


COMMENT:

Yeah, sorry, that was a brain spasm, and I meant to say
docusate above. Bisacodyl and docusate are formally labeled
as being in different groups or classes of laxatives, but
BOTH of them are in fact bowel irritants.  The difference is
mainly one of degree. The detergent docusate (the so-called
"stool softener") shows its irritative action in the fact
that it increases fluid leakage into the gut, and can cause
rectal mucosal damage (as you read in the PDR).

This is not surprising. Detergents cause havoc with mucosa,
a fact which seems to shock, but shouldn't surprise anybody
whose ever had soap in their eyes. Your cell membranes are
soap-like molecules which are susceptible to being
emulsified in bad ways and washed away, and the amazing
thing is that cells unprotected by epidermis stand up to
detergents as well as they do.  Detergents are so disruptive
to cell membranes that a simple detergent called nonoxyl-9
has been used as a spermicide contraceptive. It also
dissolved the lipid coated HIV virus in the test tube, and
was once not so long ago recommended as part of safe-sex
programs. Alas, the stuff also played havoc on the delicate
mucosal membranes of the vagina, and there is evidence that
the resulting irritation made people MORE rather than less
susceptible to HIV infection, overall. It's the same
docusate mistake in another guise. They labeled nonoxyl-9 a
"spermicide," and virus-cide, you see, and not a "lipid
disrupting detergent and mucosal irritant."  Labels.

All knowledge is one piece.  Divisions in learning are put
there for the benefit of our tiny brains, but they aren't
there in reality. A lesson HERE also applies THERE, if you
can just learn to see beyond labels.

Anyway, the body rapidly adapts to the action of both
irritant classes of laxatives. The only honest to God "stool
softeners" which don't chew on the fragile gut wall, are the
osmotic agents and soluble fibers.

SBH