This post continues from my earlier post: Spinal Cord Injury - Neurogenic Bowels and Bladder, and Impotence.
As of Wednesday 08 Jan 2020, there has only been a little bowel movement on Tuesday, the first day I used the Forlax medication, which was recommended to me by a doctor while I was at church (St. Andrews Community Chapel). I have taken 2 sachets on both Tuesday and Wednesday for a total of 4 sachets, with no effects on Wednesday. I also used Bisacodyl suppositories when I got home from work in the evenings, but the stimulant effects have dissipated. So I stopped using the suppository on Wednesday and used a Chinese medicine Centa Enema. However, there was also only a little bowel movement. In total, there has been almost no bowel movement for the week since my last bowel movement on 01 Jan 2020 with the help of Senna, Lactulose, Bisacodyl suppository, and the TCM herbal remedy Nature’s Green Constipation Relief Granules. My conclusion is that I suffer from fecal impaction.
On Thursday 09 Jan 2020 evening, I tried the enema again wearing diapers, hoping that if I hold on to the medicine longer, the faeces will be dislodged. However again, only one lump of faeces was evacuated. Hence, I decided to go to CGH's Accident & Emergency department on Friday afternoon, after my medical appointment with my psychiatrist at IMH in the morning. However, I was hijacked at IMH because the psychiatrist wishes me to stay in the ward so that I can ask the ward doctors about my past medical records. That was the official reason to me. The unofficial reasons were that I had exhibited strict anger at my psychiatrist for taking me off medication back in 2007, and they were worried about my suicidal tendencies. So I was warded at IMH from 10 to 20 Jan 2020. While there, they tried different combinations of osmotic and stimulant laxatives on me. Eventually, I realised that a combination of Senna and Bisacodyl tablets taken together, and Forlax taken at a separate timing worked. Also, based on the doctor at my Urology appointment on 17 Jan 2020, the ultrasound scans taken on 2 Jan 2020 do not show hydronephrosis or vesicoureteral reflux. However, there is still a thickening of bladder walls. In any case, I survived.
Based on the combination of Senna and Bisacodyl tablets and Forlax, I tried different permutations of taking just 2 medicines out of the 3 to see its effects on my bowel movement between 21 and 27 Jan 2020. I soon realise that just by taking Senna and Bisacodyl tablets together without Forlax is enough for my bowels to move. This happened on 26 and 27 Jan 2020. However, I must add that I also drank some carbonated mineral water regularly before I have the urge to move my bowels 1 to 3 hours later. I am also not sure about the long term side effects of taking 2 stimulant laxatives together daily to move my bowels, so I decided to try to take the laxatives on alternate days if I were to continue this treatment.
Prucalopride (Resolor), a prokinetic agent (5-HT4 agonist), has been described by my doctor during my 23 April 2019 CGH Gastroenterology appointment as a new and possibly only cure left for my chronic idiopathic constipation, but I've discovered after some research that there are other medications, such as Lubiprostone, Linaclotide, Elobixibat, TAK-954, Relamorelin, Velusetrag, Naronapride, and Plecanatide. Some of these may still be under research and clinical trials, but it now seems clear that my life may not be about to end with starvation, bowel intoxication or perforation so easily. However, during my medical appointment at CGH Gastroenterology department on 28 Jan 2020, the doctor/specialist emphasised that I should continue treatment with Senna and Bisacodyl. The reasons given are that Resolor is expensive at a few dollars a tablet, and the effects are similar to the stimulant laxatives. It is not a medicine that will cure my constipation immediately, but acts over time. Reading further into the research on Prucalopride also dampens my enthusiasm because although the rate of bowel movement increased, there's no guarantee that the bowel movements are daily although the consumption of Resolor may have to be daily, thereby making it more expensive.
21 June 2020 Update
As of Wednesday 08 Jan 2020, there has only been a little bowel movement on Tuesday, the first day I used the Forlax medication, which was recommended to me by a doctor while I was at church (St. Andrews Community Chapel). I have taken 2 sachets on both Tuesday and Wednesday for a total of 4 sachets, with no effects on Wednesday. I also used Bisacodyl suppositories when I got home from work in the evenings, but the stimulant effects have dissipated. So I stopped using the suppository on Wednesday and used a Chinese medicine Centa Enema. However, there was also only a little bowel movement. In total, there has been almost no bowel movement for the week since my last bowel movement on 01 Jan 2020 with the help of Senna, Lactulose, Bisacodyl suppository, and the TCM herbal remedy Nature’s Green Constipation Relief Granules. My conclusion is that I suffer from fecal impaction.
On Thursday 09 Jan 2020 evening, I tried the enema again wearing diapers, hoping that if I hold on to the medicine longer, the faeces will be dislodged. However again, only one lump of faeces was evacuated. Hence, I decided to go to CGH's Accident & Emergency department on Friday afternoon, after my medical appointment with my psychiatrist at IMH in the morning. However, I was hijacked at IMH because the psychiatrist wishes me to stay in the ward so that I can ask the ward doctors about my past medical records. That was the official reason to me. The unofficial reasons were that I had exhibited strict anger at my psychiatrist for taking me off medication back in 2007, and they were worried about my suicidal tendencies. So I was warded at IMH from 10 to 20 Jan 2020. While there, they tried different combinations of osmotic and stimulant laxatives on me. Eventually, I realised that a combination of Senna and Bisacodyl tablets taken together, and Forlax taken at a separate timing worked. Also, based on the doctor at my Urology appointment on 17 Jan 2020, the ultrasound scans taken on 2 Jan 2020 do not show hydronephrosis or vesicoureteral reflux. However, there is still a thickening of bladder walls. In any case, I survived.
Based on the combination of Senna and Bisacodyl tablets and Forlax, I tried different permutations of taking just 2 medicines out of the 3 to see its effects on my bowel movement between 21 and 27 Jan 2020. I soon realise that just by taking Senna and Bisacodyl tablets together without Forlax is enough for my bowels to move. This happened on 26 and 27 Jan 2020. However, I must add that I also drank some carbonated mineral water regularly before I have the urge to move my bowels 1 to 3 hours later. I am also not sure about the long term side effects of taking 2 stimulant laxatives together daily to move my bowels, so I decided to try to take the laxatives on alternate days if I were to continue this treatment.
Prucalopride (Resolor), a prokinetic agent (5-HT4 agonist), has been described by my doctor during my 23 April 2019 CGH Gastroenterology appointment as a new and possibly only cure left for my chronic idiopathic constipation, but I've discovered after some research that there are other medications, such as Lubiprostone, Linaclotide, Elobixibat, TAK-954, Relamorelin, Velusetrag, Naronapride, and Plecanatide. Some of these may still be under research and clinical trials, but it now seems clear that my life may not be about to end with starvation, bowel intoxication or perforation so easily. However, during my medical appointment at CGH Gastroenterology department on 28 Jan 2020, the doctor/specialist emphasised that I should continue treatment with Senna and Bisacodyl. The reasons given are that Resolor is expensive at a few dollars a tablet, and the effects are similar to the stimulant laxatives. It is not a medicine that will cure my constipation immediately, but acts over time. Reading further into the research on Prucalopride also dampens my enthusiasm because although the rate of bowel movement increased, there's no guarantee that the bowel movements are daily although the consumption of Resolor may have to be daily, thereby making it more expensive.
21 June 2020 Update
After almost 5 months of bliss, I started to have difficulties moving my bowels even after taking Senna and Bisacodyl every night starting from 18 June 2020 Thursday night, and Forlax once every afternoon. On Saturday 20 June, I took Forlax twice, once in the afternoon and once at night, but there was no bowel movement although I tried going to the toilet. My last bowel movement was between Thursday night and 1 am Friday morning, where only a little stool came out. My last bowel movement that was quite effective was on Wednesday 17 June, where I went to the toilet thrice and average quantities came out twice. My last very effective bowel movement was on Saturday 12 June, when I went to the toilet 5 times and average quantities of bowels came out twice, and one time of above average quantity.
Saturday 20 June was also the day I started to reduce my food intake. Lunch was only a bit of meat and vegetables without rice. Dinner at 5 pm was a normal western meal with meat, and small quantities of spinach, broccoli, corn and potato, but I was left a slight stomach pain after the meal. This sense of fullness with a slight pain lasted till after midnight, such that I only need a cup of milk before sleep instead of a cup of oats.
I do have a guess about the possible cause of my current predicament. Recently, I had started taking some multi-vitamin+minerals effervescent pills from Guardian at a cautious pace, about 1 pill every 4-6 days over about a month. I had also taken a total of 7 pills of NutriLife NutriBiotics taking 1 pill on alternate days over 2 weeks. My guess is that the iron in the multi-vitamin+minerals had increased my chances of constipation because they are iron in the ionic form, which draws water to the stomach away from the lower gastrointestinal system, thereby hardening my stools. NutriBiotics consists of probiotics and prebiotics, both of which are known to have effects that may lead to constipation, although the effects differ for different people. The last time I took the multi-vitamin+minerals was Sunday 14 June.
On 21 June 2020, I tried 2 pills of NutriBiotics with a cup of honey at 9.30 am. 2 small bits of bowels immediately came out at 9.35 am, likely due to the effects of honey. I had a breakfast of an egg and a cup of milk at 9.45 am, and at 9.55 am, 3 small bits of bowels came out. A total of 5 small bits came out at 10.05 am and 10.10 am. At 10.50 am, another 2 small bits came out with some straining. At 12.40pm after lunch, 3 small lumps come out. At 1.35pm, one small bit came out. This would be considered an average quantity of bowels moved.
27 July 2020 Update
As of Monday 27 July 2020, I try to take Senna and Bisacodyl tablets once every other night, coupled with one sachet of Forlax every afternoon, and every morning before breakfast, I'll have half a cup of honey with 2 pills of NutriBiotics. My bowels are usually moved every other day when I have taken Senna and Bisacodyl the night before, and requires the full complement of medications including Forlax and NutriBiotics in order to move.
30 December 2020 Update
I've stopped taking NutriBiotics for a few months already because it's likely to be part of the cause of my stool hardening and becoming more difficult to expel. The same goes with iron containing multi-vitamins. I've switched to "Alive, Men's Energy" multi-vitamins which do not contain iron for a few months, and I've been having no problems with bowel movement once every 3 days. In order to move my bowels once every 3 days, I'll have to take 2 pills of senna and 2 pills of bisacodyl the night before, and on the day of bowel movement early in the morning at about 8am to 9am, I'll have to drink a cup of water with one sachet of Forlax or one sachet of Nature’s Green Constipation Relief Granules. My stool will become watery and comes out as diarrhea. I can also take 2 pills of senna and 1 pill of bisacodyl the night before, but I'll have to take one sachet of Nature’s Green Constipation Relief Granules on the morning of the day of bowel movement. However, this latter method does not work as well as the former method because it will involve straining. The stool becomes chunky. Although chunky stool looks more "normal", it involves straining and requires going to the toilet several times to expel all stool.
References:
Meredith Portalatin, M.D. and Nathaniel Winstead, M.D., Medical Management of Constipation, 2012
Anam Omer and Eamonn M.M. Quigley, An update on prucalopride in the treatment of chronic constipation, 2017
Priya Vijayvargiya & Michael Camilleri, Use of prucalopride in adults with chronic idiopathic constipation, 2019
Dr. Andrew Krause, Why does Iron typically cause constipation?, https://www.cytomatrix.ca/cyto-products/iron-cause-constipation, May 1, 2015
Erica Julson, 5 Possible Side Effects of Probiotics, https://www.healthline.com/nutrition/probiotics-side-effects, December 17, 2017
Danielle Staub, What You Need To Know About Prebiotics, https://columbiasurgery.org/news/2017/02/09/what-you-need-know-about-prebiotics