Q. Can my constipation be cured permanently?
Hi doctor,
I have bad constipation. I rarely feel the urge to pass stools even though I know I am full and bloated. Since being diagnosed with bipolar disorder for 25 years, I have had some trouble. I am on psychotic medications- Zyprexa, Klonopin, and Effexor XR. I also take beta-blocker Metoprolol for palpitations and low-dose Naltrexone (LDN) for fibromyalgia. Taking stool softeners does nothing. Rarely Miralax gives me just enough bowel movement, but I never empty. I am constantly feeling bloated. What is the best thing to get me regularly going again? I have not had a good bowel movement in months.
Hello,
Welcome to icliniq.com.
Increasing age and drugs seem to be the cause of constipation in you. These antipsychotic medications use cause slow bowel movements.
Now, if we cannot stop your medications, the alternative we have is, use medicines that improve your bowel movements - Miralax (Polyethylene glycol 3350) is one of those. Identify other reasons which could explain your constipation such as, thyroid disorder, diabetes, kidney disease, and poor lipid control.
so I would suggest you Miralax two sachets thrice daily with water, and the following tests :
1) Complete blood count.
2) TSH (thyroid-stimulating hormone), FT4 (free thyroxine).
3) HbA1c (hemoglobin A1c).
4) Fasting lipid profile.
5) Urea, creatinine electrolytes-magnesium, calcium, phosphorus.
6) Liver function tests.
If we find any abnormalities in these tests, then we will go on to treat those. If nothing is found, then another set of investigations can be performed to confirm the reason for your constipation.I suggest you search the internet on dyssynergic defecation and compare if you feel resembling symptoms like these since dyssynergia is a common thing to happen to anybody and a significant cause of chronic constipation.
Hello doctor,
Thank you for your detailed answer, it is very helpful.
Also, I am attaching a document of my latest laboratory reports done nine months before. My lipids are high, liver enzymes are high, my blood sugar is slightly elevated, and a few other things, as you will see. Maybe you will see something that needs to be addressed. My regular doctor said I might have fatty liver disease but did not send me for any tests.
I hope this helps, and I will try your suggestions about the Miralax.
Thank you again for your kind and quick answer!
Hello,
Welcome back to icliniq.com.
I have gone through the document you attached (attachments removed to protect the patient's identity), it was very helpful. Your doctor is right that you might have fatty liver disease. I must tell you the other issues as well. You might be knowing those as well- obesity, dyslipidemia, altered liver function tests, and significant medications in use. The medication olanzapine is, although very helpful in treating your mental health condition, is also related to constipation (1-11%) according to certain reports and related to insulin resistance and diabetes, and irregular cholesterol metabolism. The rest of the medications are so far not associated with your active symptoms, that is, constipation. I would suggest you discuss this with your doctor and if they can prescribe some alternative.
You have hypothyroidism which, if uncontrolled, can cause constipation. The latest report you shared shows it is a little uncontrolled. Probably you need to increase the dose of Levothyroxine. Use Miralax for now and see if it improves your symptoms.
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