I have constipation, which is relieved by Miralax but recurs once I got off it. Please help.

Question

Hi doctor,

I had constipation for a few months after a pilonidal cyst last year, possibly due to the strong medications. It persisted from mild to severe throughout the year. I visited a gastroenterologist a month ago, and he recommended taking Miralax every day for a month. It seemed to have helped, but once I got off it, constipation seemed to recur. What does this mean, and should I continue to take Miralax, or should I consult my physician again.

Answer 1

Hello,

Welcome to icliniq.com.

Well, yes, you are right. Some degree of constipation usually follows after surgery because of pain medications, particularly opioid analgesics. But usually, that effect does not last more than a week. That maybe there are other components to your symptom of constipation, such as low fiber intake in a day, insufficient water intake in a day, or no regular exercise. These are some physiologic causes of developing constipation.

Diet should contain at least three to four grams of fiber. You can consider taking supplemental fiber with various brand names like Fibo (soluble fiber with green tea extract), Fibercon, and Isabgol husk; just take two tablespoons full daily with water.
Daily water consumption should be two to three liters.
Some degree of exercise is necessary. Like 40 to 50 minutes, walk regularly.
If your problem does not resolve with the above tips, you can take Miralax (Polyethylene glycol). This is an osmotic laxative that does not develop adaptation. Meaning the drug efficacy will remain the same if taken for many months to years.

But I suggest you use it when necessary. In large proportions of patients with constipation, the common cause is physiological, which I mentioned above. There are specific pathological causes, namely pelvic dyssynergia, an asynchronous contraction of anal and rectal canal muscles in response to defecation. Ideally, then we should relax during the act of defecation start. But they paradoxically contract and does not allow stools to pass. Barium defecography is the test that can be considered to confirm the pathological cause of constipation if the above treatment does not work. I want to know how you think about this.

Regards.