Is my mom’s hysterectomy worsening her constipation at 68?

Question

Hello doctor,

My mom is 68 years old and has had severe chronic constipation for almost three years now, which started after her ovarian cancer surgery and hysterectomy. She only goes maybe once a week, and when she does, the pain is so bad she cries in the bathroom. tried all the usual stuff - Miralax daily, prune juice, lots of water, and fiber. But nothing seems to help much.

Her gastroenterologist did a colonoscopy six months ago, which showed slow transit constipation and some diverticulosis, but nothing cancerous. The problem is shes on Oxycodone 10 milligrams twice daily for her back pain, which makes the constipation even worse. But she can not function without the pain medication. She is also taking calcium supplements for osteoporosis, which her doctor says might be contributing to the problem. Her thyroid levels are normal with TSH (Thyroid-stimulating hormone) at 2.1, but her vitamin D is low at 22 nanograms per milliliter.

The straining has caused hemorrhoids that bleed frequently, and now shes developed a small rectal prolapse that her colorectal surgeon wants to fix surgically. She has tried Senna and Bisacodyl, but they just give her terrible cramping without much relief. Please tell me;

Can a hormone deficiency after a hysterectomy cause this severe constipation?
Are there better medications that will not interact with her pain medicines?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

This pain is affecting her daily routine and also her health. The treatment she is taking should have helped her, but I feel her stools are getting hard because of the medicines she is on and also the supplements. Too much fiber, if not digested, can cause her some bloating. I suggest a combination of therapies.

Not passing stools for one week can worsen her hemorrhoids and prolapse. She might have frequent bleeding, which might lead to anemia and weakness. Suggest that she take a combination of the treatments. Giving her an enema every two days till her stool frequency improves can help. Hope the gastrosurgeon had some input to give.
Fiber supplements increase weight and lead to mass in passing motion. This helps but can cause digestive issues.
Osmotic agents like Milk of Magnesia are good as they increase the water content in the feces and lead to better motion.
Stool softeners are better, as they soften the hard stools, making them easy to pass. Good to use them daily.
Lubricants, such as mineral oil, also make the process of passing stools free and reduce the strain.
Stimulants can be taken in combination with softness and lubricants so that the stool gets removed with ease, and she does not have to struggle.

Take her to a gastrosurgeon. Need to check if any other cause is present for this severe constipation.

I hope this information helps you.

Feel free to ask further queries.

Thank you.