puking, can't poop, but what about the heartburn?
July 6, 2010 10:29 PM   Subscribe

sometimes i get constipated - sometimes when i get constipated, thanks to a super weak stomach, i throw up. this lasts just as long as i can feel the rock of poop in my side. today is a particularly bad round of it. to complicate matters, i'm hypoglycemic and have heartburn from time to time. so, now i'm constipated, puking, shaking from the lack of food, and i have wicked heartburn. what to do?

i tried some food earlier (1/8 of a nutrigrain bar before i realized that my stomach wasn't going to hold on to something, some apple and peanut butter, and a couple saltines) - all of it came back up. i've stabilized with a teaspoon of water/gatorade every 10 minutes.

the low blood sugar is being helped somewhat by the gatorade/water but the heartburn is making my nausea worse...

if it goes on for 24 hours (we're at 12 hours now), i'll of course find myself at the doctor/ER, but until then i'd like to ride it out, so calls of "go to the ER!" will be ignored. also, it is super difficult for me to discuss my pooping problems under my username, so please be gentle.

oh, and i'm 28, female, and in oklahoma.
posted by nadawi to Health & Fitness (31 answers total) 5 users marked this as a favorite
also: i drink lots of water and yesterday i ate a crapton of salad and tomato soup (i'm a vegetarian). i get lots of fiber (in fact, too much for a while, but i've scaled that back) - so the normal constipation advice, while nice, might not apply.
posted by nadawi at 10:33 PM on July 6, 2010

Zantac works great for me when I've got heartburn.
posted by otherwordlyglow at 10:37 PM on July 6, 2010

A really small dose of (minty flavoured) Milk of Magnesia should help both the heartburn and the constipation, and possibly the nausea.

If you want to try feeding yourself solids again, stay away from fats and fibrous foods in the immediate term (the fibre might, at this point, make the constipation worse, and sometimes fat will exacerbate nausea.) Go for just the saltines or dry white toast -- skip the peanut butter and apples. Keep up with the sips of Gatorade to hopefully help your blood sugar.

Lastly...God I'm sorry. This really sucks.
posted by Ouisch at 10:39 PM on July 6, 2010

(Actually, not sure why I specified "really small" -- a regular old dose of MoM is probably your best friend right now, provided you haven't loaded up on a bunch of other laxatives.)
posted by Ouisch at 10:42 PM on July 6, 2010

Can you handle espresso or coffee? Both usually help to turn the tide when I am having similar issue.

Keep trying fluids, even if it's only tiny amounts.
posted by archivist at 10:48 PM on July 6, 2010 [1 favorite]

Is it possible to hold a hard lolly or sweet, like barley sugars or butterscotch or whatever, in your mouth so it dissolves and you absorb the sugar? Crunch it up so it dissolves faster. It's slow and won't help much but it gets at least some sugar into your body without putting something solid in your stomach. Very sugary liquids will also help, being better hydrated is always helpful for constipation, so keep up the gatorade. Oh, or maybe lick up some spoonfuls of honey? It depends on how you react to the taste I think (not sure I could eat honey while I was nauseous!).

Proper medication to treat the heartburn would also be a good thing but constipation is an occasional side effect of proton pump inhibitors like Pepcid or Zantac so you want to be a bit careful. Things like tums don't generally do much but it sounds like even small amounts of relief will help break the sucky cycle you're in. Are you able to visit/talk to a pharmacist or similar? (no idea what time it is over there) I have no idea if laxatives would help if you're really blocked up and not hydrated, but a pharmacist could help you there too.

One medical issue to be aware of, besides hypoglycemia and dehydration and stuff, is some kind of intestinal blockage. If your abdomen feels really bloated or sore or crampy or you start to feel really bad in general then you probably want to see a Dr sooner rather than later because that can be serious. But I've also had the constipation causing throwing up thing so that's not unheard of on it's own and it did pass with time for me, although throwing in the low blood sugar adds an extra complication I don't know anything about.
posted by shelleycat at 10:49 PM on July 6, 2010

there is zero chance i can handle coffee or pills. the milk of magnesia seems to be on exactly the right track. keep the suggestions coming, my husband is on his way to the store now.
posted by nadawi at 10:49 PM on July 6, 2010

A friend has difficulty with constipation and swears by a coffee enema. He's also used glycerin suppositories with a certain amount of success.
posted by hapax_legomenon at 10:52 PM on July 6, 2010

fyi, zantac is not a proton pump inhibitor, it is a H2 blocker - different funtion, same effect (I know cause I had an ulcer and am allergic to PPI's).
posted by smoke at 10:52 PM on July 6, 2010

Do you have gaviscon over there? It's supposed to form a seal at the top of your stomach and stop reflux. It makes me want to puke all the time but if it worked for you then it could help stop the reflux and maybe damp down the nausea. Caffiene can also keep things moving so maybe caffienated sports drink instead of gatorade?
posted by shelleycat at 10:53 PM on July 6, 2010

Gah, I always get the ppis and the h2's mixed up. I think pepcid is the latter as well. H2s don't cause constipation and are the kind to try if you feel well enough to get that far, but again talk to a pharmacist because they know which ones are which!
posted by shelleycat at 10:54 PM on July 6, 2010

IANAD, I only have a life-long interest in nutrition, and have done a ton of reading. I believe in EBM (Evidence Based Medicine), and don't go for old wives tales. What I offer, is of course not medical advice, but the best suggestions I can come up with.

For now: you need something that you can readily absorb. This means a liquid based meal. If you have access to whey protein, it's great with f.ex. frozen (or fresh strawberries). Is there a store nearby where you can buy such things? Here in CA, there's Trader Joe's which has frozen and fresh fruit as well as whey protein. Whey protein is easily absorbable and a great source of protein, while fruit is a good source of fructose which should help with the hypoglycemia without overwhelming your pancreas (because the fructose is in a complex carb matrix). The liquid will help somewhat with the constipation. Don't worry about the fiber at the moment. To promote motility, it also might make sense to stroll slowly around your house/apartment (rather than lying immobile) - if you can move. Relax. Another reason not to lie down, is that heartburn is caused by stomach acids going back into the esophagus. If you get tired, sit on the couch, but try to maintain some elevation of your upper body. The acid can also be neutralized, temporarily, by some calcium tabs (like tums). Do not consume things which tend to increase acidity in the stomach or promote excessive stomach acid production - don't drink coffee, avoid chocolate and spicy things. When you are throwing up, of course, your esophagus gets irritated by stomach acid - another reason why for right now, tums (calcium) will be helpful.

For future: fiber + mobility. Yes, I know you get fiber. BUT. The key here is to reach a level of fiber consumption of around 100 g a day (the ADA recommends around 35g, but that is too little for those given to many gastro-intestinal problems), but to also reach it gradually. If you take in too much fiber at once, without giving your body time to adjust, you'll have the problems you describe. Work your way up to the 100g gradually, over weeks. As you know, there are basically two big classes of fiber, soluble and insoluble and you should get both. It is OK to supplement with psyllium powder (but get just the powder, not the concoctions with maltodextrin etc.). Veggies, fruit and whole grain fiber-rich bread should be a feature of your diet. With hypoglycemia, it is especially to avoid simple carbs - otherwise you'll get sugar spikes - rather go for complex carbs with fiber, and make sure that there is some healthy fat in the mix as well - fat delays stomach emptying, and prolongs passage, all of which will tend to even out serum glucose (avoiding rapid spikes). Motion - exercise is good. BUT again, work your way up to more exercise gradually. Try to lead a circadian-regulated lifestyle: eating your meals at the same time every day, going to sleep and waking up at the same time each day, exercising at the same times throughout your week etc. This regularity will help your digestive system become regular too. Longer term, you should definitely do something about your heartburn if it happens to you too often - if it's regular, then time to see if the doctor might put you on PPIs.
posted by VikingSword at 11:06 PM on July 6, 2010 [2 favorites]

Longer term, you might find this book useful: The American Dietetic Association Guide to Better Digestion. I'm a clinical nutrition student and practitioner, and I've also had digestive unpleasantness in the past. Reading that book helped me a lot to know which foods and OTC medicines helped with which symptoms.

If you don't end up at the ER, a doctor's visit is probably in order. Potential GI blockage is a really serious matter, as shelleycat mentioned.

Also...it's good to learn about nutrition and fibre and whatnot, but be careful. There is a lot of woo-woo bullcrap out there, especially if you search for books using the keywork "digestion." Anything that mentions "food combining" or "natural hygiene" is basically snake oil.

I'd also be really hesitant on the ultra-high-fibre regimes recommended, because it can exacerbate constipation, and even potentially interfere with nutrient absorption. Different things work for different people, true, but just because fibre sounds so healthy and benign doesn't mean there is no risk to going above the ADA recommendation.
posted by Ouisch at 11:23 PM on July 6, 2010 [4 favorites]

Not sure if you're on them, but some diabetes medications (metformin etc) can trigger digestive upsets - usually diarrhea, but more rarely constipation and so on. If this is a continual problem, you might wanna chat with your GP the next time you go in and see if dosage or variety can be tweaked slightly.

Also, people are happy to recommend fibre for digestive upsets, but it can sometimes make things worse. I thoroughly second the people that are telling you to take it slowly but I would also like to suggest that (on a normal day when you're not puking) to take plenty of liquids because even mild dehydration can affect your bowels.

Try to sleep (propped slightly upright) - even a 10 minute nap would be good. Sometimes a short break from all the stress and discomfort can re-set the system slightly and give you a chance with all the other good advice already given.
posted by ninazer0 at 11:44 PM on July 6, 2010

Since you can't take pills, you might ask your husband to see if the store has any chewable chocolate-flavoured laxatives.

I don't know the specific brand (maybe Exlax?) but I think I remember laughing immaturely because it had a picture of the brown lump of chocolate on the box.
posted by cranberrymonger at 11:55 PM on July 6, 2010

Just to add a bit of info on fiber. Here's an article on fiber from the Harvard School of Public Health with extensive references.

A couple of points for clarification purposes (see this link to a table of recommendations): the ADA recommends minimum levels - thus, for example, consuming more than the minimum is not "excess" by itself:

"The more calories you eat each day, the more fiber you need; teens and men may require upwards of 30 to 35 grams per day or more."

In other words, the recommendation of f.ex. 35 g / day is not the maximum or upper level, it is a minimum for a given number of calories and other factors, but "more" may be appropriate.

Of course, it is always possible to overdo things, so only make major changes to your diet in consultation with a qualified physician.

And again, a key to fiber intake is a gradual approach to changing levels (either up or down):

Fiber and Constipation:

"The good news is that the gastrointestinal tract is highly sensitive to dietary fiber, and consumption of fiber seems to relieve and prevent constipation.

The fiber in wheat bran and oat bran seems to be more effective than similar amounts of fiber from fruits and vegetables. Experts recommend increasing fiber intake gradually rather than suddenly. As fiber intake is increased, the intake of beverages should also be increased, since fiber absorbs water
posted by VikingSword at 12:21 AM on July 7, 2010 [1 favorite]

Fiber doesn't work for me, since I have Crohn's disease. My GI doc recommends Miralax. It works slow, so its more of a future thing for you, but might be useful. It helps retain water in stool and has helped me keep things more regular. You stir a bit into a drink and it doesn't taste or feel gritty. You may need to start with half a dose and titrate up to where its helpful so you don't end up with too much, but my doc said you can take way more than the label states without hurting yourself, so its got its advantage over traditional laxatives, and its not addictive either.

Also for constipation, I found some exercises that seem to help that "i'm ready to go but still can't" feeling. Bend over one knee so you're leaning over it, for about 30 seconds. Then turn and bend over the other. I find that it helps, I don't know if its massaging the right muscles to mimic peristalsis or what but it seems to help get things going when my body doesn't seem to be able to decide what it wants to do. There are other exercises out there you could try. I also find that laying on a cool tile floor helps with the pain component, but really at this point it sounds like a laxative is your best option. I feel your pain, its a horrible feeling. Hope you feel better soon.
posted by gilsonal at 1:21 AM on July 7, 2010

I don't have a specific recommendation for your current condition, but I think your best bet is to find a decent gastroenterologist or at least a nutritionist to guide you through this. Do you have one?
posted by plinth at 3:33 AM on July 7, 2010

I know it's been a few hours, and I hope the MoM helped...but if it didn't, I have to second the glycerin suppositories suggestion above as a last-ditch effort. They work. If you try it, give it as much time as humanly possible to dissolve and do its thing before trying to poop again.
posted by cabingirl at 6:20 AM on July 7, 2010

I know this sounds weird, but the best all-purpose stomach remedy I use is regular old baking soda (sodium bicarbonate) - 1 teaspoon per 8 oz. glass of water. It's mostly an antacid, but it usually kills my heartburn and nausea within 20 minutes. Then you can start drinking more fluids, which should help with the constipation, and eventually work up to taking a mild laxative.

Baking soda tastes gross, though, so if you tend to react to bad flavors with more nausea, you can use Alka-Seltzer instead. It's got the same active ingredient, plus some citric acid to mask the flavor of the sodium bicarbonate. I just mention the baking soda because most people have some in the house and it's great if you have no medicine on hand. And it's cheap!

In the future, for heartburn, Zantac or Pepcid, which are both H2 blockers, work well for me. I have similar digestive issues, and taking one of those a couple of hours before bed prevents the nighttime heartburn I get sometimes. You might also want to investigate whether acidic foods trigger heartburn for you - you mentioned eating tomato soup, and I've found that eating tomato-heavy foods will sometimes result in a heartburn episode, so try eliminating tomato and other acidic foods from your diet for a little while and see if that helps.

I hope you feel better soon!
posted by bedhead at 6:49 AM on July 7, 2010

Seconding that daily Miralax to prevent this may be worth looking into - it's non-addictive, and might help.
posted by insectosaurus at 7:13 AM on July 7, 2010

I've found Miralax to be the best cure for constipation. (It's tasteless, you can mix it in anything, and it gets things moving without any cramps or other problems.) And I have developed the same horrible problem of getting terrible heartburn whenever I am constipated.

For the heartburn, I've learned that gummy bears (gummy anything) do wonders. Strange, I know! As a quick fix, try laying on your right side for awhile (I hope it's the right side and I didn't just instruct you the opposite). I read that laying on the side where your stomach can lay down without sloshing on top of other organs, helps things to settle down. It has helped me.

Another easy cure with big results that I have found is yogurt. It coats the stomach so it helps the heartburn and it has the added benefit of getting the bowels more regular.

When my heartburn gets bad, I then do the 12-day treatment, I think that's the Zantac stuff that others have recommended. But for now, laying down until your settled and then getting the constipation moving is what you need.
posted by Eicats at 7:28 AM on July 7, 2010

Is the drinking water OK where you are? I lived someplace with very hard water and gradually found out that everyone in the area who drank the water was constipated. I started drinking bottled water but even the amount we used for cooking was enough to constipate some people.

Prunes, prune juice, canned pears and applesauce are all good for constipation and have a lot of sugar. I think milk of magnesia makes almost anything worse, but maybe that's just me. I really like fizzy water with some Angostura bitters to settle stomach problems. Angostura bitters are very high in alcohol but you just use a few drops.
posted by BibiRose at 7:54 AM on July 7, 2010

An enema would fix you up in about 5 minutes.

(Sometimes, the old methods are the best.)
posted by MexicanYenta at 9:29 AM on July 7, 2010

It's true that a UL (Tolerable Upper Limit) has not been set in the Dietary Reference Intakes for fibre, but it is also true that just because a UL is not set, does not mean that one can eat massive amounts of fibre with impunity. The relevant footnote on macronutrients, including fibre, in the DRIs says:

"Although a UL was not set for any of the macronutrients, the absence of definitive data does not signify that people can tolerate chronic intakes of these substances at high levels."

All I'm saying is, be careful. Especially if you're already eating lots of fibre (and, hopefully, drinking plenty of water too) and having GI issues like major constipation leading to nausea and vomiting. This is pretty serious.
posted by Ouisch at 10:41 AM on July 7, 2010

Nothing much to add other than that you should avoid apples if you want things to get moving, they have pectin which is great when you have diarrhea, but not so great for constipation. Also, try my "constipation dance." I read this somewhere, and it really works for me - you twist your abdomen ( I always to clockwise, but I don't know if it matters) kind of like a belly dancer. Go slow and exaggerate the movements. It's changed my life.
posted by The Light Fantastic at 11:16 AM on July 7, 2010

IANYD, but here's my list of things to do before going to the ER, assuming you are not vomiting so much you actually can't keep anything down (which means you're probably obstructed and need to go to the ER). In this order.
First start the Miralax and possibly Dulcolax as well for oral medicines
1) Suppositories
2) Enemas you can do at home include tap water enema, coffee enema, and milk/molasses enema (it really is just a mixture of milk and molasses).
3) Bowel prep: the stuff you drink to prepare for endoscopy. You can buy the big bottle over the counter at the pharmacy. Keep drinking until it works.

If this stuff doesn't work, again you'll need to go to the ER.

If you go to the ER, generally what we do is take an x-ray to see if you're really obstructed. If you are, you'll have to have a tube put down your nose to suction out your stomach, and be admitted to the hospital. You don't want that! So you want to avoid that at all costs. If you are not obstructed, we will try one of the methods above, particularly milk/molasses enemas at my institution. But these things can just as easily be done in the privacy of your own home. We will also do a rectal exam and attempt to manually 'disimpact' you if possible.

So the bottom line is, if you're obstructed, we can help you and want to help! Everything else we do if you're not obstructed uses over the counter medications the same way you would at home, but much more expensive because it's through the ER. Hope that helps.

p.s. treating the heartburn symptom is not going to help you, the cure for the heartburn is to treat the constipation.
posted by treehorn+bunny at 11:26 AM on July 7, 2010 [3 favorites]

thank you all so much! i've been a little like death warmed over all day, but i'm holding down food and water at this point. i still haven't pooped, but things are certainly moving. now i'm going to decend into a pit of embarrassment from posting this, but it was really helpful.
posted by nadawi at 9:05 PM on July 7, 2010

Dude, everybody poops. There's even a book about it or something. You'll be part of everybody soon and I'm glad to hear you're feeling better.
posted by shelleycat at 10:32 PM on July 7, 2010

for anyone still reading on their recent activity - ever gotten sick like this and then it messed up your next period? i have all the period stuff, cramps, inability to regulate body temp, super tired, bloating, breakouts, emotional stuff - but if my regular flow is the mississippi, this is a puddle in a parking lot on a hot day...
posted by nadawi at 2:56 PM on July 12, 2010

Irritable bowel syndrome is often strongly linked to your hormonal cycle, with a lot more women than men having it in the first place and with symptoms often occurring at certain stages of the cycle. They don't know why yet but it does support the idea that there are links between all kinds of areas of your physiology so I'm not overly surprised. If nothing else then maybe it's just from that bout of being really dehydrated.
posted by shelleycat at 7:01 PM on July 12, 2010

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