I never thought I'd be so embarrassed to seek relief.
June 13, 2016 2:55 AM   Subscribe

IBS-C thinking about trying to conceive - how go I get off over the counter laxatives? Please help.

I am completely and totally ashamed for confessing this. I've never told anyone and not even my husband of six years (married two after dating/living together for four).

About twelve years ago in my twenties I was diagnosed with IBS-C after having horrible, excruciating bouts of constipation that would last for days. At that time I was prescribed Zelnorm which was like a miracle to me and restored me to normalcy. Then it was yanked off the market in the U.S. I moved a few times in the two years to follow and every doctor to whom I sought help rejected my diagnosis and told me to eat more fiber. That obviously did not help the constipation and I eventually turned to over the counter laxatives out of frustration. I have been taking about 15-20 bisacodyl tablets daily for the past 10 years. It does what it needs to do. I've never had issues with control, it helps me have my 1-2 bowel movements a day, nothing more. I'm otherwise perfectly healthy, normal weight (5'7" and 160lbs) and exercise daily for 60-90 minutes by cycling or swimming. I drink 2-3 liters of water a day and eat generally healthy.

I'm now 36 and we have decided to try to have a kid in the next several months. I know I'm a bad person for having taken these pills daily, but it just hit me tonight that if I get pregnant, I'm screwed. Can anyone please point me in the right direction as to how to even start to address this? I'm worried about dying from constipation if I get pregnant. I'm so scared and worried that I will only get hit with more rejection from doctors.

I've tried going a day or two without taking it and can produce stool with straining, but it's the gas and acid indigestion that sends me back. I cannot use bulk-forming laxatives because they cause it to be worse. I've had complete hit or miss experience with stool softeners.

Please be a little kind. :(
posted by anonymous to Health & Fitness (18 answers total) 3 users marked this as a favorite
I don't have enough medical expertise to weigh in on that side of things, but I wanted to say that you are absolutely not a bad person for taking these pills. At all. Please don't think that of yourself. Would you consider seeing a therapist to help you come to terms with your IBS-C?
posted by schroedingersgirl at 2:58 AM on June 13, 2016 [13 favorites]

There are new recent drugs for IBS-C, although they're not going to be something that has any evidence for use in pregnancy, you should check out the options. Go get a pre-conception counseling appointment. If someone mentions more fiber to you, just tell them you tried that and it didn't work.

Laxatives are safe to take during pregnancy and bisacodyl itself is only category C, meaning it can be taken during pregnancy with caution. You're not screwed. However, the dose you're taking seems extreme. That doesn't mean you're a bad person, it means you need further advice from a doctor. Also remember there are safe things you can take for acid reflux in pregnancy, too.
posted by treehorn+bunny at 3:27 AM on June 13, 2016 [12 favorites]

Also, try to see a gastroenterologist if that's possible under your insurance/where you live. A primary care doctor is probably going to be less helpful with a problem at this level of complexity.
posted by treehorn+bunny at 3:28 AM on June 13, 2016 [16 favorites]

Have you tried glycerin suppositories? I've gone through both types of IBS, though IBS is like a fingerprint, it's different for everyone... anyway I find them to be very effective. I use them on a semi-regular basis whenever I feel like my lower intestines are slacking off, but AFAIK they're much, much safer than the pill type, and less habit-forming. (Of course, it's best to ask a doctor before doing anything as a pregnant person, and I am neither a doctor nor a person who has been pregnant.)

It's a little squicky the first time I guess, but the relief makes the gross factor go away real quick.
posted by gloriouslyincandescent at 3:28 AM on June 13, 2016 [1 favorite]

I'm concerned for you because from your question, it sounds like you've been traumatized by doctors not taking you seriously, and you've been secretly self-medicating and feeling so much guilt and shame about it that you haven't even told your husband. I think the best thing you can do is find a kind and competent doctor who has experience with IBS. Do you have any doctor friends, who you could confidentially talk to about this and get a recommendation? If you have an OB you like, could you talk to them and ask for a referral? If you don't, you will have to disclose this to your OB if you want a healthy pregnancy, so the time is coming when you'll need to talk to a doctor about this. It may be easier to start with an OB you're comfortable with, rather than trying to search for an IBS specialist on your own.

I've also had the experience of going to a doctor with a serious problem and being dismissed. I know it can leave you feeling helpless. But please, at least know that you are NOT a bad person for trying to take care of your own health. There is absolutely nothing in your question that you should be ashamed of. Your life and your pregnancy will be so much better if you find a medical professional to help you with this, and there ARE good ones out there who will listen to you and try to help.
posted by chickenmagazine at 4:29 AM on June 13, 2016 [27 favorites]

You should go to an obgyn and discuss this as part of your getting pregnant talk. That's what these appointments are for. I am almost never constipated and getting pregnant made me extra super constipated. Giving up caffiene (mostly) and having to cut way back on workout time (because exhaustion) plus hormones did it for me. You may need chemical intervention and the doctor should be ready to discuss what is safe and how unsafe other stronger alternatives are. If she isn't, have another of these appointments. You are not a bad person! You person suffering from constipation.
posted by Kalmya at 4:55 AM on June 13, 2016 [1 favorite]

I don't have a direct answer to your question, but I do have digestive issues which were at first diagnosed as IBS, so I'll tell you a few things that I've learned.

You absolutely cannot hide IBS from people who are close to you. When IBS symptoms flare, they interrupt your normal everything. You might become moody, anxious, cranky - on top of dealing with really unpleasant physical stuff. If you have to actually conceal this from loved ones, the stress of the charade will make the episode even worse. You'll be passing up empathy and understanding in exchange for a vicious cycle. Your loved ones should be allies, not additional sources of pressure. I don't know about your particular social context, but for me, after some initial awkwardness, talking about poop, gas, bloating, and all that other fun stuff became fairly unremarkable, at least with people I'm close to.

Furthermore, when you can be more open about it, it'll be easier to advocate for yourself medically. IBS is one of those unfortunate areas of medicine where large numbers of people have chronic aggravating but not life-threatening symptoms for mysterious reasons. Sometimes it's possible to find those reasons, but it requires the kind of painstaking and time-consuming investigation that these days few doctors are willing to undertake. Unfortunately, doctors are not good at admitting ignorance/helplessness/an unwillingness to tackle a complex case and many will take this out on the patient either overtly (you're overworked, go see a therapist) or covertly by engaging minimally and hoping you'll take the hint and go elsewhere. You should react to this by sticking to what you know, rejecting "get out of my hair" diagnoses, and aggressively moving onto the next doctor when you hit a wall with the current one. It's not fun at all, but in my case, this led me to eventually uncover a fructose malabsorption which led to a few simple dietary modifications and a lot of relief. This after being written off by a series of doctors in variety of condescending ways.

I'm not saying that all cases of IBS have some subtle but discernible cause that can be addressed, but you shouldn't accept an IBS diagnosis until you're very very sure that no stone has been left unturned. And if that is the case, you need to work closely and carefully with a sympathetic doctor to arrive at a cocktail of meds and lifestyle changes that works best for you. You're probably missing a lot of better options by quietly self-medicating.

Good luck!
posted by horsesock at 5:21 AM on June 13, 2016 [2 favorites]

Watermelons are in season. Commit to eating a bowlful of melon every day for a week and see what happens. You've taught your body to only go with this medication and, unless you retrain your body (which may not be possible) you will have to use a different medication. It's okay to not poop every day. Aim for every other day. Eat prunes in the evenings and yes, eat more fiber, but get the fiber from fruits and veggies, which will help the pregnancy just as much as it will help your condition.

Doctors can be jerks sometimes to women. I know this sounds completely stupid and it should be this way, but if you can get someone to go with you to the doctor, to back you up, it does sometimes help in getting them to take you more seriously.
posted by myselfasme at 6:43 AM on June 13, 2016 [4 favorites]

You are not a bad person! I am going to say it again, because you really are not a bad person. You are a person who suffers from chronic constipation and as someone who has been there, it is an awful thing to deal with. Please be kind to yourself.

This is absolutely something you should bring up with your OBGYN as part of your pre-pregnancy checkup. I would also ask for a referral to a GI specialist. I know it is frustrating to get brushed off by doctors - it took me AGES to find a doctor who wouldn't just dismiss my symptoms out of hand - but there are gastroenterologists out there in the world who are thoughtful and will help you.

I will mention that I used to have similar symptoms (gas, acid indigestion, constipation - basically, you are me 6 or 7 years ago except for the wanting to get pregnant part) and it turned out to be a food allergy. I have another friend who has suffered from IBS for ages and just discovered a food sensitivity after following a strict FODMAPs protocol. If you can, try to find a dietician who specializes in IBS as well, because you may be suffering from a food allergy or sensitivity and exploring that could help you get some relief.

If you happen to be in the NYC area, I have a phenomenal GI doc that I can recommend. Feel free to MeMail me.
posted by bedhead at 6:51 AM on June 13, 2016 [1 favorite]

ignore all food suggestions in this thread. i trust you that you've tried all sorts of combinations of more fiber, more water, more 'i swear this makes go you' foods, probably tried things like miralax. people who do not have ibs-c don't understand that this isn't run of the mill constipation.


i struggled for years with ibs-c - it got to the point where for weeks at a time i'd just go between the bath tub and the couch, in excruciating pain, unable to eat without puking, unable to bend or even wear a bra without crying. i finally found a doctor who took it seriously. he made me do the 'more fiber/miralax' thing for a month and when that didn't work (like i told him it wouldn't) he put me on one of the new ibs-c drugs (amitiza, a goddamned life saver, but not studied for pregnancy, sadly). you need to find a doctor that will help. if they start going down the 'just eat prunes!' line of diagnosis, walk out and try another doctor. a gastroenterologist is a good idea, and so is an ob/gyn - they're unsure of the particulars but ibs-c and menstrual cycles somehow interact and so a gynecologist is sometimes more up on how to best treat it.

the other thing you need to do is to be honest with your spouse. at this point it might be the sort of thing you'll feel more comfortable doing with a therapist's help. you are not a bad person! i understand why you hid this. i hid it from my partner at first too. but you know it's time he knows. trust that he loves you and just wants you to be well.

(the only drug suggestion i'll give you, and only because you didn't mention it, and only because it has given me immense relief for the gas and acid reflux symptoms, is simethicone (gas-x) both chewable and caplets. i woke up this morning with what i've come to call 'the rock in my side', ate a simethicone, and the pain is gone.)

if you wantn to talk about ibs-c, the anxiety, the shame, or any other thing about it, please feel free to reach out.
posted by nadawi at 8:15 AM on June 13, 2016 [8 favorites]

First of all, you have absolutely nothing to be ashamed about. You have a health problem. It is just as legitimate as any other health problem. You have been dealing with it as well as you can.

You mention that you've increased fiber, but you don't say by how much. The average American only gets 15 grams a day, which is not enough. The recommendation for American women is 25, but I think the idea is that that amount is "realistic." Rural Chinese and African people eat 60 to 100 grams per day. Also, fiber is best increased through fruits, vegetables, and whole grains, not supplements. You might be a person who needs more than the amount normally recommended for Americans.

Also, just anecdotally, my IBS pretty much went away when I quit dairy. That might be worth trying.
posted by FencingGal at 8:16 AM on June 13, 2016 [2 favorites]

If you are in the Northern Virginia area, I'd be glad to recommend my gastronenterologist, who put my IBD (Crohn's colitis) into remission.
posted by apartment dweller at 8:18 AM on June 13, 2016

Nthing that you are not a bad person. Taking so many laxatives a day was not a great decision, but it sounds like you tried to fix the problem the right way by seeking help from doctors, and only turned to the laxatives as a last resort when the doctors couldn't/wouldn't help you. (And if you hadn't tried to see a doctor and took the laxatives as a first choice or had started taking them as part of an eating disorder, you still wouldn't be a bad person.)

If you have trouble telling your doctors and your husband what is going on, it might be helpful to see a therapist to help let go of the shame you feel. I think that you'll be surprised to find that no one else is going to judge you anywhere near as harshly as you're judging yourself. Shame is a tricky thing.

Perhaps it would be helpful to write your husband a letter explaining what's going on. I've done this before (with a therapist) because the shame was so intense that I couldn't bring myself to start talking. Once your husband knows the basics and affirms that he loves you and is sorry you are suffering and doesn't think less of you - and I'm sure that that will be the reaction of any decent person - you might find it easier to talk.
posted by insectosaurus at 10:54 AM on June 13, 2016 [1 favorite]

I have a connection with a female gastroenterologist who specializes in IBS and IBD in women. She's at an academic medical institution in Philadelphia, and I'd be happy to connect you if Philadelphia would be convenient for you. I think she'd be very sympathetic and practical, and as an academic is up on current therapies and research. Also, academic institutions usually accept the widest array of medical insurance since they have so many patients from outside the locale who seek second opinions.

I bet you're not the only woman who has resorted to self-medicating, and she will probably have heard this before. Please understand that this in no way means you are a bad person - your solution is currently working for you and sounds sensible, actually. You need a better solution going forward, and you need to speak frankly to a person knowledgeable about constipation, laxitives (or alternatives to laxitives) and pregnancy.

If you arm yourself with factual medical information, when you do talk to your husband I bet he will be sympathetic himself, and congratulate you for your ingenuity in solving your problem. I think your shame has a lot to do with having hid this from him for so long, but having the courage to seek good medical advice could help give you the strength to trust him.
posted by citygirl at 11:26 AM on June 13, 2016 [1 favorite]

I took Colace every day through my entire pregnancy and my OB had zero concern about me doing so. I don't know enough about your condition to know if that will be helpful to you, just wanted to give you anecdotal evidence that there are medications out there that can be helpful that are completely safe to take during pregnancy.

Also I want to add to the chorus saying you are not a bad person, this is not a thing to feel bad about, you can fix this with medical help. Pregnancy and childbirth will bring you a whole new world of weird/embarrassing/awkward body stuff; maybe consider this practice in a way?
posted by beandip at 3:48 PM on June 13, 2016 [1 favorite]

You are not in any way a bad person. And I disagree that you have to tell your husband about this. If you're not comfortable doing so, then don't—this is not even close to a big deal as far as secrets between spouses is concerned.

To me, it sounds like your main issues are anxiety and shame. Why would you think you're a bad person for doing what you have to do to live a normal life? I think you would benefit from therapy to address these.

I'm sorry you've had to deal with terrible doctors who won't listen. This is unfortunately depressingly common for women.
posted by a strong female character at 7:14 PM on June 13, 2016

the reason i say to tell your husband is that my life got way better once he knew because i was no longer trying to mask my symptoms around him. it's hard to be sick and hiding - if there's anywhere you shouldn't have to hide, it's in your own home, in your own marriage. i don't think you have to tell him because it's some sort of huge bad secret, but i think you'll be relieved once you're not hiding it and if he's worthy of being your spouse, he'll help you any way he can.
posted by nadawi at 8:35 AM on June 14, 2016

Late to this but oh I so understand and feel for you and would like to offer a couple of long-term suggestions to look into:

- Bacterial overgrowth/SIBO can be associated to constipation and one treatment is a course of specific antibiotics (rifaximin + neomycin seems to be the best combination for IBS-C). Doctors will often prescribe the treatment even without having to do the breath test for SIBO, which is complicated and not exactly reliable.
There are herbal alternatives to antibiotics that were found in studies to be just as effective

- Get your gut flora tested, even if it’s not SIBO there is a strong association between IBS and imbalances in intestinal flora (dysbiosis). There are a lot of studies into probiotics for treatment, some strains may work better for one type of IBS than others. As a more potent/extreme form of treatment with probiotics, FMT has been increasingly studied as a treatment not just for life-threatening stuff like c-diff and ulcerative colitis but also for so called functional disorders like constipation and IBS and has shown promising results. This cutely/awkwardly-named website has collected a ton of useful info and links to research and all sorts of resources. (With the usual warning not to get too hopeful from individual success stories, here’s one you may want to read)

Other quick short-term suggestions to try in the meantime: unlike fiber, vitamin C and magnesium supplements can help and without making other symptoms worse; also fish oil/omega-3 capsules. You could try maybe reducing the laxatives while introducing those and see how it goes.

(Also, I like how you said fiber "obviously" didn’t help - it’s still not obvious to many doctors sadly but next time a doctor says "more fiber", you could cite this or this study’s conclusion: "Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.")

Please do not ever be embarassed. Best of luck!!
posted by bitteschoen at 2:54 AM on June 21, 2016 [1 favorite]

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