Badly constipated, very concerned here. Possible ideas?
February 2, 2023 8:02 PM   Subscribe

As per my last question, I've been taking Miralax almost everyday—forgot one day because it was hard to get into the habit. Unfortunately, my constipation has remained steady, and now my lower back/side/stomach hurts and throbs because I'm most assumedly constipated, but despite walking, taking Miralax, drinking water, trying to incorporate more fiber, etc., nothing is helping. YANMD.

I do go #2 everyday, but small silvers of poop only comes out, which is not at all satisfying, and all day long, I feel my stomach/back/sides occasionally kind of "throbbing" and "grunting". I'm not sure what to do—is this an ER-worthy situation? I'm not in dire pain; I can still move and go about fine, and most of the time, I'm fine; but the pain comes and goes. The pain itself is maybe a 4/10—annoying and somewhat disturbing, but not enough to make me double over or stop what I'm doing. My brain and stomach is feeling the need to go #2, but my ass itself doesn't feel the need to go, if that makes sense. I just feel stuck.

My doctor was aware of the original constipation situation; her suggestion was to take ML everyday, which I have. I have a phone consultation scheduled for a colonoscopy (referred to because of my anemia) but knowing Kaiser's system, probably won't be able to get one until March or even April. Last weekend, I was able to properly go #2 (even twice in a day!) and felt perfectly fine, so not sure what happened.

Bonus: I've been feeling over-simulated lately, which might be a contribution. It's a vicious cycle. I have shy bowel/parcopresis, which fundamentally means I'm unable to go #2 if people are around; however, it also becomes an issue if I'm stressed/have something in my mind/am in a bad conflict, and it stops me up (even if I'm fully alone). It's a vicious cycle because I'm already stressed, AND stressed about this constipation situation and the tiny #2's I've gotten out lately, which stops me up even more. I just don't know how to fix this or make this better. I've noticed I've been feeling increasingly cranky, too.

What would your recommendations be? I know I've been asking a lot of YANMD questions lately, but the way Kaiser's system is set up, the only way to contact my doctor is to email through the portal; I don't have a direct phone number to the office itself, and it sometimes takes a few days for my doctor to get back to me. Virtual options are available, but the doctor doesn't have an open appointment until March or so. Aging sucks so badly, for some reason, my body was hit hard after that first, initial bad stomach bout in 2021, and things just haven't been the same after that.

As an aside, a small quick update with the anemia situation itself—took the second out of five iron infusions today. Seems to be helping, but hard to tell so far.
posted by dubious_dude to Health & Fitness (37 answers total)
1. Ask your doctor or dietician about the FODMAP diet. It helps you find ingredients that cause (e.g.,) constipation.
2. Are you eating enough fiber? Standard recommendation for an adult male is 38 grams/day.
3. Drink more water.
4. Do a video search for yoga for constipation.
posted by aniola at 8:08 PM on February 2 [4 favorites]

I mean, iron classically causes constipation, so that's no doubt making things worse.

When you talk about incorporating more fiber, are you tracking how much fiber? I'm a person who gets diverticulitis, and my doc has me on 25-30 grams of fiber per day. (I'm a woman; I think the recommendation is higher for a man.) When you sit down and figure out just how much fiber is in particular foods, that turns out to be a hell of a lot of fiber, an amount that pretty much requires daily planning and counting for me. If you're not doing that, then you may actually be consuming a lot less fiber than you think you are.

(Also, I'm very sorry you're going through this.)
posted by BlahLaLa at 8:08 PM on February 2 [9 favorites]

5. Daily fermented food (e.g., sauerkraut, kimchi, etc.) is good the health of the average gut.
posted by aniola at 8:09 PM on February 2 [6 favorites]

And if you are eating more fiber, you really have to drink enough water so it doesn't get stuck.
posted by aniola at 8:10 PM on February 2 [11 favorites]

is this an ER-worthy situation?

I have vague memories of you having trouble with your advice nurse, but triage is, to my understanding, basically what they're there for (triage = do you need to go to ER, urgent care, wait until next the next doctor's appointment, etc)
posted by aniola at 8:13 PM on February 2

You might try Ex-Lax in addition to Miralax. They work by different mechanisms, so one might work even if the other doesn’t. But I’ll be honest: if it were me, and I were in pain, and my insurance covered urgent care visits, I’d be at urgent care five minutes after they open tomorrow. They might just tell you to keep taking Miralax and eat fiber, but they might not, and the latter is worth it. (Assuming you’re not paying out of pocket.)
posted by kevinbelt at 8:17 PM on February 2 [1 favorite]

You should get checked out. A close family member had what they thought was "just constipation" and did not get their pain checked. It was much worse than that and they're on their third week in the hospital so far.

Also, stomach feeling like you need to poop but bowel not cooperating is a classic sign of appendicitis. So it is worth getting checked.
posted by rednikki at 8:26 PM on February 2 [4 favorites]

Miralax and fiber supplements make me more constipated, I have better luck with one prune 3x a day (all at once will make you gassy) and these peppermint supplements for IBS.
posted by stellaluna at 8:27 PM on February 2

If you can I'd see a doctor, yours or at the ER, as soon as you can. That constant pain might well be nothing, and it might not.
posted by i_am_joe's_spleen at 8:35 PM on February 2 [4 favorites]

Yes, that's ER-worthy. You might have an obstructed bowel or appendicitis. Please go, and please go quick!

Reminds me of this.
posted by toucan at 8:45 PM on February 2 [4 favorites]

Response by poster: Sorry for the threadsit, but realized I forgot to add that last week, when going in for my first iron infusion, I weighed about 6lbs less than today, when I went in for my second iron infusion. Not sure if that's normal or not, or indicative of constipation?
posted by dubious_dude at 8:55 PM on February 2

Can you reach out to the Advice Nurse? Your doctor doesn't have appointments, but are they responsive through the online email system? Honestly, this sounds bad and if neither of those two options are available immediately I'd go to the ER.
posted by Toddles at 9:14 PM on February 2 [7 favorites]

Additional things you could try:

magnesium supplement
eating prunes
drinking a little beer or red wine
squatting (getting butt lower than knees, if possible) and doing sun salutation-style yoga
massaging your belly
an Indian senna-based laxative pill called Anuloma
Dulcolax suppository
an enema
posted by brainwane at 9:24 PM on February 2 [2 favorites]

I have had many, many iron infusions, of numerous different formulations, and they have never made me constipated. And I am in general somewhat prone to constipation. That kind of constipation comes from iron supplements, not infusions. So, not to say there's no way it's from the infusions, but I'm dubious.

Magnesium citrate supplements are a good and mild laxative, but if you want a decidedly not-mild laxative, you can take a liquid magnesium citrate laxative. This is what they give people after surgery. If you do take it, don't make plans. You will be otherwise engaged.
posted by HotToddy at 9:35 PM on February 2 [6 favorites]

I've heard good things* about acupuncture for constipation.

*Yes, the efficacy of this method surprises me. However, this person wasn't me. And Kaiser technically offers it under "Alternative and Complementary Medicine."
posted by oceano at 10:05 PM on February 2

Well, you could try a saltwater laxative. I've used it twice when I had multiple-day bouts of gastroparesis. It works fast but it's quite unpleasant. Add in some yoga moves or hula hooping to speed up the process.

Nthing that you should get checked out, in case it's something else.
posted by lloquat at 10:15 PM on February 2

Get this checked out. By health care professionals. Soon.

I don't know if this needs an E.R. visit, but you will NOT be wrong if that's what you choose.

If they ask (It's a standard question.) "what made you come to the E.R. now, if it's been going on so long?" you can tell them the pain finally got too much, or you were getting frightened of the symptoms or whatever best describes your motivation. They see a lot less urgent stuff.

When I teach EMTs the unit on abdominal pain I tell them there are so many dozens of possible causes we won't be figuring it out in the field, so get information, get vital signs, and get going - some of the possible causes are scary.

The constipation you describe definitely points toward a GI origin, but even that doesn't narrow it down all that much. Please get it checked out.

I hope you'll be better soon !
posted by wjm at 11:33 PM on February 2 [13 favorites]

Weird but works for a lot of people: Do a bunch of jumping jacks or skip rope, until you physically can't do anymore.

If that doesn't shake things loose then I think it's worth a trip to the walk-in clinic. Depending on your local walk-in clinic's capabilities, they might be able to do a lot of the same diagnostic tests that the ER would do, then tell you whether you should go to the hospital or if you just need a prescription.
posted by Jacqueline at 12:36 AM on February 3

I suggest Urgent Care and an enema. Possibly even an enema at an Urgent Care. Best of luck to you, I hate that you have to suffer with this and I hope that it can be resolved quickly.
posted by Jenny'sCricket at 1:54 AM on February 3 [1 favorite]

I would either go to Urgent Care or possibly, if you feel comfortable doing this, use a warm mineral oil enema and then try to slowly and gently break up the mass of feces manually yourself by inserting a gloved finger (basically what's described as treatment here.) If that doesn't work, Urgent Care or E.R.
posted by needs more cowbell at 2:04 AM on February 3

Another vote for going to the ER/urgent care, you never know, when there's any pain it could be anything GI related, but if it's nothing more than constipation they may still be able to help there. And severe constipation can become a pretty serious issue in itself.

I used to have this problem a lot, particularly when I was very underweight, for some reason everything improved with a combination of a) gaining weight back to a normal level, and b) taking antidepressants and c) taking high dose vitamin C and magnesium supplements.

But those are possible options for longer term, when you have an acute flare of severe constipation you do need urgent help especially if there's pain. I once went to the ER due to severe constipation and acute pain that luckily turned out to be just gas pains so they gave me some buscopan and sent me home with a prescription for lactulose which helped for a while before I discovered the vitamin c + magnesium combo.

Another thing I found in my experience when I was suffering from severe constipation is that fiber really didn't help, in fact made things worse (I had constipation + lots of bloating and trapped gas which was really painful). So I eliminated it for a while, ate low residue foods, until things improved and then very slowly reintroduced gentle fiber like oat bran and cooked veggies.

Another thing I tried for a while back then (in agreement with my doctor ofc) was specific GI tract antibiotics like rifaximin followed by course of probiotics. That helped too back then. oh and I tried enemas too when things were really difficult... I tried pretty much everything, I had this issue for years and years! feel free to memail me even if you just want to vent about it.

Anyway, back to the present, if I were in your shoes, again, I would not hesitate to go to the ER/urgent care. Please let us know how it goes if you do!
posted by bitteschoen at 2:27 AM on February 3 [2 favorites]

I'm sorry you've been feeling so unwell.

I agree that it's a good idea to go to an Urgent Care or even an ER, if only to rule out something more serious.

I have some (as yet undiagnosed, we're working on it) issues causing digestive distress and weight loss, plus I had c. diff in the fall and recovery has been uneven.

I was sent to the ER a few months ago by my physician to run tests during a pretty serious bout of abdominal pain.

The ER is totally used to this sort of thing. In my case, I kept things very simple and factual: "My symptoms are XYZ, based on the location and my medical history my physician wants to make sure it's not an ovarian cyst problem."

I carry a printout with my contact info, medical history, medications, health conditions, etc, like a little resume, so I handed that over. (I have APD, I find giving written info much easier.)

Then they ran my vitals, gave me a bag of fluids, ran the tests, said that the cyst hadn't burst so the pain was likely constipation, and sent me home with instructions.

I was treated with kindness and respect.

My instinct is to tell you to get checked out, to make sure nothing more serious is going on.
posted by champers at 2:56 AM on February 3 [1 favorite]

Try sitting on the toilet with a stool under your feet, so you’re closer to squatting than sitting. It really really helps me with constipation.

As a data point, I had the exact symptoms you have for YEARS (including the poop shyness: I just don’t poop on vacation) until I got a colonoscopy. The cleanse restarted my pooping, I guess, and I’ve been fine since if I use the stool to poop when I feel a little backed up. Adding fiber or Miralax made things worse for me. Drinks lots and lots of water.

Don’t ignore any change in the discomfort, and seek care if it gets worse, but try to relax and go sit in the bathroom for a little bit with a stool.
posted by lydhre at 5:54 AM on February 3

If your ERs are anything like my ERs, going to one will lead to 8-16 hours of exposure to really nasty germs, and in the end they'll say "you're constipated, good luck getting an appointment with a gastroenterologist." Especially since you are pooping every day even if it's inadequate.

Your primary care provider doesn't have any ability to see anyone in under a month, even for semi-urgent problems? That's rare in my area. Do you have access to something like "online urgent care" which might assist you in getting more efficient referrals?
posted by metasarah at 6:19 AM on February 3 [2 favorites]

One thing you may want to pay attention to is not just fiber but soluble fiber in particular. My understanding is that soluble fiber in conjunction with water "works", but insoluble fiber - not so much. Or at least not as effectively. Towards that end, I swear by these. One a day works wonders.
posted by fingers_of_fire at 6:21 AM on February 3

Just adding only fiber has never really helped me, but prunes or raisins always do the trick for me. Also, slow cooked oatmeal.
posted by gt2 at 7:36 AM on February 3

You could try the stimulant laxatives at this point (once won't get you dependent), and fiber gummies (Benefiber). I would try an enema at home. I'm sure you don't want to, it's not pleasant, but ... that's what they'll start with at the ER or urgent care, and you may as well try it at home alone before you have to have someone else do it, which is gonna be a lot worse given your shyness. If that doesn't work, then it's time to go get it treated professionally.
posted by Dashy at 7:54 AM on February 3

When I have been desperate, I've used glyercin suppositories. They work very quickly. But I'm sorry, I have no idea whether this is run off the mill constipation or something else, so proceed with caution.
posted by kitcat at 8:50 AM on February 3 [2 favorites]

IANYRD, but nthing that you go get checked out. Urgent care and/or the 24hr nurse line if you can use it to help guide your decision making on what care to seek out. The unintended weight loss and pain are concerning to me. While constipation like you're describing is common with iron supplement/infusions, the pain that you're describing is enough to warrant getting further information, because everyone's GI is different and clearly what you're trying hasn't worked yet. There may also be an underlying cause of your anemia that's not being treated, but that's a HUGE range of possibilities that your medical professional (doc and RD {registered dietitian}) would be better suited to helping you with. See if you can get a telehealth appointment with an in-network RD? You won't gross us out talking about the gut, promise. We all went through clinical rotations.

Also, type of fiber matters - not just insoluble (think: crunchy stuff, bran, etc) but soluble (cooked beans, split peas, bananas, etc). One helps bulk up stool, one helps it transit. Standard US fiber recc's are 25-30gm/day but that recommendation changes based on individual need, dietary intake, and any GI conditions a person has.

I hesitate to give you any quick fix suggestions because the gut is complicated, and IANYRD.
posted by OhHaieThere at 9:18 AM on February 3 [1 favorite]

"Vegetarians don't get constipated."

This is not true.
posted by i_am_joe's_spleen at 11:13 AM on February 3 [10 favorites]

I have chronic constipation that flares up a few times a year, leaving me going a week without going, in constant shooting pain, and with no appetite. I've been to the ER/urgent care for it multiple times, in multiple countries, over the past ten years. Without fail, every time I've been they've just told me to take Miralax - if I was already on it, they'd tell me to up my dosage to several times a day - or they'd put me on a stronger osmotic laxative that still took days to work (but, to be fair, was often pretty effective once it did kick in). I pretty much don't bother going in anymore because I can usually treat it myself more effectively at home. I would, however, go to the ER if I was showing symptoms of a bowel obstruction, and if you think you are, please take that seriously.

One thing you'll soon learn about constipation, if you haven't already, is that every single person is different. One person's "eat more fiber/drink more water" is another person's "stop eating vegetables altogether". One person's "go running/walking more often" is another person's "avoid exercise". One person's "go vegetarian" is another's "stop being vegetarian". (And here I'll just mention that I've been vegetarian for 10 years, and I'm still lucky if I poop more than twice a week.) But sometimes hearing what other people do can give you ideas you hadn't considered outside of the typical eat more fiber/put your feet on a stool advice, so I'll list my own go-tos in case they help:

- I swear by a daily regimen of oatmeal with a spoonful of ground flaxseed, plus coffee. Coffee is my #1 ally in the fight against constipation, but it has to be drip, not espresso. Idk why. The feet-on-a-stool thing helps too. But these are everyday maintenance things for me, not for when I'm already in trouble.
- If I haven't been keeping up with the oatmeal and I start to get more constipated than normal, eating an entire bag of prunes at once sometimes does the trick within a day or so.
- If the prunes don't work, I re-start or up my dosage of Miralax. But sometimes I'm already too far gone for Miralax, and I hate taking it, so if it's been a week or so I skip this step and just jump to:
- An enema. Fleet saline enemas are absolutely amazing. They work immediately. If for some reason they do not work immediately, that could be serious, and you should see a doctor like it says on the package. I don't think I've ever had one not work immediately, and they unblock me enough to return to my normal schedule of daily oatmeal, so I've never had to do more than one enema within a 12-month period.

Other things I've tried for quick relief that don't work for me but other people rave about:
- magnesium citrate
- smooth move tea
- sugar-free gummy bears
- stimulant laxatives
- upping intake of fats
- avoiding fiber
- low FODMAP
- sticking a finger up various holes (anus, vagina) to stimulate the poop

I recommend checking out r/constipation on reddit. It's a gold mine of ideas and advice on interacting with the medical system as a constipated person who has already tried the fiber thing and the water thing and the stool thing and all the other things.

Good luck!
posted by ravioli ravioli give me the formuoli at 12:45 PM on February 3 [3 favorites]

Nthing that if any of these suggestions don't turn things around for you very soon (e.g. a couple days at most), then you absolutely should go to urgent care or an ER to get this looked at. Also Nthing to talk to a nurse hotline as soon as you can, if that's available to you.
posted by Aleyn at 3:16 PM on February 3

I was told that fiber is good for keeping you regular but will make things worse if you are already constipated. Since you have been trying fiber, I would stop and try a low residue diet. Drink a ton of gatorade or pedialyte so you are getting electrolytes. Like 16 ounces an hour. Basically, a colonoscopy prep. Manually breaking up anything that may be caught is a good idea, be sure to wear gloves and go slow so you don’t tear anything. If it doesn’t clear up, seek help!
posted by Bottlecap at 3:24 PM on February 3

Vegetarians don't get constipated.

This is hilariously false.
posted by HotToddy at 4:43 PM on February 3 [2 favorites]

Liquid magnesium citrate, already mentioned up thread, is what the doctor gave me when a similar situation arose for me and glycerin suppositories did not work. You can get it at the drugstore. As noted, don't make plans.

Hope you are feeling better soon!
posted by sevensnowflakes at 6:06 PM on February 3 [1 favorite]

I am not at all a fan of daily laxatives. Fiber, yes, absolutely. Laxatives, no.

If I were in your shoes, I would start by making absolutely certain that I was drinking enough water and incorporating some movement, such as yoga, into my daily routine. Then I would address the current issue with with a warm water enema. Not a laxative enema but just warm (body temperature) water. Then I would quit everything that you're using to stimulate your bowels because frankly I think that regimen is what is causing your discomfort.

Instead, I recommend Konsyl. Not gummies or capsules, but the powder. I mix it with water and a little vitamin water for taste and, with regular use it makes me forget that I have ulcerative colitis-- a form of inflammatory bowel disease.

I also urge you to get a second opinion regarding your condition. I would be very wary of a doctor who prescribed a daily laxative. Laxative dependence will make your condition worse, not better.
posted by janey47 at 9:05 AM on February 4

Response by poster: Good afternoon,

I realize my updates has been very sparse. So, as it turns out, my colonoscopy will take place in April; having it earlier is probably not possible due to them being fully booked.

However, I have reached out to my doctor and explained the symptoms, and she recommended I take warm prune juice and some stool softeners in addition to the Miralax. If that does not help, then we'll look into getting a CT scan to rule out any obstructions. I'll probably try the prune juice itself only first, though—the less medicine in my body, the better.

I have also been walking more and upping my water/fiber intake, so here's to hoping for some improvements soon!
posted by dubious_dude at 12:55 PM on February 6 [2 favorites]

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