Constipation, medication.....confusion!

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Lori M
Regular Member


Date Joined Aug 2010
Total Posts : 65
   Posted 9/9/2010 5:38 PM (GMT -7)   
Hey all,
 
So I'm in the middle of a flare, but it's being kept at bay with Pred, AZA and Asacol.  I'm on my 2nd round of pred (went from 40 to 30 to 20 to 10 the first time and then back up to 40 a week ago when all the flaring symptoms came back.  I backed down to 30 yesterday.).  Started AZA a week ago as well.  I feel fine really, but I know it's probably not "real" - just the pred masking the symptoms at this point until (hopefully!) the AZA kicks in.
 
The problem is that for the last two days I have only gone a couple of times.  No D - just really small skinny poo.  Not enough for the amount of food I've eaten.  And my gut feels totally bloated.  It's not painful or anything, I just feel full all the time.  I'm sure it's probably the medication.  So I'm considering Metamucil or some other fiber supplement, but I'm confused.  From what I've read, when we're in a flair, we should avoid fiber.  And although I feel fine, I'm pretty sure I'm still flaring and the symptoms are just being masked by the meds.  So my question is, if I'm feeling okay, even though it's a "masked" feeling okay, is it okay to take a fiber supplement?
 
Thanks for your insight!
 
Lori
46 years old. Diagnosed with Crohn's August 3, 2010

Well the first round of drugs didn't work. Back up to 40 mg of pred, 150 mg of Aza and 3600 mg Asacol per day. Hoping this is the combo that works!

Started prednisone on 8/4/10 for 4 weeks (40 mg 1st week, 30 mg 2nd week, 20 mg 3rd week and 10 mg final week) Asacol 1200 mg 3 times a day

Lots O D3, Calcium, Probiotic, Folic Acid

Kiwi12
Regular Member


Date Joined Aug 2010
Total Posts : 486
   Posted 9/9/2010 6:26 PM (GMT -7)   
poor you Lori :(

Skinny poo could be because inflammation has caused a stricture so taking fibre to help it along is not a good idea without checking with your GI first. In fact it could be a really bad idea!

Hopefully the pred will releive the inflammation and it will settle down soon just remember it is the pred making you feel OK. If you WERE OK you wouldn't need the pred ;P

Good Luck
Lesley

Becky77
Veteran Member


Date Joined Dec 2005
Total Posts : 1768
   Posted 9/9/2010 6:37 PM (GMT -7)   
I personally wouldn't do fiber, but that's because I know it makes me feel worse, and I tend to get obstructed. I have taken miralax before when I felt like I wasn't going as much as I was eating. I also drink lots of water and gatorade and sometimes that in itself helps.

Can you imagine just eating and not worrying about how much you go to the bathroom? I was just thinking...most people never think about this kind of stuff. It would be nice...
Becky

32 yr old female-dx with Crohn's in '97 after emergency resection and appendectomy, 2nd resection '05, Bilateral pulmonary emboli 10/09
Currently on Humira, Omeprazole, Effexor, Seroquel, Calcium, Vit D
Coumadin stopped 3/15/10!!!!

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 8586
   Posted 9/9/2010 7:12 PM (GMT -7)   
Pred can cause constipation, particularly when it's first started. The good news is that the constipation will go away as you taper down, but in the meantime it's pretty horrible. It's certainly safe to take a fibre supplement or eat fibre - the exception is if you have a stricture narrow enough to obstruct; too much fibre might plug up the stricture then.

Otherwise go for it. Remember to drink a lot of water. In desperation, if fibre and water don't work, then a suppository laxative will do the trick in 15 minutes to an hour. (Pro-tip: use vaseline... ¬_¬) Don't worry about it being unsafe. Think MoviPrep. Enough said.

After you have managed to go properly, I would continue with fibre and liquids (warm to hot water, if you can stomach it). That will hopefully keep you regular without the aid of laxatives. Good luck!

PS: Since you are new to Crohn's, I doubt your constipation is caused by a stricture. Strictures can arise from the start, but mostly they tend to be a complication of long-standing disease.

Lori M
Regular Member


Date Joined Aug 2010
Total Posts : 65
   Posted 9/9/2010 7:16 PM (GMT -7)   
Thanks you guys - good information. I'll give my GI a call if it keeps up. Monkiray....I know! I've never been so obsessed with poo! And like every little twinge I feel, whether it be in my gut or my ear or my toe.....before I wouldn't give it another thought. But now, it's like oh no, what now!
46 years old. Diagnosed with Crohn's August 3, 2010

Well the first round of drugs didn't work. Back up to 40 mg of pred, 150 mg of Aza and 3600 mg Asacol per day. Hoping this is the combo that works!

Started prednisone on 8/4/10 for 4 weeks (40 mg 1st week, 30 mg 2nd week, 20 mg 3rd week and 10 mg final week) Asacol 1200 mg 3 times a day

Lots O D3, Calcium, Probiotic, Folic Acid

blueberrydecaf
Regular Member


Date Joined Jan 2010
Total Posts : 257
   Posted 9/9/2010 7:19 PM (GMT -7)   
I am on prednisone and I have had the same problem with constipation (an issue I have never had to deal with). I drank some fruit smoothies but didn't really help. I went without going 3 days and my gut was hard as a rock. I called the nurse and she told me to NOT take any fibre or laxatives without talking to my doc because if the stool was trying to get through a stricture/narrowing and it was difficult a laxative could try to push it through and cause a rupture. (I did cheat and take a stool softener but I realized after that my BM wasn't that hard it just isn't wanting to come out). I haven't gone again in the last while except a very little bit yesterday morning - we'll see how it goes. I haven't gone back to my doc yet, I am just waiting to see how it goes. I am hoping as the inflamation goes down the constipation eases too. I have heard other people having prob with prednisone and constipation...keep in touch and perhaps we can share ideas. Also remember that lots of ppl get constipated for days - we're just not used to it!
diagnosed 2003
vit D, calcium, iron when my tummy can handle it
stopped Pentasa
prednisone 30mg

Lori M
Regular Member


Date Joined Aug 2010
Total Posts : 65
   Posted 9/9/2010 7:24 PM (GMT -7)   
That's for sure BBdecaf - we're not used to not going! Now I'm half wishing for a bout of 5 or 6 a day! Did I say that outloud??
46 years old. Diagnosed with Crohn's August 3, 2010

Well the first round of drugs didn't work. Back up to 40 mg of pred, 150 mg of Aza and 3600 mg Asacol per day. Hoping this is the combo that works!

Started prednisone on 8/4/10 for 4 weeks (40 mg 1st week, 30 mg 2nd week, 20 mg 3rd week and 10 mg final week) Asacol 1200 mg 3 times a day

Lots O D3, Calcium, Probiotic, Folic Acid

blueberrydecaf
Regular Member


Date Joined Jan 2010
Total Posts : 257
   Posted 9/9/2010 9:23 PM (GMT -7)   
ha, ha too true - I actually said out loud 4 days ago that I would WAY rather have D than constipation - because I felt so full and my belly was as hard as a rock! It has to come out one way or another eventually - take heart! I tried microlax (suppository enema - mini one) twice even and that barely helped, but then eventually I went. Actually when you said you had gone "a couple of times" in two days I was jealous :) Right now I'm aiming for a couple of times a week!!
diagnosed 2003
vit D, calcium, iron when my tummy can handle it
stopped Pentasa
prednisone 30mg

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 9/10/2010 7:44 AM (GMT -7)   
When I have constipation I use stool softners. They are not harsh like fiber or a laxative can be. They just draw the water to the stool to make them softer and easier to pass. Give them a try, they work great, and I have used them successfully for years. Hugs!
Gail*Nanners* Co-Moderator for Crohns Disease 
Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

tooth
Regular Member


Date Joined Jun 2010
Total Posts : 337
   Posted 9/10/2010 1:56 PM (GMT -7)   
When I get constipated, I usually try to eat/drink something that makes me go to the bathroom. Coffee usually has an "insta-poo" effect on me when I'm feeling bad or sugar free sweetners like in Crystal Light or Diet Coke.

I'm afraid of stool softeners because my poop is always harder the next time I got to the bathroom. :( I'm also terrified of laxatives...

If you have a stricture, I'd beware of fiber. Maybe just eating a little teeny tiny bit? Though I'm not quite sure what to do about fiber personally...
Diagnosed 2002 at 18. Remission for about 7 years. Getting back into the swing of things at 26.

100mg Imuran, 750mg Balsalazide 3x day, Flagyl (death pills. yuck)

Flaring...

Had to abandon SCD...for now.

blueberrydecaf
Regular Member


Date Joined Jan 2010
Total Posts : 257
   Posted 9/10/2010 9:22 PM (GMT -7)   
Today I finally went to the doc and he gave me lactulose to try - he said is is gentle and just a stool softener so it shouldn't cause any problems if there is swelling / stricture. I'll see how it goes! The thing is I think my poo isn't very hard, I just don't really have the urge, so who knows...?!

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 9/11/2010 8:21 AM (GMT -7)   
Stool softners are the only thing that work gently for me, without giving me the runs. I have taken them nightly for years. I wasn't taking them for awhile, but since I found that a new probiotic I was taking was causing the diarrhea, I am now back to being constipated again and back on the stool softners. They can take a couple days to kick in when first starting them, so I am trying some apple juice to help things alot today.
Gail*Nanners* Co-Moderator for Crohns Disease 
Crohn's Disease for over 34 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

blueberrydecaf
Regular Member


Date Joined Jan 2010
Total Posts : 257
   Posted 9/11/2010 9:13 AM (GMT -7)   
The lactulose seemed to work wonders for me now (over the counter). I took two tablespoons last night and this morning it has worked miracles...
good call on the stool softener!
diagnosed 2003
vit D, calcium, iron when my tummy can handle it
stopped Pentasa
prednisone 30mg

rlsnights
Regular Member


Date Joined Apr 2006
Total Posts : 449
   Posted 9/12/2010 3:42 PM (GMT -7)   
I would suggest that you do a slower pred wean than you described earlier. It may help to reduce the chance that you will flare badly.

Many GI's recommend too quick a wean - at least according to the 2 endocrinologists we've seen.

Check with your gi to see what he thinks about a slower wean of course.

But the endo's both recommended split dosing (am and pm) and reducing by no more than 10 mg a week until you reach 20 mg.

At 20 mg you start going to 1/2 dose of the pm dose until you reach 2.5 mg pm and 10 mg am.

Then you drop the pm dose altogether and begin dropping the am dose by 2.5 mg until you reach 5 mg. Then you drop by 1 mg a week.

So if you are doing split dosing of 10 mg am and 10 mg pm you would:

wk 1: 10 mg am and 5 mg pm
wk 2: 10 mg am and 2.5 mg pm
wk 3: 10 mg am and zero mg pm
wk 4: 7.5 mg am
wk 5: 5 mg am
wk 6: 4 mg am
wk 7: 3 mg
wk 8: 2 mg
wk9: 1 mg

I know this makes it look like it will take a really long time to stop the pred. But in our experience it really reduces the unpleasant side effects and reduces the chances of flaring quite a lot.

And it is actually less pred total than if you had to restart all the way back at 40 like you are doing. That way (2 times through 40/30/20/10) you get a total of 1400 mg of pred. This wean you get a total of 1050 mg pred.

If there are breakthrough symptoms then you step back up to the previous level for 1-2 weeks and then resume the schedule.

Finally it usually takes about 4 months or 16 weeks before you know whether AZA is going to work for you. So doing a slower wean may help you get to that point without flaring again.

Hope things go well and that's good to hear about the constipation. On our gi's recommendation we rely on miralax with benefiber added if the miralax causes leaking.

Post Edited (rlsnights) : 9/12/2010 4:48:05 PM (GMT-6)

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