Laxative Questions

As I mentioned before, A started taking Ex-Lax and Miralax because of possible constipation issues. She is supposed to take an Ex-Lax square in the morning and at night and 1 capful of Miralax at night. I have some questions that you all can probably answer so I can sound a little less uneducated when we see the doctor on Tuesday.

First, should she be having formed stools or just diarrhea? Since starting this regimen A has had only one formed stool and it was very bloody.

Also, how many times a day is considered "normal" when using laxatives? Prior to laxatives she was going 2-3 times a day. Upon starting laxatives we were up to 6-7 times a day. I cut out the morning Ex-Lax because of stooling accidents and we're averaging 4-5 times a day still. That seems like an awful lot to me, and being that she's having watery diarrhea she has only seconds to find a bathroom.

These questions probably sound silly, but honestly I'm confused as to why she needs these medications in the first place and so I have no idea if they are working properly or not.

First- When did she start them?
Second- Is her cramping worse on these?

She started Thursday night, so almost a week ago. She isn't having any major stomach pains, but she wasn't having any just prior to starting them either. She gets crampy from time to time but nothing that lasts.

Well the whole point of this is for it to get soft. I know Grace had a week plus of normal stool.
I believe it was just the "old stuff" coming out. Again your girl might have been really back upped and it will take awhile to clean out.

Call your GI in the morning and up date them. You want to make sure they understand what it's like for her.

Oh sorry I forgot. Old stool doesn't get soft with Miralax. It's only the new "stuff".
MLP am I right on that?

A's stools were never abnormally hard. Formed, but not hard. Her x-ray Wednesday night showed she was not backed up (so I have no idea what made her vomit stool...). This whole process really confuses me and I'm not sure if we're coming or going. I do know that she has watery diarrhea 4-5 times a day, sometimes it contains blood, and sometimes the bathroom just isn't close enough. It just doesn't seem right to me.

Grace same thing. The GI is always amazed when I say she has SOFT stool.
She will go 3-5 days between BM's and still have soft stool.

Can you get a second opinion? Are you in the USA? Sorry I forget.

This is our 2nd opinion, lol. I really like our doctor and I feel that he is probably the best in this area. I just happen to disagree with him on this constipation thing (though I admit, I'm not the expert). And since I've never taken laxatives I have no idea what the "norm" is when on them. I would hope that 4-5 times a day of watery diarrhea isn't what he was aiming for. If this is normal when laxatives are first started and then things settle down....well, I'm good with that. Otherwise this is a major bummer.

Farmwife said:

Oh sorry I forgot. Old stool doesn't get soft with Miralax. It's only the new "stuff".
MLP am I right on that?

Click to expand...

If you do high enough doses of miralax, it can soften/break up old stool. Miralax is an osmotic laxative, so it makes more fluids go into your intestines and basically flushes them out. Sometimes newer softer stool can also go around harder stool that is still stuck. But usually for miralax to liquify old stool, it would have been taken at colonoscopy prep levels.

Senna is a stimulant laxative, so it doesn't soften the stool, but it makes it come out faster.

Was she supposed to just do a clean out or be on the laxatives all the time?

Oh and my daughter takes laxatives all the time for severe constipation (I have IBD not her, she has nerve damage), and usually our goal consistency is soft and formed or a thick creamy consistency. I don't really know what normal is since her constipation is so severe.

Well, we started with a clean out last Wednesday which went horribly wrong. The reason for the clean out was her Sitz test showed that she was constipated (though no motility issues). After an ER visit Wednesday night we found out she was no longer "full". The GI nurse called the next morning and said to forget the clean out but start on daily laxatives to "retrain her bowels".

Could they be trying to keep her moving to prevent a recurrence of the SIBO? Can't that be caused from constipation?

Yes that's one possible cause. We were told to keep it soft because we didn't want it to irritate the lining in her track and to put less strain on her rectum to push the stool out.

Did you know I use to be a professional women. Here I am years later taking about poo with a stranger on the forum.:yfaint: Oh well, takes all kinds.:lol2::ylol::lol2:

I had these issues as well. When we were trying to find out what was wrong with my daughter they seemed to use "constipation" as a general diagnosis and we were taking 4 - 8 satchets of Movicol depending how she was doing.
We were told to take as many as necessary to ensure the stool was soft and that she was going at least once a day.
My personal opinion (me not being a doctor :smile is your daughter shouldn't be on so much if she is going so often and having watery diarrhea. I know they want her to be regular and keep on the soft side to make it easier on the bowels, but surely going so often would cause it's own set of problems, eg. sore when wiping and the having to rush to the toilet like you said.

Agree with Sascot your doctor should allow you to titrating her dose as needed. We wee instructed to go up and down as needed. Granted it takes a couple of days to find the right dose. I would ask the doctor if you can skip the ex-lax which can give her a belly ache and see if you can just use the Miralax which is way more gentle. Make sure she is drinking a ton of water though bc the Miralax can dehydrate her bc it does pull the water from the other organs and causes colon dumping.

Her bathroom trips sound very excessive. I would ask if you can titrate until you achieve the right consistency. You should be getting more direction as to what he expects it to look like.

Our GI said the goal is to get to chocolate pudding consistency. My daughter takes about 20 grams usually at night to keep her going. If we see blood or her not going for a few days then I will up it a little. We were told if stools are frequent and loose then titrate down to around 17 grams.

same her- prior to remicade- ds was on miralax for 2 years-
aim was for 1-2 bm a day- like pudding
but he has rectal prolapse when things are inflamed so.....
ask your GI