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Our 34 year of disabled daughter is very constipated. We…

Our 34 year of...

Our 34 year of disabled daughter is very constipated. We have tried every thing and nothing seems to get things moving. What can we do?

Doctor's Assistant: Have you seen a doctor about this yet? What medications are you taking?

Took her to the ER last night. They couldn't do anything. We have given her OTC meds. Nothing helps.

Doctor's Assistant: What medications do you take daily? Are you allergic to any medications?

Not allergic to anything I know of. She takesCulturelle Probiotics, eats lots of greens, and takes Gummie Fibers daily.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Not that I know of. She has always had problems with constipation.

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Answered in 7 minutes by:
3/13/2018
Doctor Jennifer
Category: Medical
Satisfied Customers: 105
Experience: Surgery Fellow
Verified

Hi, I'm Dr Jennifer and I'm a surgery fellow. Hopefully I can come up with some ideas for you! What over the counter medications have you tried?

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Customer reply replied 1 month ago
Fiber Gummies, Magnesium Citrate, Probiotics and enemas.

OK. Do the mag citrate and enemas work, but only temporarily, or not at all?

Have you ever tried miralax (the generic name is ***** *****)?

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Customer reply replied 1 month ago
far nothing has worked. She is in a lot of pain.
Customer reply replied 1 month ago
She use to take miralax. It didn't help so she stopped taking it.

I hope the emergency room personnel did a rectal exam to make sure she doesn't have rectal impaction--do you know if they did?

Did they take any images, like X rays or a CT scan?

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Customer reply replied 1 month ago
I They did not do an exam, nor any x rays or CT scan. She did have a small bm a few minutes ago.

OK, if you go to the ER again I would certainly ask them to check for rectal impaction. A digital rectal exam should be done. If the stool in her rectum has gotten hard and dry, it can be nearly impossible for her to pass it on her own. Instead, a doctor or nurse breaks up the stool ball with their finger to allow her to pass stool again.

You can also try a stimulant suppository, like dulcolax; if you are the one who administers it, you might notice a hard stool yourself.

In general, with patients like her, I recommend daily miralax, stopping it only if they have loose stool. It can help keep the stool soft and hydrated much better than fiber can. Sometimes patients with developmental disabilities can have such severe constipation that they require an enema every few days to prevent buildup of stool.

There are also prescription medications (like lubiprostone and plecanatide), but you will have to talk to her doctor about those.

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For now, I would keep her hydrated, possibly try another enema (just water, ideally) or a dulcolax, and if still nothing by the end of the day, I would return to the ER to get her an exam to rule out fecal impaction.

Does that help? Let me know if I can clarify anything. If you're satisfied with my service, please consider giving me a 5 star rating!

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Customer reply replied 1 month ago
OK. We will start with the miralax again. She is drinking a lot of water.
Customer reply replied 1 month ago
Thank you for your help and have a good day.

I hope things start moving along soon! Even if they do, I would discuss a formal plan with her doctor the next time you see him or her, including prescriptions if necessary, in case this happens again.

Doctor Jennifer
Category: Medical
Satisfied Customers: 105
Experience: Surgery Fellow
Verified
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