Health Organization for Pudendal Education

Hi folks
hope all are doing well. I have a question that I hope someone can help with.
Any ideas on is the safest yet effective laxative to take for those who use pain meds? Gastro Doctors have offered very little effective direction
I have found that I need a large amount of Duclolax a--- strong laxative.at least 3 pills daily - in order to have enough of a BM that I am comfortable... especially after i eat my 2nd or 3rd meals of the day.
After a while I think bowels become dependent on these products and want to stop the pwerful laxatives as soon as possible.
Either they don't work, or they empty out my system for hours.irritating my rectal pain more,and keeping me stuck at home and in the bathroom!

Sometimes I even have to use a dilaudid suppository, which lately only produces small output.I think you have to use them regularly at the same time of day for them to be truly effective.according to one doc who recommended I used several senna pills at night and a laxative suppository by day. it worked but I did not like using a laxative supp each day! not good for rectal pain! and very nerve-wracking when your're waiting for it to work!
That was about a year ago when I was on oral opiates and the pain pump and pain supps...all of which did not take away my pain very much!

Now I take less opiates....a low level of of Dilaudid in pain pump, and a low level of bupivicane.

I still take Dilaudid pain suggs 12 mg as needed usually once a day.... they are not that helpful in pain reduction but necessary until something else works for me.
My Pt and urologist recommended Baclofen/valium supps for me cause they feel (and I agree) that my pain issue comes from very tight muscles in the peri-anal area. Baclofen can constipate but my Pt thinks it may help relax things and make go...which sometimes it does.
Its usually does not help the pain tho.
Everything my PT - whom I really trust- has noted about me --points to the muscle issues... from clenching --partly out of tremendous fear of pain, and I guess habitally over years. She re-assures me that she can help and reminds me to keep telling myself that all my symptoms point to muscle issues.
The muscles and brain need to be re-trained back to normal again, as they think pain is the "norm" right now.
She also says that Im not really constipated but that feeling of 'having urge to go' or having stool in the anal canal (severe pressure etc) comes from the ever tight muscles.
She showed me some evidence of it the other day..

Meanwhile tho, the feeling is awful to deal with; if anyone experiences this, do you take a safe but effective laxative and if so what?
.If I go down to lower dose of Duclolax, the next day I will feel awful as I wont "go".
I fear the same would happen on a safer, milder laxative like Miralax..It is said to take days to work!

Tho my PT is probably right, what'a a person to do or take ot deal with this. I try to walk when I can (weather and pain -permitting) and try to up water intake, tho water often turns me off and me feel bloated,,Since I have bladder issues.. juices and such are too acidic..Im assuming.. tho at times Ive had to resort to prune juice ,,which may or may not work. (warm prune juice can be faster Ive heard,

I am soon starting a protocol which includes stretches, and eventually will add relaxation training etc but due to medical procedures and holiday stuff, have not had time to do it this week ...very time consuming.
Any recommendations from someone in my situation would be most appreciated as this bowel presssure can be hell on rectal pain
My best to all of you for the holidays! and thank you!

Violet had a suggestion that she uses which is Magnesium Citrate tablets. You start at 200 mg and work your way up. After she suggested this I had that to my regular list of stuff I have to use and it does help.

There is a common constipation recipe that many doctors recommend.
1 cup applesauce
1 cup oat bran or unprocessed wheat bran
3/4 cup prune juice

Start by taking 1 Tablespoon in the evening with 8 ounces of liquid. May cause bloating while getting use to this. Increase to 2 Tablespoons in 2 weeks if not desired results. Increase to up to 4 tablespoons. This should be kept in the frig. You can make a larger batch and freeze in ice cube trays.

I have not tried the above recipe because I've been working on cutting gluten out of my life to see if it helps with the pain but I might be able to find some oat bran that is gluten free.

Hi Kathi
How did it go with the combo I suggested? I guess not well... So sorry! I hope someone else can chime in and give some suggestions for you.

Blossum

Hi Blossum
Hi checked for your email. I found it and it contained a link...For some reason the link did not work
I think at the time my computer was acting up. could you pls copy and resend your advice in another email, if you don't mind, or whatever way is easier for you?
Thx very much
Kathy

Senna ( herbal) and ground flax seeds.
Some people just take Senna.

I buy Swiss Kriss (Brand)

Thx Ray
I do have that brand on hand ....will try and also put flax over bran cereal. Hope something works soon.

Btw the way Blossum, I hope you got my msg...I found your info and thx!
I responded by email or another thread,
I am scattered this week and forget which.
Thx again!

Thx NYT
For this recipe
I have some wheat bran and oat bran on hand but it's in cereal form..I guess not what you meant for the 'recipe' right?
Looked in a couple supermarkets yesterday but they didn't carry unprocessed bran. They also didn't have the magnesiums that Violet advised either.
Will try the vitamin shoppe if hubby can get me there today.

Meanwhile I have apple sauce and some prune juice on hand.

I also have magnesium citrate but had heard once that it can flare sensitive bladders. ...For me sometimes things flare me, sometimes they
don't
there 's no logic, to it.
I am desperate enough to try it. The bowel pressure against rectal pain can be brutal
Thx again,
Kathy

Kathy,
I do not have a box on hand but check the ingredients on the box - I think my oat bran is listed as cereal on the front but just oat bran. That is usually found in the cereal aisle next to oatmeals.
Janet

Hi Folks
Thx for all ur replies and various ideas! I really thank you!
Something must rid of me this feeling, tho Im starting to feel its Me - my discouraged, scared attitude that causes continued bowel issues from clenching and from worr.
My PT, feels that more than likely my muscles are so tight that the 'tightening up' makes me feel the stool in the anal vault painfully and urgently, long before the normal person would! I feel it as sooni am on my feet for awhile and mostly after eating.
One doctor I emailed a few month back ( Dr Antolak) in Minn, said this feeling was due to 'spinal cord windup'--- He simply added that comment in a reply to my email..He said he would call me to discuss, but never did! A month later he send me pics and info about PN surgery...yikes.
Since then I've been warned by a close friend whom I trust to avoid surgery with him. or getting involved with him, based on what she's heard.(I don't want more surgery anyway, unless it was the LAST resort and I knew of one doctor whom I felt true confidence in!

Yesterday I was finally able to empty bowels well.after using a Dulcolax supp combined with other remedies all day( lots of water, prune juice walking, a new magnesium pill etc . I had a small BM the day before, but still felt pressure afterward
Yesterday evengin I felt such great relief! ,but since my rectal pain was so bad from all the pushing etc,, I t needed a dilaudid rectal pain supp. This process repeats-- like a vicious cycle I have a BM sometimes, but the back-up feeling soon returns. Im lucky to have one day here or there without the 'feeling'. I m at my wits end, this pushing on already brutal anal rectal pain. Sorry to keep posting about this but its an awful feeling to live with.. and Ive got lots accomplish as we all do. Hubby ignores my worries etc, as he his system works like clockwork, and he doesn't get it!
I feel the pain supps could be causal but I need them.

Today my PT noted there was no stool in the rectal vault, which I figureed due to last nights 'results'
and that the lower intestine ..the last stop in the body before the stool goes down to the rectal canal ..had only a small amount from this AM's breakfast...totally normal!

But tonight, after walking. eating dinner, and having a small piece of cupcake, that awful "football feeling in butt" is back.. I need to eat all kinds of foods --balanced meals-(Im trying lots of fiber but also water -lots- to balance it . Im very underweight yet afraid to eat lunch as that's when this all usually starts. So I skip it alot which is bad I know!

My PT strongly feels my muscles are tricking my brain, which may be true!
But Wed/ Thurs there was stool there, when I checked it, just wouldn't come out till it was ready and through the use of a strong laxative suppository. So painful until it finally came out .
She feels the tight muscles make me feel whatever bit of stool is there, She was surprised that I actually had a large BM last night.. But since I'd taken laxatives, prune juice, water, etc and finally the Dulcolax supp. it came out!. A normal person would not have even noticed the feeling of pressure in the vault yet. I do 'go' fairly regularly through use of Dulcolox, but still struggle with this feeling
lately almost daily.
I can best describe it as an awful feeling of object-- like a football in rectum.
Has anyone else had this? If so what did you do at the time?
Blossom, you mentioned a laxative which I don't thing will work for me currently tho I used it successfully in apprx 2102-2013. . Thx so much (not strong enough at the moment? Altho it could be I''ve become tolerant to the Dulcolax and its worsening things. I would hate to tak more of this strong stuff unless necesscary...I can make one nauseau too!
Is there anything else you did for this feeling. I tried to drink lots of water again today but felt a bit queasy so couldn't get as much down.
Does anyone have this issue?
Again, my PT feels that I don' t have true PN....for various reasons, one of them being that my most painful trigger points are not anywhere near the PN , but in another spot.

Sorry for long post.
My questions are these.What can I do?
I need to take pain suppositories for the rectal pain--.Dilaudid 12mg.... helps a just little, -but best thing I have for now.
Also have Valium/ baclofen rectal supps for muscle relaxation..they don't help pain ,tho I times they help me pee better.
Which one? they both are known to constipate, but docs say "we are all different" as usual so they have advice for me.

Another way I know muscles are involved.--- last night after all the effort to poop etc, after I finally had relief, my bladder spasmed! and it was hard to pee)! Aye, Aye aye.. I need help.

PT says continue to take ur pain supps...it's the muscles, angering the nerves and causing all this stuff, and meanwhile I'm to find time daily to do a long skin rolling and relaxation protocol at home despite my above issues and being a busy Mom at Christmas etc.
She will work with me on it weekly.

Phew!...sorry for this same info..looking for any help I can find.
Thx so much!

Hi everyone , just wanted to add--
So sorry for long post above . and so many details.

M y question to anyone who may be familiar, am I feeling this constant urge to poop, and heavy pressure of stool as described above,
because I keep taking the strong laxtive Dulcolax, so it casues urge?
Or:
cause as PT says my muscles in the sphincters are tight, and I have trigger pts there,so I'm super sensitive to least bit of stool there?

Or is Both?......PTs can't comment on meds, and docs haven'' that been helpful thus far.
Patients seems to be our best source of info at times

I 'went' to bathroom 5 times day , bits a time, rather than just once in the AM, like most people. Sorry again for this lovely subject

I want to take a milder more natural laxative , but am afraid things will back up if stop the dulcolax, This week's problems began when I took one less
Dulcolax Tues, cause I was traveling that day and didn't want any sudden 'urges' to occur in the car!

Before taking pain meds. I rarely gave this stuff a thought!
I had IBS episides, about 10 years ago - painful cramping and diahrrea etc- once every few months,, but if I was careful to eat more small meals, that kept it a bay.

Any answers on how to get rid of this painful feeling would be grea? Will be doing relaxation protocol -which God- willing will help,- but in the next few days, not too much time for that
Happy Holidays!
That it!
Thx and sorry to beat a dead horse!