Unrelenting constipation

[Kconstipated]

Since being treated with IV antibiotics in August 2016, I have been consistently constipated. More accurately, the severity of my chronic constipation suddenly and significantly increased from manageable to not-so-manageable. My BMs are hard and dry, often like pellets/plum-sized, hard to pass. I have rectal pain just before a movement and during a BM but no other pain. Occasional piles (family tendency, I have gotten piles since childhood regardless of diet and BM pattern, i.e. I don’t need to be constipated to have piles). My diet is very high fibre (any less and I become loaded or impacted), I drink huge amounts of water and hot water (at least 4 litres daily), I am not on any constipating medications or supplements, and I manage stress well (e.g. meditating). I go to the toilet when I need to and don’t stay too long, use a stool etc. I have a chronic illness that restricts my activity but there has been no change in my activity level, just in my constipation. I am not able to increase my activity level at all, unfortunately, so exercising more is not a feasible solution. I have been taking 1-2 Movicol daily but I still run into trouble every few weeks. I am taking probiotics, and was prior to August 2016, VSL#3 and saccharomyces boulardii – is it possible that these are constipating? My diet consists of vegetables, fruit, legumes, whole grains, nuts, seeds and a bit of fish, all of which I tolerate well. Many years ago some FODMAPS were problematic for me, but not any more. I have tried all the usual recommendations to no avail. All advice welcome.

[Dr Neil Galletly]

It sounds as if you are very knowledgeable about dietary and lifestyle treatments for constipation and it sounds as if you have tried most of these already. Constipation can often be a side-effect of various medicines but it sounds as if you have already looked into this. From a medicine point of view, you can increase the dose of Movicol as necessary (Movicol helps keep water in the stool making it softer and easier to dispel). You are not going to cause problems by upping the dose - although I appreciate you would probably prefer to find a solution that doesn't involve having to take regular medicine. If this doesn't work there are some newer medicines available to treat chronic constipation (prucalopride and lubiprostone) which can be very effective - your GP may need to refer you to a Gastroenterology specialist for these

Good luck!

Neil Galletly