hepatic encephalopathy

[Holidaymad22]

My husband has just been discharged from hospital with a bad episode of HE he is on 30ml lactulose 4 times a day and 4 senna tablets a day, he is now soiling himself in the night and also wetting the bed, is this how it’s going to be now, it’s so upsetting seeing him like this 😢

[AyrshireK]

Is he not on Rifaximin to help with HE? Certainly being on so many laxatives is going to cause accidents. Usual treatment for HE now is Rifaximin in conjunction with lactulose .... the dose of which can be tweaked to ensure a sufficiency of toiletting (3-4 times a day) but hopefully not so many accidents.

Obviously, constipation needs to be avoided at all costs but if he's going enough then maybe they need to reduce the laxatives since you and he need a quality of life too.

Katie

[Holidaymad22 in reply to AyrshireK]

Yes he is on Rifaximin and he has been going to the toilet 3 to 4 times a day, but he says he doesn’t realise he’s doing it in the night

[AyrshireK in reply to Holidaymad22]

It sounds like you need to discuss this with his doctors and amend dose of laxatives to prevent these overnight issues. He's obviously getting too much laxative. You need to strike a happy balance between going enough/not going enough.

My hubby has never had a major HE episode but a diagnosis of mild HE, he's on 20ml lactulose daily plus two rifaximin daily and no additional laxative (previously was on movicol/laxido).

Senna is potent stuff, combined with lactulose too it's no wonder he's accidentally soiling himself. My hubby has issues of urgency and accidents when out an about sometimes but never over night.

Discuss reduction of senna with doctor because it's probably the reason for night soiling.

Katie

[Holidaymad22 in reply to AyrshireK]

Thank you so much for your advice we are back at the hospital on Thursday, so hopefully they may adjust his laxatives, I didn’t realise senna was so powerful

[AyrshireK]

BLT page on Hepatic Ecephalopathy may be useful to you. britishlivertrust.org.uk/in...

[Holidaymad22 in reply to AyrshireK]

thank you

[EmmaThom]

Hi - just got out of hospital after severe HE. My hepatologist took me off lactulose last year and swapped it for Laxido with some senna if needed. When I was in hospital they wouldn't listen to me and keep feeding me lactulose for over 24 hours until I finally saw a gastro registrar and was put back on Laxido- have also been on Rifaxamin for over a year. The first 4 days after discharge was terrible.....many many accidents but I'm back to "normal " now, which is still diarrhoea 3-4 times a day but not incontinent anymore. Unfortunately living with HE does mean we are a slave to our bowels 😀 But if it prevents a coma then so be it. Laxative meds do require some tweaking until you find what suits. But it took me quite a few days when I got home to stop messing myself. Hopefully your husband should settle down soon, it did get better for me. Perhaps mention Laxido? Lactulose doesn't suit everyone but it's the first one they always prescribe. Good luck 👍

[Holidaymad22 in reply to EmmaThom]

thank you we stopped the 2 senna tablets last night and he seems more settled, still having 3 to 4 bowel movements a day but no accidents yesterday

[Richard-Allen]

This might be of some help.

I have often advised people to apply for a "Just Can't Wait" card. Normally if you go into a shop and get caught short, showing this card should let someone in charge know of your urgency in a discreet way.

If they are a customer caring outlet, they should allow you to use the staff toilet facilities.

The Bladder and Bowel Community also have a digital version which can be download onto your phone once you’ve registered with them.

I have both versions, but as yet, have never had to use them: bladderandbowel.org/help-in...

Hope this helps.

Richard

Just can't wait

[Holidaymad22 in reply to Richard-Allen]

thank you I’ve downloaded the digital one