Chronic Constipation Since PD Prescription Changed

[TaffyTwoshoes27]

Since my Kt/V started declinng in May 2019, my renal nurse has changed the prescription for my PD treatments 4 times. Previously, i was doing fine dialysizing 6 nights a week, 4 cycles a night, about 2000 mil dwell between cycles and a 500 mil dwell during the day. Now, I am up to 7 days/week, 5 cycles each night, 2300 mil dwelled between cycles, and dwelling 600 mil during the day (she wanted to change it to 1000 mil!).

For the last 3 weeks, I have had such severe constipation (and vomitting for 2 weeks) that I had to do some embarassing things to evacuate feces from my colon that I have never done in 64 years PLUS was ordered to perform a Fleet Enema! I've never done one of those in my life either.

I have consumed much more fluids, salads, prunes, veggies, apples, stool softeners and laxatives -- to no avail. The enema worked, but BMs are still not normal. I believe that the extreme change in my PD treatments is removing all fluids from my intestines. In August, my Kt/V finally reached 1.74 -- which is acceptable but still on the low end.

Has anyone else had problems with chronic, severe constipation while on PD? This is very frustrating and anxiety-producing.

[Hidden]

At one time I was looking at PD should I need to be on dialysis. Since I've made the decision to go with HHD I archived the file. I went through it and found an article on what you are asking about. Some parts of the article mention things you have already tried but I thought I'd send it along and see if you might find something different to help you get through this. Hope it helps.

homedialysis.org/life-at-ho...

[TaffyTwoshoes27 in reply to Hidden]

Thank you for sharing.

[mhawk123 in reply to Hidden]

Good article as I have tried the Colace 100mg po bid with the Metamucil twice a day with a little exercise one hour five days a week with the veggies at least three times a day with good results. If all else fails, I do the ALOE VERA MIXED BERRY solution at nighttime with caution. Causes effect within two hours....Good luck

[KidneyCoach NKF Ambassador]

When I was on PD constipation was always an issue I did everything the listed article suggests. It takes time for the body to adjust to a change in dialysis. If prescription has changed that much in short time likely your gut and system is trying to find a new balance. Everyone reacts to the treatments differently so finding a resolution is as individual as your treatment. Miramax worked well with me with exercise and increased fiber intake from vegetables.

Kt/V is an antiquated method for determining adequacy. That being said, 1.74 is still short. CMS guidelines state a level of 2.0 or more must be achieved for adequacy.

Some don't do well on PD. Perhaps you are like myself and others who just don't transport toxins well. Eventually a good discussion with your dialysis team will need to occur for your optimal health.

Hang in there my friend.

Many Blessings

[TaffyTwoshoes27 in reply to KidneyCoach]

Thanks for your input. You are correct that CMS requires a 2.0 level of adequacy for the KT/V.

One of my recent appointments with a gastroenterologist included the suggestion of Miralax. I had taken Miralax before, but when I read the label of its contents, polyethylene glycol, I was hesitant to take it. Polyethylene is used in plastic and glycol is used in antifreeze. No wonder the system tries to evacuate that stuff as quickly as possible. I'm still hesitant to use it. The gastroenterologist was not very well versed on kidney disease and dialysis. His suggestion was to eat lots of fiber cereal (phosphorus) and to drink lots and lots of water. I am on a fluid restriction, as most dialysis patients are.

I have found some success with what I read from the article Mr Kidney provided. I've been taking 2-4 Dulcolax stool softeners a day plus I started taking some organic coconut oil capsules, 2,000 mg. The bottle indicates to take two a day, but I have started with one. I have noticed a great difference already.

I am still vomiting quite often, which concerns me. I will be seeing my renal nurse for labs in the next week or two. I have been getting a great UF on my nightly treatments, so I hope that my KT/V comes back to within range.

I have been on PD for over 3 years now and have been doing great. I think there's a possibility that some life stressors that started about May and have not let up may be contributing to some of the lower numbers.

[KidneyCoach NKF Ambassador in reply to TaffyTwoshoes27]

When my doc recommended Miralax the first thing I did was check ingredients, side effects, contraindications etc. I ended up not ever taking it for exactly the same reason as you. Why on earth anyone would or that it is even FDA approved is shocking to me. Stressors can certainly contribute to the vomiting. I get cyclic vomiting from time to time. Sometimes it is pretty bad like dry heaves every 5-10 minutes for a hours. I've had to go to hospital for anti-nausea meds. Please take care and let us know how things progress. Many Blessings

[TaffyTwoshoes27 in reply to KidneyCoach]

Thanks for agreeing!! My Nephrologist, his Nurse Practioner, the Renal Dietician and my assigned Renal Nurse at Fresenius all recommended it! One day, we will see Class Action Lawsuit commercial from Attorneys on TV! If you own a pet, be on the lookout for that same "polyethylene glycol" (abbreviated as " PEG" in that constipation article) -- especially in dog treats (Milk Bones, etc.). I worked as a Pet Food Nutritionist in Big Box Pet Food chains.