Constipated IBS: prucalopride, laxative and fibre questions

[captainscapegoat]

Hi, new to the forums, thought I'd post my story while I read posts...

Background

I’ve recently been diagnosed with constipated IBS. I was originally diagnosed with IBS many years ago, but it was never like this and hasn’t seriously affected me until now.

Five months ago I stopped drinking alcohol. Before that, I was drinking little, but regularly - 3 pints of beer a week. Historically I was a much heavier drinker, but have scaled back loads in recent years. As soon as I stopped I was beset with chronic constipation, bad enough that I couldn’t have a bowel movement at all without a laxative. No choice but to take Dulcolax (bisocodyl), which I’ve been on for five months, while waiting for doctor’s appointments.

I had a CT colonoscopy & blood tests, which were all clear (phew!) apart form evidence of ‘quite a tortuous sigmoid colon’.

I then got a GI consultation. I went private to avoid the 4 month wait, then referred back to the NHS. The doctor diagnosed IBSc, said it wasn’t IBD and the tortuous sigmoid colon wouldn’t be contributing to it. He advised a celiac blood test and a referral to a dietitian, which I’ve yet to attend.

He also prescribed prucalopride (Resolor), a relatively new drug for laxative resistant constipation. Its a 5HT agonist working in the gut much like prozac does in the brain synapses. So far, it seems to be helping with minimal side effects (fingers crossed).

I now have several concerns:

I don’t want to become reliant on prucalopride as I have been on bisocodyl, because while its helping the important symptom its doing so by masking it, not tackling the problem. Does anyone else have any experience with prucalopride?

I don’t want to go back to Dulcolax if the prucalopride loses effectiveness, but I may have no choice. I reckon the Dulcolax was causing inflammation/irritation in the colon, which is not something anyone needs. I hear differing reports, some saying stimulant laxatives are harmful and addictive for long term use, some saying that there is no evidence to support that. What is the consensus?

I want to modify my diet and lifestyle to help me out and I’m willing to put in the work. However, how can I try various diets if the medication is masking the symptoms? I can’t come off it if its working, as I really can’t have a BM without it.

Diet wise, I’m looking forward to seeing the dietitian. Does anyone have any thoughts on fiber for IBSc? I’ve had a reasonably high fibre diet in the past and upon reflection, I think I’ve been suffering from functional constipation for years. I’ve seen many reputable sources that recommend a high fibre diet. The traditional view is a high fibre diet to bulk stools and aid peristalsis. Fair enough. But won’t that lead to even bulkier stools, more straining and more pressure on my tortuous sigmoid colon? Won’t that cause more issues in the long term?

The inability to have a bowel movement without medication coincided with stopping drinking alcohol. I suspect the small amount of alcohol may have been acting as a natural laxative and I’d become dependent on it. Maybe this is a red herring, but has anyone else experienced something similar?

Also, has anyone else experienced systemic itching with IBSc? I’m wondering if it was actually exacerbated by the bisocodyl also.

Thanks for reading.

[Hidden]

Hi, sorry but I haven't tried any of the laxatives you have mentioned. I do suffer with IBS C at times (I was diagnosed in 1996 following a bout of food poisoning) but not all the time; my main problem is the pain associated with IBS so I am going down the diet route for mine. Unfortunately I don't seem to be able to tolerate a high fibre diet so I am eating more soluable fibre i.e. root vegetables. I can only eat very small amounts of onions, broccoli, cauliflower, wholemeal bread - these are all vegetables that I love.

I am going to try and go dairy free and will be starting that some time this month but need to research the alternatives I.e. almond milk before I start - I hear that lactose can also be a problem with IBS. I feel that looking at and overhauling your diet is the only way to tackle this awful condition. I have been better with root vegetables but I stupidly drank a glass of orangeade (I very rarely drink alcohol) last night and suffered most of the night with tummy pains.

I love dried prunes - these are good for constipation if you can tolerate them but unfortunately I can't.

A lot of people also follow the FODMAP diet with a fair bit of success, it's certainly worth going down that route but from what I read on this forum it takes some getting used to understanding what you need to do.

Best of luck in whatever you do.

[claire_louise]

I'd continue with the prucalopride if it works for you. While some laxatives can be habit forming, they aren't 'masking' the problem, they're making it go away (at least to a reasonable extent). Assuming you've had all the tests done to rule out underlying causes, e.g. coeliac disease, IBD, food intolerances, then IBS is an idiopathic condition. IBS won't do you any harm in the long run as long as you're able to manage the symptoms.

One thing I would suggest about prucalopride is that it always worked better for me when I had a break of a few days in between doses (this was suggested to me by my consultant). This stops the body becoming used to it, although it did mean I experienced quite bad side effects each time.

Good luck!

[Ralphy38]

I would be careful with fibre, as for me fibre makes my IBS pain horrendous. I have had to cut out so much veg because of my IBS & most wholemeal/wholewheat products(which is pretty much all the stuff thats supposed to be good for you!!) and I have always loved my veg so I miss it. However because of this I get constipated so now need Laxido laxative to help me go.I have also been on morphine for last 2 years which also causes constipation so that doesnt help. I know what you mean about not wanting to be on laxatives long term as I have heard the same thing, it not being good for you but difficult to know what to do when the conventional 'eat more fibre' cure doesnt work. I definitely think the beer has been a laxative for you so sounds like your body is having to learn how to cope without it, as the body becomes lazy, so maybe if you give it some time your body might kick into action again. Haven't had any itching so no help there sorry. Hope your appt with dietician is useful. Good luck.

[hensonne]

Go to gutsense.org and read it thoroughly. You are right in the fact that fiber bulks you up too much. I have had agonizing IBS-C for 38 yr. The colorectal recovery system plus lower fiber has worked for me since May. Usually I will try something & it fails after a month or two. But this has consistently made me normal. It's worth a try.

[captainscapegoat]

Thanks for the replies folks.

I've read through the gutsense website. It does make sense, but I'm not sure if I can get his recovery program stuff here in the UK - I'll ask when I've read the website in more detail. Not sure how he specifies how to actually get in a position to do the recovery program though - as I am now dependent on meds to have a BM, coming off them completely is a non-starter.

I'm hoping my dietician is conversant with the current ideas on fibre for IBSc - will see at the weekend I guess.