I have recently received a diagnosis of idiopathic constipation & my rectum does not empty fully. know it will take time, patience, self help (diet,CBT), trial & error to get better but I have never felt so medically alone. My gastro put me on glycerin suppositories, discharged me back to my GP who basically doesn’t care.
I have been using the suppositories each night for 2 months, but find each morning I wake up with hard, un-formed stools which are difficult to pass. Also my rectum feels internally bruised and inflamed. Is this normal/side effect when using suppositories?
I have been trialled on other laxatives such as Laxido, Fybogel & Senna but these made me worse. If anyone has any feedback on the suppositories would be great to know. Thx
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Hopetobewell
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I think glycerin suppositories can be helpful if the problem is "right at the end of the line", but if your constipation is higher up they might not make much difference.
Have you tried Dulcoease or Colace? They are otc stool softeners which might work better for you than fibre?
Ditch the suppositories - obviously they aren't helping. As Luisa mentioned, for most people suppositories don't really help - because pathologic constipation (not talking the occasional episode a person with 'normal' GI tract gets, is much more involved than some stool in the rectum. Nothing wrong with using something to get yourself relief while you are searching to try to get at root cause. And I stress YOU - b/c your doctors won't. Do not accept "idiopathic" as a diagnosis. Just b/c your doctors, or perhaps any; can find a cause - there is something causing you to be constipated, particularly if you weren't before. It is so hard to say much with your limited information. But one first ? would be: how long have you experienced this? Did anything change before this symptom began?
You will need to start educating yourself and then becoming a detective First - do you know the difference between the 2 basic kinds of laxatives - Osmotic and Stimulant? This will be important. Since your stool is hard and dry, getting more water into the colon might be a place for you to start - the osmotic laxatives. These draw water into the colon - Magnesium works this way, as do usual 'stool softeners'. Suppositories will do nothing to help you, the glycerin can lead to further drying out and it is made from cheap GMO sources, so I stay away from it.
I am in the U.S - I think this is a U.K. site so not familiar with those brands - except I know about senna. The problem with most over the counter (and prescription) 'gi aids' is that they are full of irritating chemicals (look at ingredient lists - the inactive ingredients.
Fiber will often make people with constipation worse, because while it will had bulk, your colon will not respond to it, it won't be able to contract more to move the bulk along. This is a problem for many with constipation - it is a TRANSIT problem. So many of these therapies are suggested based on someone with a normal colon. The presence of a big glob of fiber is supposed to make your colon contract more, however , if there is something wrong with this 'reflex' , or the muscles can't contract - the fiber will sit there , drawing more water in, making you more and more bloated and in pain.
So, some need a stimulant laxative to move things along. Senna a that. However, if you want to try I recommend trying to get pure senna - often available in a tea form. I use this and it works very well. The pills at the drugstore are full of extra ingredients that can be irritating to the GI tract?
Were you using each of those products you mentioned one at a time? Or in combo.
Also remember - these laxatives are only to keep your bowels moving while you try to figure out the underlying cause.,
Obviously, this would be a GI doctor's job - but - no comment.
I know for a lot of people, a cause is not found (or one that can be helped). However, I have read 100s of reports of people who have had constipation cured with treatment with antibiotics based on SIBO, one woman who struggled for 7 years, and turned out to have microscopic parasite, when treated, her constipation resolved. Some report great results with high dose thiamine treatment (see the parkinson's disease forum here- they have a lot of information). This is not an exhaustive list, just a few things I've commonly read about.
Am in the U.K., 68 & diagnosed with primary infant onset incurable progressively debilitating multisystem immune dysfunction & connective tissue disorders lupus, hEDS + Pan-Antibody Deficiency Disease ) + the usual secondaries, all of which were managed via lifestyle techniques with only pharma during acute episodes until my 50s. By then gastroenterology had investigated & diagnosed a series of mouth to exit conditions related to my underlying illnesses. By my 60s these had progressed enough to warrant further investigations. Am now diagnosed with Visceral Hypersensitivity & Chronic Intestinal Failure + Chronic Intestinal Pseudo Obstruction, all of which have proven to involve inflammatory process.
All my body systems Inc GI tract are responding v positively to the combined therapy treatments my lead tertiary consultants in rheumatology, immunology & gastroenterology have me on long term + to the treatments am on from other hospital depts.
because over the decades I’ve gradually become allergic to all main classes of laxative inc food fibre/residue (.except the following) my slow transit dysmotility is managed via weekly sodium picosulphate bowel cleanses, with Glycerol suppositories several days each week in between due to my long sigmoid loop & stretchy colon trapping stool high up in the large bowel. Gastroenterology have given me linaclotide & prucalopride to try should the sodium picosulphate + glycerol combo stop helping as much as they are, but because my kidneys are all processing a heavy load of strong daily meds, am postponing trying these as long as poss
Otherwise am in my 5th year off all food, surviving thanks to the predigested amino acids etc in Elemental Diet. I feel very lucky that I respond pos to 4g glycerol suppositories even though my impactions are high up in the colon - this is extra amazing, because I’m one of the 2.5% of video capsule endoscopy patients who officially ‘retained’ the capsule long enough to be on the brink of surgical emergency removal .
Dear elenak,Thanks so much for your reply. Your words give me a lot of encouragement & motivation especially since I have been feeling so low this week.
A little more about my background. I have had bouts of constipation in the past, but all easily managed. My constipation became chronic in March after a series of antibiotics for H.pylori. I mentioned this several times to my Gastro & GP but they didn’t want to know. I have had a Gi Endoscopy & a MRI scan of the colon. All came back clear.
First I was prescribed Laxido twice a day (on it’s own) for around 6 weeks. Ended up having up to 9 small solid bowel movements a day and lots of inflammation & irritation. (Please don’t ask why I stayed on this so long). Then advised to add Senna to the Laxido in combination. It didn’t make any difference. Then moved to the suppositories with Fybogel. The Fybogel made my stools rock hard so came off that. (During this time I have lost at least 3 stones in weight). The suppositories do clear quite a bit of stool each night, but as mentioned I still wake with hard stools in the morning. I am thinking that in truth which I may of already suspected that the suppositories are not helping and using them every day is actually impeding my improvement and causing a lot of the morning hard stools, irritation & hypersensitivity. Trying to solve a problem it is creating a new problem. You mention the irritation & dehydration in your post. I think this is definitely the case. You are right I need to crack on and find the underlying cause and find my cure!! I am just hoping that these laxatives have not caused any irreversible damage. (I have just started working with a dietician at the moment. (We are not doing anything crazy). We have introduced the magnesium citrate, some other supplements we are going to get a stool test done.
Thanks again Elena, if you have any other info that may be useful then please let me know.
Hello there.. I totally empathise with your post. Can I ask you, do you drink at least 2.5 litres of water a day ie apart from coffee or tea? It makes a huge difference. If you have other conditions such as dry eye, dry skin, vaginal atrophy etc it could be you have some vein of Sjogrens type thing such as I have. A friend on the lupus site has transformed her previously once a week movement by tons of meds only to regularity now and has changed her life.
I’ve had constipation since 7 yrs old (am nearly 60 now!) and it seemed to be linked to eating white bread and other non healthy foods when I went to stay with friends… as my parents gave us a very healthy diet.
If you graze on 3litres of water a day(I fill a litre bottle and make sure it’s all drunk every 2.5hrs (and stop 3hrs from bedtime) and have lots of Fodmap friendly veg, salad, fruit and wholemeal rice/cereal/pasta, fish, seeds etc, it really helps. Do you do this already?
Along with a yon of other meds, I am on 2 Bisacdodyl and a sachet of fibogel a night too. I certainly wldn’t be doing suppositries as so v hard on the body (i have rectal prolapse for 20 years now but too risky to have operated on due to my being immunocompromised) and as lots say on here, probably not ideal for you, as you’re finding out yourself.
There is little good support out there for gastric stuff - been waiting for an actual ftf app for 2.5yrs now! Just keep getting phone assessment. I hardly sleep most nights as in so much pain from stomach to bum, snd now have begun to vomit too… Being seen in November amd hope can make to till then.
Please try the 3litres a day… and let is know how you get on.. and def no white, refined foods. Here’s hoping! D x
Hello there,Thanks so much for your reply. I am drinking 2 litres a day but will look to increase to 2.5 to 3. Last night for example I woke up gasping so ended up drinking about 600mls through the night. I will let you know how I get on.
All refined bread & pasta, rice out the window. So only whole grains now, lots of fruit & veg. I have seen some improvements which is promising. Yes definitely need to start to wean myself off these suppositories
I really do hope you get your Ftf appointment soon. Wishing you all the best.
Thanks for taking my advice so well... I know I'm a bit of an evangelist on all this ;). Yes, more water really might make a difference in the dysmotility side of things.... I drink two large glasses of purified water at least on waking... and let it go through for an hour before eating or having any tea. Coffee is a no no as makes my dodgy ticker go beserk. I find this really helps.
I find even sliced wholemeal bread in plastic bags (or not) from supermarkets is really bad - last night I had to buy/eat some as going with my v healthy soup affair pre Ocado delivery today (I hate waste and that was my planned defrosted soup supper)... and was in UTTER AGONY all night and puking. This always happens I find... I should have known better. I was meant to make my own 3 ingredient organic wholemeal bread yesterday but a friend descended unexpectedly. Never again shall I eat any supermarket type bread, even the bread in the likes of healthy organic patisseries and bakeries is so much better... less weird additives to help it's shelf life perhaps and just better quality ingredients... so more expensive but worth it. Bread generally isn't any good for us with inflammatory conditions.. too complex... but my wholemeal organic bread with organic yeast, water and salt is bearable now and then.
So awful that we have to be so careful with our diets. I did try the recommended microbiome happy tablets by the NHS gastro chap who diagnosed my with IBS 2yrs ago - but I really didn't find any difference.. and they weren't cheap. Can't remember the name - think began with S? I eat live yoghurt every day and hope that helps... plus I take Welleco Super Elixir which has probiotics in anyway... been taking it for 6 or more years now, as was just very unwell all the time and failing at work as always off sick with bad infections and exhaustion. It really helped for a while...Sadly it's got it's work cut out now as go a a lot of grim health stuff going on. Not cheap though - but I daren't stop taking it! There's an offer on right now.... Maybe worth a go?
Anyway, I do hope you can get an urgent review.. Have they suggested bisacodyl?
I have (last week) finally talked to a specialist dietician because I can eat no fibre without problems. She accepted that but has told me to take one teaspoonful of either psyllium or linseed powders or one psyllium tablet every day with a full glass of water. I’ve chosen the tablet (500 mg) and have now had that for two days. Still have urgency but things are much better. First day a little better and today a small improvement on that. I’ve just taken my third tablet. I have to admit it is making things a little sticky but I think that will improve as it firms up. She told me to increase to two tablets if needed. I might try ground linseed (flaxseeds) if it stays sticky. My next appointment is not until November, such is the state of our NHS but at least my GP has been excellent in getting me help.
You should try getting a colonic. That will relieve your symptoms most definitely and then you can work in what the root cause is. You're probably so mentally effected by this that you can't begin to figure out a diet plan or work on any kind of CBT. You need to get your colon flushed first.
Hello sorry to say I have no suggestions except to say might be worth going back to the gp and demand HD does something at least advise you , as 2 months to me sounds adequate time for the meds to to work or at least soften the stools for you , sorry I can't help more but I do feel for you , I really hope you get some relief soon . Xx
HI HOPETOBEWELL:-D. I’M SORRY TO HEAR ABOUT YOUR CHALLENGES. I WAS DIAGNOSED WITH THE SAME THING. FOR MANY YEARS I PUSHED MY GP TOWARD A RESOLUTION. I HAD TO DO SO MANY THINGS THAT ONLY MADE MY CONDITION WORSE. SINCE I DON'T KNOW YOUR SYMPTOMOLOGY (OTHER THAN CONSTIPATION), DIETARY INTAKE, EXERCISE, ETC., HERE'S WHAT I LEARNED AND HELP RESOLVE THE CONSTIPATION AND OTHER SYMPTOMS THAT WENT WITH IT LIKE: PAIN, BLOATING, FATIGUE, NAUSEA, VOMITING, AND MUCH MORE.
1. For years my GP had me trying all kinds of laxatives and fibers: PEG (Polyethylene Glycol), Linseed, psyllium/psyllium-based products/prescriptions, flax seed, etc.). None of them worked and all made me sick. The one thing I have found that is very helpful is pure organic Acacia Powder. It is a soluble fiber. The only type of fiber that I have no negative response, which is amazing, since I have not responded well to all plant-based foods. I started with 1 tablespoon dissolved in 8 oz of warm water 30 minutes before each meal. If you have any kind of pain with eating or IBS symptoms, you can take 2 peppermint oil capsules with the Acaia Powder solution. The soluble fiber is well tolerated and helps with constipation and/or diarrhea. It helps with the slip and flow of the bowel movement. If you begin to have too many bowel movements, then you can back off to 2 tsp with each meal, and if still too much, continue to titrate back. Don't take more than 3 tablespoons a day as each tsp has 2 grams of fiber. 1 TBS has 6 grams. 6x3=18 grams of fiber. If you are eating fiber foods, you will exceed the daily 20-25 grams per day. If you are not currently getting at least 20 g of fiber per day, this could be supporting the constipation. For me, fiber foods were too much of a burden on my GI and just put me into a horrible loop of additional physiological challenges. The Acaia Powder is the ONLY soluble fiber that didn’t create any negative effects. Additionally, doctors either don’t know this or haven’t kept up with the literature. Soluble fiber is most helpful with GI issues. Acacia seems the least triggering in comparison to other soluble and insoluble fibers. Since all the other things you’ve tried, hopefully this can be a helpful tool.
2. I don't know if you're doctor has tried giving you Polyethylene Glycol (PEG). It helps pull water into the GI and helps along bowel movements.
3. DO YOU HAVE ANY PELVIC/HIP OR LOW BACK PAIN? I had so much pain from the constipation that I had many tests, films, MRI, Colonoscopy, plus more. My doctor referred me to PT to try and combat the pain. The PT had a small impact, but in the long run it was not helpful. One of the "traveling" PTs thought a Pelvic Floor specialist may be the best next step. After so many years of no improvements, I jumped at the chance and I found a great pelvic therapist not far from me. I had to pay out of pocket. It was worth every penny! I worked with her for a couple of months. She determined that I had severe hyper contraction in my pelvic floor, mainly the levator muscle area. She compiled all her test results, therapy notes and findings down in medical terms so that I could give it to my doctor. Once he had this information, he was able to refer me to the UCSF Medical Center Pelvic Cancer department. They conducted tests and found that I had a severe and chronic contraction in my levator muscle. It attaches to each side of the pubic bone and runs around and behind the rectum. The chronic contraction was pulling my rectum forward causing extreme difficulty with normal bowel function. I had surgery to inject Botox into the muscle. Not many people respond well to this treatment, BUT I DID. It didn't completely resolve the problem but did make a huge improvement. When I incorporated Acacia Powder (a soluble fiber) with the Polyethylene Glycol I was already taking, I started having 2-6 bowel movements per day. The pendulum swung way too far in the other direction!! The wonderful opportunity was that I was completely able to manage it on my own, no more doctors. I just stopped the PEG for a few days to see what would happen. I continued to have more BMs per day than desired with slight straining. I then reduced the Acacia Powder to 2 tsp per meal and 1 TSP PEG with filtered water 1 hour before bed. If I feel challenged, I have more PEG in the morning.
4. Gentle exercise like walking or Sun Salutation Yoga moves can be quite helpful to move things gently along.
5. Be careful with Magnesium. There are many types and it does make a difference what kind you take. Magnesium Oxide is the most prescribed and has the least impact. Magnesium Glycinate and a good probiotic is helpful in reducing the stress you and your gut are experiencing. Natural Vitality Calm with Probiotics is a great Mg + Probiotic Powder. No need to buy a bunch of supplements. Just add to warm water and drink
With the exception of surgery, these are just a few suggestions all of which are the most gentle self-care opportunities that you can control. I hope this helps!! Take care and wishing you recovery and increased vitality
Hopetobewell, research thiamine. Thiamine needs magnesium to become bioactive. Search on "krispin mgnesium" for helpful information. Anti thiamine factors diminish or destroy thiamine and the stuttersence link has a comprehensive list. The B vitamins work better together and it's important to use a BComplex once a day when using high dose thiamine. Always consult your health cate provider before using any supplement.
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First - do you know the difference between the 2 basic kinds of laxatives - Osmotic and Stimulant? This will be important. Since your stool is hard and dry, getting more water into the colon might be a place for you to start - the osmotic laxatives. These draw water into the colon - Magnesium works this way, as do usual 'stool softeners'. Suppositories will do nothing to help you, the glycerin can lead to further drying out and it is made from cheap GMO sources, so I stay away from it. 
Fodmap diet
Constipation
Constipation 
constipation leading to Pelvic Floor dysfunction
