IBS constipation - hit it early (day or two with no go)? Preventative enemas on a schedule?

I have IBS-C. Tried the doctor route, primary care helped a little but then sent me to specialist which was generally a bad experience and a waste of time. I basically was told “you’re not dying. Deal with it.” with no suggestions beyond the basic “add fiber, try eliminating onion, milk, wheat … and see what happens” (answer – not much change). Because it’s constipation I don’t spend most of my days in the bathroom, which is good, but when the intestines slow down I often loose my appetite, have mild nausea, and start loosing weight (and I no longer have much extra to loose).

Before I was running my own protocol with fiber, periods of Mirilax with breaks and other measures (usually enemas) if things stopped for 3 days or more. I avoided stimulants because I don’t want to have dependence issues. Sometimes I went to an enema after 2 days, because in the past I’ve had almost zero success with things straightening out on the third day even with Mirilax started. I find that the enemas on the second day go much easier than waiting to the third day. There are significant returns (I weigh several pounds less after ~20min of expulsion, even with the retained water), and I get very hungry somewhere between 30 minutes and an hour after the last enema (usually take 2-3 of increasing volume to clear out the colon).

Over the past 2 weeks I have tried being a more aggressive, taking an enema on the second day of no-go (sometimes even the morning), when I start to feel things slowing down and backing up, have a persistent reduced appetite, or start to get hard, pellety stools. The good news is that things seem to return to normal for a while much quicker, and the appetite seems to be more consistently there and I’m even gaining a pound or two. The bad news is that I’m wondering if I’m messing with things too much. I know the “boogyman” is that “you will become dependent on enemas,” but I find that things seem to be either working or not working, and if they’re not working then sometimes they don’t go back to “working” after the enema, but sometimes they do, and the probability is about 50:50. I’ve also stopped worrying as much after hearing the following advice about SANE experimentation: “what’s the downside? The downside in a normal person is that you’ll get constipated while your body gets things sorted out. Well, you’re constipated most of the time already, so there really isn’t that big of a downside now is there?”

I’m not asking for medical advice, just interested in experiences, ideas, "what I do" stories, "what I've heard others do", etc. What would the pros/cons be of hitting it hard and early? It seems that there are some members who deal with IBS or persistent constipation with “preemptive strikes” when things seem to be starting or even on a schedule (weekly or so, but this seems to be more IBS-D) – any of these members willing to say more about their protocol or how they developed it? Upsides/downsides?

I wouldn't be concerned with enema dependancy. You have to empty your colon after all.

I was diagnosed a couple of years ago with non-specifically caused constipation -idiopathic. Not IBS-C, but close enough in symptoms.

Like you, my various doctors tried several drugs, fiber and Miralax. Of all of them the Miralax worked the best, but I found the effects of having to go several times a day coupled with never feeling empty less than pleasing. I started a weekly enema routine and that helped but still found that the annoyances returned before the week was up. I talked it over with my doc and as a result changed the enemas to twice a week. I also took her advice to stop using baking soda and substute soap.

Since beginning this regime my quality of colon life has improved. The two quart SSE empties my colon with minimal discomfort. I can tolerate the three day/four day interval as well. I still take Miralax every day to keep things soft.

I am retired so I have the hour or so these enemas require.

Best of luck.

UncleO,

Did your GI Doctor mention any particular reason for you to change from baking soda to soap? Better cleansing/solids removal? I have had IBS since age 14, but probably not specifically IBS-D or IBS-C, as virtually my only symptom has been severe abdominal cramping during times of marked emotional stress. I can fortunately use enemas purely for enjoyment rather than medical need.

Thanks,

Eric

Ericmacson

Basically she said water and soap was best. When I brought up enemas at first she was concerned I was using Fleets. I told her no, I was using a bag enema with baking soda. That was when she voiced her concern about too much baking soda affecting my system.

Frankly I was surprised that someone so young was both familiar and positive about enemas. She was my GI doctor's PA.

THANK YOU! I thought I was nuts or doing something really wrong because the Mirilax didn't seem to really "work," even on double doses. It's so nice to hear that it isn't just me, although I fortunately (?) never had to go more than once a day. One dose in the morning and one dose in the evening barely keeps things moving when I'm on it and having problems, and I do often feel "not empty" and notice the bowels slowing down and putting out less and less after a while. One of the few takeaways from the GI doc was a raised eyebrow and comment that "most people take that at night so they don't have to run to the bathroom during the day." Sort of makes me wonder what a "normal" person would be feeling like if they took a double dose. You also make me feel much less alone in needing larger than 1-qt enemas to work.

So you do it on a schedule or count days of symptoms (seems like you are pretty much symptomatic 100% of the time so they might be the same thing)? Not that I have very much time symptom free anymore, but every once and a while I get 4 days to a week where things remember how to work again.

I'm thinking I'll continue hitting it early then. I'll probably table the scheduled enemas for now, it just seems as though it's better to not mess with things when they actually work. An hour definitely seems about right to go through 2-3 fillings, though I'm trying to come up with some more rapid options for days when I really don't have the time.

I do not have IBS, but the various drugs I take leave me with C. I was giving myself enemas 2 or 3 times a week and also taking psyllium fiber but ti did not do much good and enemas take time--2 hour sessions are common for 2 or maybe 3 fillings. I switched to stool softener and take two pills a day, at breakfast and supper, and my C has largely gone away.

I still enjoy my enemas at least once a week (Sunday mornings instead of going to church), and perhaps at other times, but I do it because I enjoy it not because I have to.

hankb

Re: Moliere's post. ......

I have moderate to severe IBS-C and HAVE to take a 2-3 quart enema every two-three days (eventhough I take a full cap or two of Miralax every single day). The only benefit to Miralax is that it makes my enema easier to expel, as the poop is somewhat softer. It does make me gassy and bloated all the time, however, which is pretty much the constant state I'm in on any given day.

I am dependent on enemas to have a bowel movement, otherwise, I would get very sick and perhaps impacted. When I didn't take Miralax, I would have to make a strong, Ivory soap and Epsom Salt solution, (which I like) but it would be very difficult to expel with severe cramping and nausea or vomiting. There was no real enjoyment associated with the enemas, only profound relief.

My point is, with taking Miralax every day, I can actually enjoy my enemas and focus on all the delightful sensations they provide.

This is so nice - I get VERY sick of variations on "it's all in your head - think positive thoughts," "you just need to get more fiber," "find your trigger food and things will settle down," "Mirilax and fiber will do it," and the like. I don't want to discount the very real and debilitating symptoms suffered by IBS-D and -A sufferers, but -C has it's own set of issues (at one point I was near-dangerously underweight because of the lack of appetite and mild nausea combined with trying to "let it all work out naturally.") Again, it's such a relief to hear of some other people with the same troubles and not be dismissed as a crybaby.

I'd always thought it was not possible to get clinically impacted while on Mirilax because it should hold enough water to keep the stool soft- that would be a question for the med types, but I do know that double doses give me just near normal consistency and things still get backed up and very uncomfortable after a while. I also know that in general what "should" happen doesn't always happen for IBS types, so I'll start being careful even when I'm on the double dose week.

At least for me there's a plus side to the gas and bloat from high fiber+Mirilax (I think it's the fiber mostly, as Mirilax should be inert) - the flatulence is pretty much odorless.

I can thank my lucky stars I'm not dependant yet. Every once and a while things start working again for a while. Generally now it's no more than a week 😢. Other posters - did you notice things generally getting worse, or do they stabilize, or just keep bouncing around - getting better some years, worse others.

In case anyone's wondering - at one point I figured that it was silly to spend money on Metamucil and Mirilax if I was going to be taking enemas anyway. Same as Moms Egirl I found that didn't work - difficult to expel and things got worse over time (I would have to take every 1-2 days). I've been leery of Epsom salt in enemas because I haven't found any data on absorbtion of magnesium from it if it gets "stuck," anyone have any info there?

I haven't gotten to where I enjoy the enemas yet. Haven't even gotten to where I'm trying to, or allowing myself to. Starting to wonder if that would help things.

Not sure if this is in the right area but I have something similar to many of the Posts problems. I was diagnosed with Diverculitis which continually gives me C. I take 17 grams of Miralax powder each night before bedtime. And two Dulculax 100 mg pills each morning. My main concern is the fact that I have always indulged in enemas, and now with div. I scared that I could injure myself with a high volume enema. Does anyone know if this thought is true or not

Not sure if this is in the right area but I have something similar to many of the Posts problems. I was diagnosed with Diverculitis which continually gives me C. I take 17 grams of Miralax powder each night before bedtime. And two Dulculax 100 mg pills each morning. My main concern is the fact that I have always indulged in enemas, and now with div. I scared that I could injure myself with a high volume enema. Does anyone know if this thought is true or not

The general consensus here seems to be that while you have diverticuITIS it's best to take a break and let the antibiotics work. DiverticulOSIS safety seems to be connected with how bad the diverticulosis is, where it is, and how you take enemas (colon tubes are probably a bad idea, as is pressing yourself with the volume). There are many reports here of people taking smaller, sane enemas and reporting that it even helps. As with all things your body is its own case, so it's ideal to discuss it with your doctor - though I personally don't discuss much of my IBS "struggle" with my doctor because, let's face it, it's embarrassing, personal, and if you say the wrong thing it has the possibility of getting more embarrassing and unpleasant if they decide they need to check things out.

If the 100mg of bisacodyl is not a typo I'd be a bit worried about that - it seems as though diverticulae may be increased with high colonic contractions, and stimulant laxatives in high doses do just that. You might want to run that one by your doctor.

What you have is not quite the same. IBS is a functional issue that is irritating to (at worst) debilitating, with constipation, diarrhea, and pain, but it doesn't damage the colon or cause risk to your health (unless it gets so bad that you don't eat). Diverticular disease can become a serious health issue, though it often remains just a potential serious health issue.