Patient 34

Patient 34

Date: Tue, 29 Jan 2002 15:37:38 -0800
To: jackfaf6.arc.nasa.gov
Subject: Found relief after 26 years

Jack,
 
I found your website to be informational, and I wanted to share what has given me relief from severe constipation and fissures.  I'm going to get right to the point at the beginning of the email, and move on with my history afterwards.
 
My physician prescribed MIRALAX powder for me.  The formula name is Polyethylene Glycol 3350.  It is an osmotic agent that helps bind water to your stool.  Contrary to what the name denotes ("lax,") it does NOT have any of the severe effects that typical over the counter laxatives have.  It is a powder that you mix with a 8 oz glass of water or juice that completely dissolves in the water.  There is no discernable taste, except perhaps it tastes slightly like "dusty" water.
 
I was told to take it everyday, but found that if I took it for 3 days in the beginning, then I only needed to take it once a week for maintanence.  After that, I found that I only needed it monthly, until I was functioning regularly 1x per day in the afternoon, early evening.
 
This of course helped my fissure to heal and not return.
 
FYI:  Many doctors do not know about this prescription and they always ask what is is when I report that I use it.  Don't let this stop you from having them look it up.  Doctors have easy access to databases of drug information, and can easily look up the information.  Some are too busy, and not interested enough in your care to do so.  I've been to a few local pharmacies and I can ususally look back to the shelves and see the bottle of it sitting right there, waiting to be filled and given to someone like myself.  So it isn't a rarity.
 
Now the history. (I really didn't focus on the treatment of the fissures and hemorrhoids themselves, because so far, the treatments, though long, have been successful.  Nothing new or different to report on the treatment of them, just the prevention of them.)
 
I am a 27 year old female and my first reported bowel trouble was (according to my parents) at birth.  I had severe "colic" (I put colic in parenthesis because doctors call any infants ailment of unknown cause in which the baby won't stop crying: colic.  You can look up this definition.)  My mother was in hysterics after a while and refused to leave the doctors office until they gave me some medicine.  My mother can't remember the name of it, but it sort of drugged me and relaxed me as an infant. 
 
Then came the constipation and the refusal to potty train and go to the bathroom as a toddler.  They chalked it up to being "naughty" but I truly believe that if I could have talked and expressed myself in some other manner than acting out, things would have been different in their treatment of me.
 
My earliest memories of my problems are when I was about 5.  I remember sitting on the toilet crying and both my parents kneeling in front of me holding a shiny red apple out, saying "You can have this if you're brave and can go potty."  Throughout my childhood, there were times in school or at church where I would go into the bathroom, only to be stuck there crying in pain, unable to pass a stool.  At home, my mom would bring me the box of Corn Bran cereal or warm water with lemon juice & sugar to me while I sat struggling to have a BM.  As a teenager, I was afraid to spend the night at other people's houses, because I might have an episode.   I held in the urge to go at school, just in case I would be stuck there, crying and people would hear me and gossip about me. 
 
I used metamucil, took fiber pills, tried laxatives (which would so severely affect me,) had colonics, used enemas at home.  Went on several diets to eliminate foods that would worsen my symptoms, all to no avail.  My parents would frequently wake up in the middle of the night to hear my crying and moaning in the bathroom down the hall.  Sometimes I would go as many as 15 days between bowel movements.  At that point, diarrhea would form behind the hard stools and made for a really painful experience because my body need to evacuate the toxins that were causing the diarrhea, but was unable to pass.
 
I experienced several fecal impactions that would leave me with a high fever, severe abdominal pain and vomiting.  Nothing would help except putting a heating pad on my stomach and wait for the impacted fecal matter to loosen.  One time I was sick for more than 3 days, became dehydrated and was treated in the ER with laxatives (not my favorite thing.)
 
I also made 2 trips on separate occasions to the ER with a large and hard stool that was stuck in my rectum and causing tremedous pressure on the anal opening.  I had attempted to have a BM, only to find it so completely stuck that it needed intervention.  The first time it happened, I was so desperate that I tried to help pick it out with the tip of the disposable enema tube.  This was not a good idea, because I ended up damaging the tissue, in my frantic effort.  Each time, fissures and hemorrhoids were a nasty-product of the whole episode.  Each time, I was treated with cortisone creams for months and told the same thing over and over about diet, exercise, blah, blah.
 
I truely don't believe that my problem is one of poor fiber intake and insufficient diet.  Fiber just makes it worse.  It just packs it in tighter.  I have found a few things that make my symptoms worse:  citris (oranges, OJ, cooked tomato sauces, etc..), a large quantity of red meat in one sitting, rice, turkey, a large quantity of starchy foods as in potatoes, pasta, and bagels, refined foods such as pretzels and crackers, and grilled cheese sandwiches. Of course all foods that I love!
 
Unfortunately, the doctor that prescribed the Miralax powder for me lives in Seattle and I just recently moved to Portland when my husband's job relocated.  The doctor in Seattle was the first doctor to believe me and not send me home with sample packs of metamucil, or tell me that it was phychological (I had one MD tell me that it was due to my childhood, and wanting to exert control and power over my parents by holding in my bowel movements!)  He wanted to send me to the hospital for a sigmoidoscopy, but unfortunately, I had to cancel because I had to move. 
 
I have yet to select a physician in the Portland area.  I'm am putting it off because I hate the way I'm treated by some doctors.  I'm not a hypochondriac, I just happen to know a lot more about my body and my treatment history than they do.  That's why I applaud your efforts to have a website to educate and sympathize with people who are brushed off by the medical world.   
 
I hope this story might relate to someone else and the problems they are going through, and even give them hope by trying Miralax.  The ironic thing about me writing this story today is that I am 17 weeks pregnant and haven't been cleared by my OB/GYN to use Miralax, because it is a class C drug, meaning there isn't enough information about how it affects the fetus and breatmilk.  I had a particularly difficult BM today after not going for a week, and now have a fissure.  I was frightened by the presence of bright red blood in the toilet, but recognize the symptoms of a fissure that I had been able to previously avoid.  I am going to try some of the non-drug suggestions that people have so kindly shared!
 
Thank you!

Subject: Patient 34 followup
Date: Mon, 08 Jul 2002 18:47:33 -0700

A follow up:

My OB/GYN did clear me to use during pregnancy.  She had never heard of Miralax before, but after looking it up in her Physician's Desk Reference, she felt confident in prescribing for me.  Apparently, the molecular weight (size of the molecules) were large enough that they wouldn't cross the fetal-blood barrier, and the drug itself stays confined to the colon.  I took it faithfully for 2 weeks to get my system moving again and haven't had a major problem since.  I am even taking an extra iron vitamin in addition to my pre-natal vitamin with iron, due to anemia with my pregnancy.  Every once in a while, I will take a stool softner (docusate sodium) with my vitamins for good measure, just to keep things going.

If anyone is having problems with severe constipation in pregnancy that isn't being resolved by regular measures (water increase, fiber increase, exercise, milk of magnesia, stool softners) they should ask their doctor about Miralax and have them evaluate it.  I did feel nervous about taking something which saftey hasn't been proven nor disproven in pregnancy, but my OB made me feel comfortable in the decision, and I am thankful for the relief.  I really didn't know how I was going to survive the rest of the pregnancy, and wasn't so sure about ever getting pregnant again.  Now, I am due next week, and overall have been pleased with my experience, since the constipation problem was relieved.

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