Posted by ed_uk2010 on February 23, 2015, at 19:14:35
In reply to Re: Best med for IBS-C, posted by pedr on February 23, 2015, at 14:56:35
Hi Pete,
>Zelnorm - helped with C but not with pain
>Amitiza - did not help in any way
>Linzess - some help with C but increased painYou've obviously tried most of the hi-tech meds. How do you respond to low doses of more traditional laxative? The new expensive meds aren't necessarily any more useful.
Polyethylene glycol laxatives (MiraLax) have a good safety record. Initiating treatment with the full dose is likely to cause bloating and discomfort in IBS. A very gradual introduction may be well tolerated and effective for constipation. Pain may improve once constipation resolves. Miralax is not gas-forming.
Small doses of mineral oil laxatives usually produce little in the way of cramps or bloating, unlike most laxatives. Long-term use is not appropriate but they can be used short-term for constipation. Short periods of use are not unsafe unless you accidentally inhale the liquid!
Psyllium products have a very variable effect in IBS-C. From very useful... to unpleasant. They are very safe. Similar to Miralax, standard starting doses are likely to cause cramps and bloating in IBS. A very gradual introduction may be beneficial. Some people can't tolerate any increase in fibre, unfortunately.
Bowel stimulants such as senna tends to cause cramps. Bisacodyl and sodium picosulfate can cause severe cramps. Avoid.
I wouldn't suggest lactulose for anyone with IBS because it's gas-forming. Sorbitol causes similar side effects.
I don't know if there's anything here you've not tried which might be suitable.
>I currently take Bentyl and Levsin as needed but they don't help much.I think part of the problem with the above anticholinergics is that they can aggravate constipation, even if they are slightly beneficial for cramps.
Peppermint oil capsules are sometimes effective for relieving abdominal cramps in IBS (often 0.2ml of oil three times a day, max. 0.4ml three times a day, if needed). Enteric coated capsules are preferable, especially in those with GERD. They do not worsen constipation but they are unlikely to treat it. Can be a useful treatment to take alongside a mild laxative. It is very safe.
>If my IBS pain is low (or, heavens-forbid - absent) then my mental health will likely be OK. As the IBS pain increases, my mental health (mood, cognitions and OCD and the myriad other facets) deteriorates linearly.
I don't know whether this applies to you, but some people with IBS-C who spend a lot of time with other people, often in stressful situations, find that their constipation is alleviated by having more time to themselves. Bowel function is closely linked to subconscious brain function. You may not 'go' until you have some time completely alone in a relaxing situation.
>What medication are you currently taking? (Both psych and non psych).
>
> Lexapro, Wellbutrin, Provigil, Valtrex (for suspected CFS), a.n.other CFS med, Omeprazole (for GERD).Do you think any of them help, or make symptoms worse?
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poster:ed_uk2010
thread:1077014
URL: http://www.dr-bob.org/babble/20150223/msgs/1077045.html