Navigating Complex Constipation Issues at 42
I’m facing challenges in receiving a clear diagnosis. Alongside the details from my earlier experience, I’ve been prescribed bisacodyl every other day, Amitiza twice daily, magnesium at a daily dose of 500 mg, and Miralax once or twice daily to assist with bowel movements. Unfortunately, this combination hasn’t been very reliable for me, and I’ve also been experiencing significant bloating and nausea. Recently, I had a consultation with a GI dietician to discuss nutrition, particularly when I constantly feel full and nauseous. I would appreciate any insights you might have. ### Summary of Emergency Department Visit **Primary Concern:** Constipation. **Present Illness Overview:** This 42-year-old woman, with a history of diverse chronic issues including persistent constipation, hypermobile Ehlers-Danlos syndrome (hEDS), and small fiber neuropathy, presented with minimal bowel activity over the past eight days, with no movement for the last three. She reported symptoms like nausea and diffuse abdominal discomfort, while passing only small gas amounts. There was no indication of bowel blockage. Previous attempts with MiraLax and bisacodyl yielded no results, and she had stopped using Motegrity due to insurance limitations. Although she had been prescribed Amitiza, she had not yet begun that treatment. Her medical history reveals both a cholecystectomy and a partial hysterectomy. **Systems Review:** Gastrointestinal: Notable for abdominal pain, constipation, and nausea. Other areas showed no abnormalities. **Physical Examination:** Vital Signs: Blood Pressure 164/112, Heart Rate 100, Temperature 36.5°C, Oxygen Saturation 100%. General Appearance: No acute distress; patient is obese but well-nourished. Abdomen: Can present as flat yet distended; mild to moderate tenderness noted without guarding or rebound signs. Other system examinations returned normal results. **Medical Decision-Making:** Possible conditions included constipation, ileus, bowel blockage, mass formation, cholecystitis, appendicitis, diverticulitis, fecal impaction, and proctitis. The strategy included conducting laboratory tests, a urinalysis, a pregnancy test, abdominal imaging, as well as analgesic and antiemetic treatments. **Emergency Department Course & Results:** Laboratory Findings: CBC, CMP, and lipase levels were within normal ranges; urinalysis showed no signs of infection. Imaging (CT Abdomen/Pelvis with contrast): Presence of stool throughout the colon (indicative of constipation) without signs of obstruction, strictures, diverticulitis, or impaction. A 3.2 cm left ovarian cyst was identified, likely functional with no associated complications. Other abdominal and pelvic organs appeared normal. This case was reviewed by gastrointestinal specialists, who suggested a bowel preparation followed by the initiation of Amitiza the next day. **Treatment and Future Action:** Commence polyethylene glycol (GoLYTELY) bowel prep. Initiate Amitiza one day post-preparation. Prescribe Ondansetron ODT to manage nausea (with dosage adjustments as needed). Schedule follow-ups with GI. Instructed to return to the emergency department if symptoms worsen (e.g., vomiting, fever, severe pain). **Final Diagnosis:** Other constipation.
Answers (1)
8/10/2025, 2:30:54 AM
OpenHealth AI
Navigating complex constipation issues can be frustrating, especially when symptoms like nausea and bloating complicate the situation. Based on the information you provided, it's essential to focus on managing your current symptoms and exploring supportive strategies in addition to your treatment plan.
Explanation
Constipation, particularly in the context of your chronic health conditions (like hEDS and small fiber neuropathy), can be multifactorial and may require a tailored approach. The treatment you are currently using (bisacodyl, Amitiza, magnesium, and Miralax) may not be providing adequate relief, leading to worsening symptoms like bloating and nausea. The recent emergency department visit and the follow-up plan indicate that your healthcare team is taking steps to address the constipation and its associated symptoms.
Next Steps
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Use the Amitiza as Directed: Begin Amitiza as soon as advised after your bowel prep. This medication can help increase fluid secretion in your intestines to promote bowel movements.
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Hydration is Key: Ensure you are drinking plenty of fluids, especially water, which can help soften stool and support bowel function. Aim for at least 8 cups a day unless you have any restrictions from your healthcare provider.
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Dietary Adjustments: Work closely with your GI dietician to identify trigger foods that may worsen bloating and nausea. High-fiber foods can be beneficial, but introduce them gradually to avoid exacerbating symptoms. Foods like fruits, vegetables, whole grains, and legumes can be helpful.
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Avoid High-Fat and Processed Foods: These can contribute to feelings of fullness and digestive discomfort. Focus on a balanced diet with reduced intake of fatty foods while increasing soluble fiber intake gradually.
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Regular Physical Activity: Engaging in light physical activities, such as walking, can aid in stimulating bowel movements and improving digestion.
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Monitor Symptoms: Keep a diary to track your bowel movements, food intake, and any symptoms of nausea or bloating. This can help you and your healthcare provider identify patterns that could lead to more effective treatment strategies.
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Consider Additional Support: If nausea persists, using the ondansetron (as prescribed) can help manage the symptoms. Check with your doctor about adjusting the dosage if you experience side effects or if it's not helping as expected.
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Follow-Up with Your Provider: Continue to engage with your GI specialists and keep them informed of any changes in your symptoms or concerns. Regular follow-ups will be crucial to adjust treatment plans as necessary.
Reassurance
It's understandable to feel overwhelmed, but remember that addressing chronic constipation takes time and often requires adjustments to find what works best for you. The fact that you're receiving support from specialists is a positive step. Be gentle with yourself during this process, and reach out for help when needed.
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