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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by pedr on February 23, 2015, at 9:24:38
Hi,
what's the best med for IBS-C? Here are the qualities the ideal med would have:
- reduce the intensity of ibs pain and sensation
- help with depression, anxiety and ocd
- not cause constipation
- not cause somnolence
- not cause insomniaMany thanks,
Pete
Posted by ed_uk2010 on February 23, 2015, at 12:52:00
In reply to Best med for IBS-C, posted by pedr on February 23, 2015, at 9:24:38
> Hi,
>
> what's the best med for IBS-C?As you know, there is no universally effective med for IBS-C, but linaclotide is a potentially useful option, if you've not already tried it. I assume you're asking because you have not done well on older/standard treatments.
Linaclotide:
>reduce the intensity of ibs pain and sensation
Yes, it is known to help these symptoms. Around half of pts treated will get some pain relief, normally beginning a few days after starting treatment.
>help with depression, anxiety and ocd
No, it will not directly benefit any psychiatric symptoms.
>not cause constipation
It does not cause constipation. At times, it is too strong and causes diarrhea, but this is rarely severe. Most people do not experience any diarrhea.
>not cause somnolence...not cause insomniaNo, it doesn't cause these.
Posted by pedr on February 23, 2015, at 13:06:31
In reply to Re: Best med for IBS-C, posted by ed_uk2010 on February 23, 2015, at 12:52:00
Hi Ed, thanks for the post.
>> As you know, there is no universally effective med for IBS-C, but linaclotide is a potentially useful option, if you've not already tried it. I assume you're asking because you have not done well on older/standard treatments.
I tried Linaclotide and found it made my pain worse, which is what I've found for all IBS-specific meds I've tried. Go figure :/
Posted by ed_uk2010 on February 23, 2015, at 13:52:32
In reply to Re: Best med for IBS-C, posted by pedr on February 23, 2015, at 13:06:31
>I tried Linaclotide and found it made my pain worse, which is what I've found for all IBS-specific meds I've tried. Go figure :/
Oh dear. How long did you try it for?
Please will you list all the meds you've tried for IBC-C, and how you responded. This will make it possible to look at your options.
Is there any relationship between your mental health and your IBS symptoms? Also, how long have you had IBS for and has it been affected by any of the psych drugs you've tried?
What medication are you currently taking? (Both psych and non psych).
I will try to recommend something :)
Posted by pedr on February 23, 2015, at 14:56:35
In reply to Re: Best med for IBS-C » pedr, posted by ed_uk2010 on February 23, 2015, at 13:52:32
I've done my best! :
> >I tried Linaclotide and found it made my pain worse, which is what I've found for all IBS-specific meds I've tried. Go figure :/
>
> Oh dear. How long did you try it for?about 2 months I think. I keep a daily pain diary and it was reasonably clear-cut that it was not helping and perhaps making the pain worse.
>
> Please will you list all the meds you've tried for IBC-C, and how you responded. This will make it possible to look at your options.Zelnorm - helped with C but not with pain
Amitiza - did not help in any way
Linzess - some help with C but increased pain
Xifaxan - did nothing
I currently take Bentyl and Levsin as needed but they don't help much.>
> Is there any relationship between your mental health and your IBS symptoms? Also, how long have you had IBS for and has it been affected by any of the psych drugs you've tried?Yes, a totally crucial relationship. 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. Since the pain can change radically in the space of a few minutes I often end up feeling like Jekyll & Hyde.
>
> 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)
>
> I will try to recommend something :)
>Many thanks Ed!
>
>
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?
-
Posted by pedr on February 24, 2015, at 12:19:53
In reply to Re: Best med for IBS-C » pedr, posted by ed_uk2010 on February 23, 2015, at 19:14:35
Hi Ed, answers inline
> Hi Pete,
>
> >Zelnorm - helped with C but not with pain
> >Amitiza - did not help in any way
> >Linzess - some help with C but increased pain
>
> You'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.not well. The only 'traditional' approach that doesn't cause me loads of additional pain is doing an enema. Which itself long-term is known to cause issues.
>
> 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.I gave Miralax a good go twice now and both times it results in really unpleasant GI sensations and was ineffective for me.
>
> 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!mineral oil cramps me up badly. I must have some serious hypersensitivity going on.
>
> 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.another no-go for me.
>
> Bowel stimulants such as senna tends to cause cramps. Bisacodyl and sodium picosulfate can cause severe cramps. Avoid.agreed.
>
> 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.I haven't found them to increase my C but like I said, they're not very effective. Bit of a Band Aid solution.
>
> 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.I've never had any joy the times I've tried peppermint oil. Just no relief from it.
>
> >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.That's an interesting supposition that I've not heard before. With my poor mental health, being alone is just (if not more) as anxiety-laden as being with company.
>
> >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?Wish I knew. I do know that each of the myriad AD's I've tried have had different qualitative effects on the IBS pain & sensations. I guess some have toned down the pain more than others but it's so variable and subjective it's very hard to say.
>
> -
Posted by ed_uk2010 on February 24, 2015, at 20:24:06
In reply to Re: Best med for IBS-C, posted by pedr on February 24, 2015, at 12:19:53
Hi Pete,
You do seem very sensitive to side effects, for sure.
Have you tried the stool softener docusate?
>The only 'traditional' approach that doesn't cause me loads of additional pain is doing an enema.
What sort of enema works for you?
>Which itself long-term is known to cause issues.
I suppose some are safer than others. Certain side effects are common only in particular populations. For example, phosphate enemas are more problematic in people with kidney impairment and in the elderly.
>Peppermint oil. Just no relief from it.
What country are you in? I'd suggest trying mebeverine but I don't think it's available in the US.
>I do know that each of the myriad AD's I've tried have had different qualitative effects on the IBS pain & sensations.
What do you think might have helped? SNRIs, rather than SSRIs, are useful for some types of pain, but they do occasionally worsen constipation.
Posted by pedr on February 25, 2015, at 11:15:54
In reply to Re: Best med for IBS-C » pedr, posted by ed_uk2010 on February 24, 2015, at 20:24:06
Hi Ed, replies inline
> Hi Pete,
>
> You do seem very sensitive to side effects, for sure.yes. I have very few days without pain :(
>
> Have you tried the stool softener docusate?Yes, it didn't get things moving.
>
> >The only 'traditional' approach that doesn't cause me loads of additional pain is doing an enema.
>
> What sort of enema works for you?water, saline, glycol. Some days it works well, other days not so much.
>
> >Which itself long-term is known to cause issues.
>
> I suppose some are safer than others. Certain side effects are common only in particular populations. For example, phosphate enemas are more problematic in people with kidney impairment and in the elderly.Right. I was alluding to the reports that it can make your GI muscles "lazy" since they "forget" how to push.
>
> >Peppermint oil. Just no relief from it.
>
> What country are you in? I'd suggest trying mebeverine but I don't think it's available in the US.The US and from what I can tell you're right, it's not available. That's a real shame since it sounds like it could have been useful.
>
> >I do know that each of the myriad AD's I've tried have had different qualitative effects on the IBS pain & sensations.
>
> What do you think might have helped? SNRIs, rather than SSRIs, are useful for some types of pain, but they do occasionally worsen constipation.Man I just don't know. My health is so variable, most of the time I don't know what's up and what's down. I do know that pretty much all the meds I've been on (barring the current regimen) caused strong (as witnessed by the litany of C meds I've tried) C.
Posted by ed_uk2010 on February 25, 2015, at 19:02:51
In reply to Re: Best med for IBS-C, posted by pedr on February 25, 2015, at 11:15:54
Hi Pete,
>water, saline, glycol. Some days it works well, other days not so much.
Saline etc. Are you using a commercially prepared product? I'm just wondering because the safety would be dependent on the concentration of salt used.
>I was alluding to the reports that it can make your GI muscles "lazy" since they "forget" how to push.
This is widely claimed, but doesn't seem to be based on much.
For the glycerol, was it a glycerol suppository?
I think it's important to find the minimum dose which works. If you do this, it doesn't seem likely that you will harm yourself.
Problems with laxatives and enemas tend to follow their abuse eg. as part of ill-conceived attempts at weight loss, or extreme 'bowel cleansing' regimens associated with psychological problems. If you only use just enough to allow you to 'go', it's a different matter.
You could use a suppository on alternate days, perhaps, for a trial period.
Posted by pedr on February 26, 2015, at 9:18:14
In reply to Re: Best med for IBS-C » pedr, posted by ed_uk2010 on February 25, 2015, at 19:02:51
Hey Ed,
> Hi Pete,
>
> >water, saline, glycol. Some days it works well, other days not so much.
>
> Saline etc. Are you using a commercially prepared product? I'm just wondering because the safety would be dependent on the concentration of salt used.Varies. To save money I just clean & re-use a Fleet enema bottle, filling it with water. So overall I don't often use saline solution.
>
> >I was alluding to the reports that it can make your GI muscles "lazy" since they "forget" how to push.
>
> This is widely claimed, but doesn't seem to be based on much.
>
> For the glycerol, was it a glycerol suppository?Sometimes. They're more convenient to take at work, for example. I find the suppositories less effective though.
>
> I think it's important to find the minimum dose which works. If you do this, it doesn't seem likely that you will harm yourself.
>
> Problems with laxatives and enemas tend to follow their abuse eg. as part of ill-conceived attempts at weight loss, or extreme 'bowel cleansing' regimens associated with psychological problems. If you only use just enough to allow you to 'go', it's a different matter.
>
> You could use a suppository on alternate days, perhaps, for a trial period.Agreed, that's what I try to do.
Many thanks for all your input Ed! I'm currently chasing up Mebeverine with my GI doc but it looks like it isn't available here, gah.
Pete
Posted by ed_uk2010 on February 26, 2015, at 11:57:55
In reply to Re: Best med for IBS-C, posted by pedr on February 26, 2015, at 9:18:14
>Varies. To save money I just clean & re-use a Fleet enema bottle, filling it with water.
I think water will be safe, unless you use a huge volume. But rapidly drinking a massive volume of water by mouth might not be safe either! Everything in moderation, as they say.
Plain water given rectally is partially absorbed.
>Sometimes. They're more convenient to take at work, for example. I find the suppositories less effective though.
A convenient alternative might be a micro-enema. Have you tried one? You could easily take them to work. Each enema is narrow and only a few inches long.
>I'm currently chasing up Mebeverine with my GI doc but it looks like it isn't available here
I didn't think it was, I don't think alverine is available either.
Posted by SLS on March 11, 2015, at 6:47:48
In reply to Re: Best med for IBS-C » pedr, posted by ed_uk2010 on February 26, 2015, at 11:57:55
What about TCA?
- Scott
Posted by pedr on March 11, 2015, at 8:42:03
In reply to Re: Best med for IBS-C, posted by SLS on March 11, 2015, at 6:47:48
> What about TCA?
>
>
> - ScottYes those are top of my list, having not tried one for literally decades.
Thanks, Pete
This is the end of the thread.
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