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constipation, but no real serious condition/diagnosis

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I am a 21 y/o female with muscular dystrophy and am in a wheelchair. I have had constipation problems my whole life but no real serious condition/diagnosis. I am on a very low dose narcotic pain medication (Norco 5/325 1/day) and am battling constipation as I take these meds.

For the past 4 days I have been feeling a very strange feeling. If I had to describe it, it would be "nervousness" in my abdomen. When I would get nervous as a child I would feel this and it would allow me to evacuate (it has always seemed weird for me!). I could control it and it never happened unless I was nervous. I am not nervous or anxious and this feeling has been constant for these 4 days. I go to the bathroom and push, and the feeling intensifies so bad I have to stop because it's so strong. I am a hypochondriac and don't have a regular primary care physician. Do I need to make an appt with my (old) doctor about this? It is such a weird and alarming feeling. Also, no pain or vomiting, just nausea.

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replied July 4th, 2014
Digestive and Bowel Disorders Answer A48118
thank you for asking
muscular dystrophies followed by narcotic opioid meds are all very much the reason for your constipation. you need diet andf lifestyle modification for that. now this strong feeling to defecate is worth examining by a gastroenterologist. If the stools are impacted then they might be evacuated manually and the gastrocolic reflex as a result might be causing it. You need a complete thorough GI assessment for that.
Initial treatment measures for constipation include manual disimpaction and transrectal enemas. A well-lubricated gloved finger might be required in patients with lower anorectal impactions. These initial measures are then followed by elective evaluation of the causes of the constipation.

Medical care should focus on dietary change and exercise rather than laxatives, enemas, and suppositories, none of which really address the underlying problem.

The key to treating most patients with constipation is correction of dietary deficiencies, which generally involves increasing intake of fiber and fluid and decreasing the use of constipating agents (eg, milk products, coffee, tea, alcohol).

Medications to treat constipation include the following:

Bulk-forming agents (fibers; eg, psyllium): arguably the best and least expensive medication for long-term treatment
Emollient stool softeners (eg, docusate): Best used for short-term prophylaxis (eg, postoperative)
Rapidly acting lubricants (eg, mineral oil): Used for acute or subacute management of constipation
Prokinetics (eg, tegaserod): Proposed for use with severe constipation-predominant symptoms
Stimulant laxatives (eg, senna): Over-the-counter agents commonly but inappropriately used for long-term treatment of constipation

Newer therapies for constipation include the following:

Prucalopride, a prokinetic selective 5-hydroxytryptamine-4 (5-HT4) receptor antagonist that stimulates colonic motility and decreases transit time
The osmotic agents lubiprostone and linaclotide, which are FDA approved for chronic idiopathic constipation, constipation caused by irritable bowel syndrome, and (in the case of lubiprostone) opioid-induced constipation in adults with chronic, noncancer pain
i hope it helps
Take care

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