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My wife’s MS symptoms include lack of bowel movement. Sometimes not too bad, other times quite bad like we’re currently having. Last week, she hadn’t had a movement. It had been 5 days and she was miserable. She takes Colace daily, as well as Miralax on occasion, and is constantly drinking plenty of water. We play with the mix depending on her frequency. She has had times in the past where nothing works, so my cousin, an Internist, had suggested what hospitals sometimes use in severe cases, Lactulose. A few months ago, without a movement for a week she took a dose. 4 hours later, still no result. I decided to take her to the ER where she finally went after a further couple hours, (those poor nurses), I know first hand what the results are like. She is in the same situation now. She is quadriplegic so she doesn’t always know when or if she’s going and must be in a diaper. She doesn’t really use the toilet, and I don’t want her constantly using a powerful prescription laxative if we can help it. I’m looking for alternatives and appreciate any you can offer.

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It's know as slow transit colon OldSailor and is fairly common in parkinson's and other neurological diseases, no doubt MS is one of them. The BM can be very soft but the colon has just forgotten how to expel it, that's why it is sooo frustrating to treat.
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I just saw on the TV show "The Doctors" today that it could be caused by more that just lack of fluids, etc.
One of the guest specialist said sometimes with age it could be a slight shift in the colon because of changes in the muscles, allowing the colon to form a pocket which causes a slight build up of feces. Sorry I don't remember the actual treatments. Won't hurt anything to have it checked out by a specialist.
Maybe a search of their website could reveal more info.
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Try to develop a specific time each day for her to use a bedpan (or commode, or toilet) to move her bowels & put her on the appropriate surface (listed above). Like most of us has a usual set time we go #2, try to establish her unique time period.
I too would add senna and bisacodyl daily until she is moving her bowels regularly. It’ll be a fine balance to achieve the correct mix of Colace (docusate), senna & bisacodyl. When/if her stools are too loose, cut back on senna/bisacodyl but always give Colace (docusate) daily unless she has sustained diarrhea.
Of course good hydration and adding fiber to her diet can help too.
Good luck! Figure out what her best time of day to poop to assess her daily time pattern.
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This can be so hard to manage :(
I know that everything I tried for my mother seemed like a miracle until it gradually stopped working.... we started with miralax every other day, then daily plus milk of magnesia as needed, then added in colace. Visiting nurses recommended adding senna daily and I kept bisacodyl suppositories and fleet enemas on hand for when things went on ridiculously too long (more than 7 days). Now mom is in the nursing home and they manage her bowels with a probiotic and lactulose, I guess if it works in the nursing home we shouldn't be so resistant to using it at home.
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