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Suggest Treatment For Persistent Constipation

Posted on Sat, 24 Jun 2017

Question: I have had severe constipation since may 26 8 days.i have had no bowel movement.i was told to taker trulance for constipation but this isn't supposed to be given if bowel obstruction occurs or is suspected.isnt severe constaption my stoold have been stuck high in my colon for many days a bowel obstruction?

Answered by Dr. Prof. Kunal Saha (3 hours later)

Brief Answer:
Contraindicated in intestinal obstruction due to mechanical cause

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through your query and understand your concerns. Trulance (plecanatide) is a medicine prescribed in chronic constipation and acts by activating certain substances within your intestines that help increase fluid secretion and muscle movement. However, it is contraindicated (not to be used) when intestinal obstruction due to mechanical cause is suspected as in your case.

You can find the same information at:
https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm537725.htm

Let me know if I could help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (2 hours later)

the ct was negstive before the pcp saw the possible obsctruction 3 days after the ct was done.they are not repeating the ct and saw no bowel obstruction is there.they have done abdomainl xrays can abdomanil xrays tell if bowel obstruction is there/they are going only by the abdomanil xays but no repeat ctwas done.my pcp saw possible obstruction on xray but er xay radiologist didtn see obstruction,do abdomanil xraysdiagnose bowel obsruction

Answered by Dr. Prof. Kunal Saha (1 hour later)

Brief Answer:
Can you take an image of the X Ray plate and post it?

Detailed Answer:
Thanks for writing back. A diagnosis of intestinal obstruction is usually done using a straight X ray of abdomen taken in erect posture. Multiple air-fluid levels point to intestinal obstruction. I would need to glance on the X ray plate to be able to comment. Unless that is present and unless there are definite points of severe tenderness over the abdomen, intestinal obstruction is unlikely.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (16 hours later)

I had a repeat xray of the abdomen.i usually put my chest on the xray machine then turn around and they xray me from he front to view my abdomen,today they put my abdomen on the xray machine like a chest xray.i have nevr been xra=yed tyhis way beoreis this as acuurate

Answered by Dr. Prof. Kunal Saha (5 hours later)

Brief Answer:
Right technique

Detailed Answer:
Thanks for writing back. Yes, this is the right technique. In case of chest X ray, postero anterior view is taken (the front of the chest faces the film) whereas in case of abdominal X ray it is antero posterior (the back faces the film). This is accurate.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (13 hours later)

I was xrayed with my abdomen facing the board lie a chest xray.this was not done correctly was it.i told them my back was supposed to be against the board and they had me put my abdomen on the board.will this way show the colon area for cnstipation

Answered by Dr. Prof. Kunal Saha (51 minutes later)

Brief Answer:
No problem

Detailed Answer:
Even if this is done in this way it will show the abdomen clearly. The only thing that will make a difference is the vertebrae but in this case that is not a cause for concern. The requisite information would be clearly visible. The area of colon would be visualized.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (16 hours later)

thank you I got my results of my abdominal xray and I have a few air fliudlevels in the colon.i belive I have a bowel obstruction because I cannot pass normal stools.i read online that air fluid levels are a sign of bowel obstruction

Answered by Dr. Prof. Kunal Saha (12 minutes later)

Brief Answer:
Discuss the plan of management with your doctor

Detailed Answer:
Yes, fluid gas levels are indicative of intestinal obstruction. Discuss with a surgeon what the next step should be.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (33 minutes later)

they wrote that there are a few air fliud levels in the nondilaited bowel and colon.this is nonspecific possibly mild changes of gastroenteritis.they have me on trevalance for constaption,this should not be taken if suspected bowel obstruction.isnt that what I have with my xray result.please reply back soon.i am seeing docor today but want to know answer now please

Answered by Dr. Prof. Kunal Saha (4 hours later)

Brief Answer:
Constipation& diarrhea can alternate but that does not mean gastroenteritis

Detailed Answer:
It is possible even due to gastroenteritis but highly unlikely especially when you have constipation predominant. Clinical correlation is needed and seeing the doctor would help.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Prof. Kunal Saha (38 minutes later)

is it true that youneed 5 or more fluid levels to be considered a blockage or obstruction?itstated I had a few in my colon so that still can mean obstruction is that correct.

Answered by Dr. Prof. Kunal Saha (4 hours later)

Brief Answer:
Stasis leads to constipation

Detailed Answer:
Welcome back,

Let me explain the pathophysiology for your better understanding first. Ideally, 5 or more levels are needed to diagnose obstruction. The levels are formed due to stasis. The number, therefore, indicates the extent of involvement. In your case, even the few ones may be due to stasis (irrespective of whether it can be classified as obstruction). The cause needs to be managed suitably.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Prof. Kunal Saha (35 minutes later)

i accidently inhaled prune juice wrong.i a,m having chest apin now should I go t er and when would chest xray show lung problem

Answered by Dr. Prof. Kunal Saha (14 minutes later)

Brief Answer:
Does not seem to be a cause for concern.

Detailed Answer:
Inhaled prune juice? Do you mean aspirated while trying to drink? In a case of the nominal aspiration that you might have while trying to drink, the little amount that enters your lungs would gradually be absorbed.

It is only if a reasonable amount has entered your lungs that you might be vulnerable to aspiration pneumonitis. Unless that is the case you do not need to get a chest X-ray done or visit the ER. But in case you are apprehensive or if you have aspirated a lot of prune juice, do visit the ER and get a chest X-ray done.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Prof. Kunal Saha (14 minutes later)

yes sir I was drinking prune juice and I accidently aspirated it.i dontusaully drink prune juice but with my constipation I started it.i knew I took too much in accidently bu thought I would be okay but I must have aspirated a lot.it was canned,i am having shest tightness and pain but not heart pain.how soon would this show on a chest xray or do I nned to wait until tomorrow to be xraye to show the damge.i cant belive I did this and yes I am huring in my chest what will they do for me in the er?please respond soon.aslo will this get better on its own if I don't get help.what willthey do for me and how soon will the xray show damage.I am not kidding I am hurting in my chest.i do not want to go to the er.what would the do for me there.will this possibly get better on its own.i am definely not having heart pain but chest tightness.what causes the chest pain from the fliuds

Answered by Dr. Prof. Kunal Saha (4 hours later)

Brief Answer:
Get an X ray done. Take someone along for help.

Detailed Answer:
Thanks for writing back. In such a case it would be a good idea to go and get an X ray of the chest done. Be sure to take someone along. You might ask them to look up the film and give you an idea about what they see.

Most often however it is not very serious and gets well on its own. Neverthelss, upload the report and I would guide you accordingly. You can upload the attachments using the facility on the upper right of this page. Alternatively you can email the attachments to YYYY@YYYY with the query id and my name mentioned in the subject.

Regards

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Above answer was peer-reviewed by : Dr. Yogesh D