For CFers afflicted with GI presentations, usually they have constipation. CF screws with the bowel, both in motility and fecal plasticity. A healthy bowel re-absorbs about 92% of the water passing into the bowel. The sticky, as opposed to slippery mucus membrane stiffens the bowel, reducing its pliability and therefore its ability to massage the feces up, over, down and out of the body. The mucus membrane can be seen as one layer of a tube, with nerves, blood vessels, and lymph ducts surrounding a muscular tube designed to massage and transport food/food waste through peristalsis, lined with the mucosa, which due to CF the mucus resembles a never drying rubber cement.
If the bowels aren’t moving things along at a normal pace, the CF errors won’t stop drawing water out. The sticky quality of intestinal mucus can’t be understated. Isolated fecal material gets stuck on the wall of the bowel, and the peristalsis fails, but not without a fight. This results in a bone dry, clay hard future fecal conglomerate that pulls the mucosa off the bowel wall, like your skin peels off a frozen pipe. Hence these bowel blockages fortunate to leave on their own resemble random clumps of hard clay pressed together with bright red tender mucosa defining the boundaries of each clump.
You are now officially constipated and when you finally do have a successful bowel movement, it can resemble a birth without the baby. Understanding the mechanisms for practical purposes describes the dilemma in hopefully actionable terms. First, 92% of how much water implies greater hydration will help. Added electrolytes and if the bowels start awash in water, some of that sticky mucus in the bowel gets more hydrated which can quantifiably improve bowel function. I am surprised I haven’t heard more people talk about Amitiza.
Amitiza uses a direct counter mechanism to keep water in the feces that would normally be sucked dry via CF. I take it with my daily meal, in the evening. It is prescription so talk to your doctor. Some may have taken the short course on Amitiza and in a particular dose and schedule, it is specific to women. Not! It is prescribed equally for men and women. The end result is keeping feces plastic presenting no difficulties rounding the corners, and generally responding properly to transport.
Oh Mirilax, not long before Mirilax hit the market I was prescribed colon prep, which I then measured the powder, found in Mirilax, along with way too much electrolyte, but for the same effect. Mirilax, (polyethylene glycol) bonds with water to make a bulk gel, also immune from being dried out by the bowel, adds plasticity, bulk and weight. And it slides over the sticky mucus, because it is slippery, and popularly understood to mitigate some of that mucosal gluing. There probably is a practical limit to the amount of Mirilax one can take, but my GI doctor set a practical limit of 6 dosages in 24 hours. The process of arriving at the correct dosage is through titration. Starting with a single dose and slowly increasing until a person feels they are regular. Amitiza can cut the dosage limit of Mirilax considerably.
Amitiza has a limit, not to be exceeded. Mirilax is the original “do no harm” solution. It remains inert and as long as it is taken with a proper amount of liquid, at some point it will work.
My situation mimics the worst CF presentation of constipation. My pancreatic pain is off the scale and narcotics have been the only useful analgesic for decades. Narcotics=constipation, and I have lived long enough to now have Parkinson’s disease which Parkinson’s=constipation and the controlling medication causes serious constipation for those who only have Parkinson’s to deal with. This brings up extreme measures. Magnesium is the next, in practical quantities, it is harmless. For somebody not taking magnesium already, 300mg to 900mg will usually get things moving. The higher the dose, the more you pay in the trade off of being in pain vs. getting relief. A regiment of 300-600mg is good for keeping normal and is in my daily routine. Last is controversial, bisacodyl sodium 5mg a stimulant laxative and prime fodder for laxative abuse. My GI doctor is flatly against its usage, especially on a daily basis. My GP who also is my pain management specialist feels it is necessary to counter the bowel paralysis from narcotics. I use it daily unless things are moving well, then I stop until I have to resume. I neither advocate nor dismiss bisacodyl sodium, but lay out an example including the controversy for each person to decide what an how to develop a regularity, including different complications. There is a formula embedded in all this from which is a routine I feel anybody with constipation issues can follow. This is one to be proactively managing avoiding really serious bouts of constipation that is in fact an acute GI problem that someday one might look up and realize some real harm has been done. Constipation can cause so much pain and discomfort, not to mention some unwanted toxicity, invitation to microbial imbalance so necessary for the oil soluble vitamins to be processed and absorbed. That balance and your yogurt are compatible with colon health, but remember, or log what works better, when. Colon health should be a self read and not burning up memory in posts. The minimum is to have a good probiotic daily, whether you take a capsule or eat Greek yogurt, upping probiotics with antibiotics to keep killing off healthy bacteria in the gut aids in that normal balance. Foods for bowel health is a topic for another forum.
