Laxatives and Domperidone for Constipation
Question: Could you write about laxative compounds not to take? In addition, could you recommend a laxative to use for pain medication related constipation?
Dr. Bruno’s Response: Laxatives of any kind should only be taken when needed to prevent becoming laxative dependent. Reglan is used when the gut stops moving but should never be taken by polio survivors since it can cause Parkinson's-like symptoms that last years. Miralax seems to be the safest laxative, along with suppositories. And diet is very important to keep things moving, for example drinking lots of water and having a big salad before dinner.
If you feel you need a laxative frequently, talk to your doctor:
Taking Colace, Dulcolax and Senna frequently can cause laxative dependence.
Again, polio survivors should never take Reglan since it can cause Parkinson's-like symptoms and abnormal muscle movements.
Domperidone (available with a prescription from Canada) can be substituted for Reglan, since it doesn’t cross into the brain.
Note: Both Domperidone and Reglan can slow electrical conduction through the heart.
Methylnaltrexone by injection is used to treat constipation caused by opioid (narcotic) pain medications.
Additional Question: You suggest that Domperidone may be helpful for constipation and I have found this to be so. It also helps with some nausea I had. But the instructions advise not to take it for more than 7 days and my GP in the UK is very cautious about possible side effects. I took it initially for about 10 days, without any ill effects, but stopped. I am wondering what your advice would be about how long an interval to allow before I take it again?
Dr. Bruno’s Response: Poliovirus-damage to the vagus parasympathetic nerve seems to be the cause of slow guts in polio survivors. Domperidone bypasses the vagus and indirectly stimulates the intestines to get moving. But Domperidone should only be taken when the stomach stops emptying or the intestines stop moving. Also, Domperidone can slow conduction through the heart and your gut can become dependent upon it.
Once you take Domperidone and your intestines start contracting on their own, you need to establish a bowel program. As part of this, you keep a daily poo log, increase your intake of water, eat a salad before dinner, create a time every day when you sit on the throne and occasionally take laxatives, preferably Miralax (polyethylene glycol) to help you when you haven’t had a bowel movement for three days.
Please talk to your doctor about all of this.
Please see the article: Slow Guts and Polio Survivors.
More information is under the topics: Constipation, Diet and Muscle Weakness listed in the Index for the Encyclopedia of Polio and PPS”.