Health Organization for Pudendal Education

carolynm wrote: I am constipated at times as well but I don't get too focused on it. If I can't go, I can't go. People can go 5 days or so and still be OK.

For some PNers, during an ano-rectal pain flare, having stools in the rectum is extremely uncomfortable, like having a poker up your butt. The rectum pretty much must be empty at all times or it is intolerable. This is not a question of "oh dear, I haven't had a BM today, I better quaff down some more Miralax to keep regular".

Lernica,

I have awful anorectal pain and I have read that you do too, so I know exactly what you mean about stool in rectum. There is no way I could go for 5 days without having a BM, but I do feel much worse on days that I go several times. If I dont go then I have less pain. Violet's recommendation of "applesauce consistency" being a goal just doesn't work for me, it makes me feel worse to go frequently. Do you have this too, Lernica, or anyone else? I take magnesium oxide as a supplement and this works fine unless I take more narcotics than usual, and then I might have to take extra magnesium.

Violet recommends Magnesium Citrate, not sure of dose but think it is 800mg.

Yes, Jeanie, me too. I think it's a question of finding a balance between not enough BMs v. too many. Not enough BMs means constipation and pain; too many can mean cramping and irritation. I think one BM a day is ideal, preferably in the morning. My husband does this easily without even trying! For us PNers, though, trying to find the right balance of magnesium supplements, roughage, water and laxatives is a daily challenge because of variables such as pain meds and lazy bowel reflexes.

Totally agree with you both, Lernica and JeanieC, about this.

I am having some problems at the moment as my bowel seems to have forgotten how to work after the surgery, even though nothing very major happened to it, just some stitches and being repositioned. And I'm also having continence problems, sigh.

With Movicol/Miralax I am having trouble finding a balance. Going too often means the pain comes back. Not going means great discomfort. I think I shall go and see what I can find by way of magnesium supplements.

I agree maybe try something other than Miralax....over in the US we used Colace (docusate sodium) or Senekot (senna) (http://www.senokot.com/html/product_guide/ in the hospital postop setting frequently. MIralax has taken over as the favorite but in the old days that is what we used. I hope, Calluna, that you find the right balance for you. Remember, 2 steps forward, 1 step back, may be how any surgical recovery will be.

xx

The recommendation of "applesauce consistency" came from a doc but it may not work for everyone. Have heard that nitroglycerin works well for some people but I haven't tried it myself. Would be interested to know how it works for you, Rob. Thanks.

The pudendal nerve does not innervate the lower abdomen, I am pretty sure it is the iliohypogastric nerve if there is suprapubic pain.

Another thing with Valium is that you tend to quickly develop a tolerance for it and will require higher and higher dosages to get the same effect. I find it is very effective for the painful spasms, however I only use it when I have really bad flares when the lyrica and tramadol are unable to control the pain. Sometimes I might use a 5mg tablet but then might not use it again for a week or more.

There is another muscle relaxant called Norgesic that is also available and apparently is not addictive like Valium as informed by my GP and pain specialist. It might be worth looking into for people who require muscle relaxants around the clock for long term usage for pain relief.

I personally have tried the drug myself and found it effective, the only reason I don't use it here in Australia is because its not on the PBS and is more expensive than the Valium.