Over the past few years, my bowel management has to be changed. This could be due to the low-protein diet that I have to adhere to because of chronic renal failure. I can no longer eat as much food as I want because a lot of food contains protein. I believe that it is because of this that my bowel movement has been affected.

Chronic renal failure causes anemia. My anemia is slightly below the normal range. I have to make up for the reduction in red blood cells with iron supplements. Iron supplements cause constipation. That caused a lot of problems for me because I could not empty my bowel fully. To counter that, I started taking Lactulose in the middle of last year.

Lactulose is a form of liquid synthetic sugar. It tastes sweet just like sugar syrup. It is almost never absorbed in the stomach. It is instead metabolised by bacteria in the colon. This process draws water into the bowels and softens the stools. I am taking 15ml of Lactulose daily after lunch. It has greatly helped in my bowel management. I seldom, if never, get constipated after I started on it.

Lactulose alone will not solve the problems of constipation. Water intake should be sufficient too apart from a diet high in fibre. Currently, I am eating up to four portions of fruits, not only to prevent constipation but to vary the tastes in my meals because of the limited choice of food that I am allowed to eat.

Lactulose also draws ammonia from the blood. It is used to treat people with liver disease. Lactulose also causes gas. This could one of the reasons for the unpleasant putrid smell in the stool and when breaking wind. Overdosing on Lactulose may cause diarrhea, excessive gas and stomach upset. Therefore it is advisable to consult a doctor first before taking it.

Proper bowel management is vital. It allows me the freedom to go out confidently without the fear of accidentally soiling my pants. Over the years, my bowel management program has not changed much. I have worked this into a routine to allow me the flexibility to plan my daily activities and trips outside appropriately.

I found it most comfortable to move my bowels every other day. It is easier when there is more bulk. I do not follow a set time but I usually select evenings where I bathe afterwards so that I do not need to do it again later.

One suppository is usually sufficient to initiate bowel movement which occurs approximately 30 minutes after insertion. In rare cases, when I am constipated and there is no movement after the normal duration, another suppository is inserted. All in, I spend about 1 hour from insertion to completion.

Diet plays and important role in my bowel management. I drink about 3 litres of plain water daily, excluding fruit juices, soups and other beverages. This helps in keeping my kidneys and bladder flushed to prevent the formation of stones and infections.

Fruits and vegetables are the main features in my meals. Whenever I can remember, I drink prune juice, too. This greatly aids in moving my bowels more efficiently. On the other hand, I try to avoid greasy and spicy food. More than once, I had diarrhoea after eating such food.

Note: This was written in February 16, 2003. I have since modified my bladder management and will post an update soon.

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