When would you go to A&E?

[Usedphone]

I suffer from chronic constipation, I've been to the GP in the past and they just have me tons of laxido and senna to use "sparingly/when needed" but that was it.

The hematologist mentioned it was related to my iron malabsorption (by not dieting it, it sediments in my colon and causes blockages). He also said there was nothing that could be done, and it had never been mentioned again.

So I've been suffering from a blockage for the last 3 weeks I still go, so I get some relief, but this time the laxatives have stopped working which made me go to the pharmacy. There the very kind pharmacist gave me like 20 mins of his time because he was shocked that after 4 senna tablets NOTHING has moved. I took them in one go btw. He then told me the next step was A&E because there was not much more tablets could do.

So then he told me to take 8 sachets of laxido and that if still nothing had moved it was hospital time.

So here I am 12 hours after I took the first 2 sachets, and about 6 since I took the last 2 (8 total) and still nothing! I just have pain but that's it.

Given that I'm not a priority case, would it make more sense to wait it out another day (and take 8 more sachets)? I'm thinking of popping in after my 9am meeting hoping that they see me before the school run, and if they don't, I just walk back home. The only thing is that for the past 5 days it has become super painful, especially my lower back.

You must be in terrible pain, OP. Unfortunately, with such a bad blockage, I think you're expecting movicol etc to work much faster than it actually does. It takes months. Build up to taking the maxmimum dosage and keep taking it until you are pooing brown water. Slowly reduce the dosage and then when you get back to normal, take 1 a day to keep you that way. For a quick solution, the pharmacist was right, and an enema at the hospital is the only way. It won't stop the problem happening again though.

Movicol is something that softens the poo to help it come out. If that's not working, there is something else the hospital can prescribe. I can't remember the name DS was prescribed, but it was a stimulant which causes the intestine to contract, forcing the poo to move down and out. It causes VERY painful stomach cramping, but is effective. I hope you get some relief soon!

I'd take the pharmacist's advice and go to A&E. But be prepared for a long wait. You might get seen quickly but can't guarantee it.

Please either go to A & E or an Urgent Tretment Centre even if they check your tummy and make sure there isn't a blockage there and send you on your way. You are not wasting anybody's time!

I don't want to frighten you, but constipation can be very serious. My sister was in a similar position a few years ago and tried to soldier on. She ended up going to A & E when she started vomiting brown liquid and was doubled up in agony. She had to have a 2 hour operation and was lucky not to end up with a stoma bag. She spent a week in intensive care and another three weeks in hospital.

I really hope you’re on your way to A&E now. I don’t understand why you would ignore the pharmacist and then the nurse who replied on p.1 here and delay for so long.

Yes exactly, I think it has been mismanaged by both the GP and the Hematologist but at least the pharmacist connected the dots.

'A&E is the right place. You’ve not had a bowel movement for absolute days - you are at risk and they need to rule out toxic megacolon, blockages etc.'

Lots of things put people at risk but until someone is vomiting or in severe abdo pain then A&E isn't always appropriate despite what a pharmacist said. A review by a hcp yes, but a nurse at the gp surgery couldve performed a rectal and assessd the situation. Or prescribed/administered enemas.

A&E are such an overcrowded horrible places, someone with constipation will be kept waiting hours and hours. Primary services either gp or utc would have sorted this much quicker.

Absolutely. I’ve been with someone when the worst happened. Get there NOW.

Waiting to be triaged

Is there a reason the OP can't give herself an enema at home if that's what they would do at hospital?

Ring 111. They might get you an urgent GP appointment.

If you don't go to the loo soon you'll need A&E regardless and you'll become an emergency, so if you don't want to ring 111, go. You're not a time waster. You've tried home remedies.

She’s following a medical practitioners advice. Which of course is the correct thing to do.

I nearly had to go to A&E once with an impaction after a few days of having to take codeine for back pain. I had lactulose which eventually worked, but omg it was like giving birth on the toilet. I don't take codeine anymore now, I don't trust opoids.

Not even any seepage past the worst bit of blockage? This sounds absolutely horrendous. i can only imagine the cramps you must be getting.

I hope you’re seen/ sorted out soon . I think so much of the nhs is firefighting healthcare. So the person you’re talking too will deal with an immediate problem but prevention of future issues not really a priority.

I haven't read the whole thread but I think/hope you're at the hospital now, OP.
I spent 5 days in hospital last November with a bowel blockage - apparently caused by Covid. I got taken into A&E and then straight into a surgical ward.

I was in the most incredible pain and was sobbing and begging for morphine (which helped until it wore off). I didn't get the treatment I needed for 5 days.
I'd say to anyone to get help before you get to the state I was in. I was climbing the walls in agony. I was worried about time wasting too so didn't contact my doctor until it got really bad. I would never let that happen again.

Have you thought of having a regular colonic irrigation? You'd need to take a daily supplement (can't recall name) but sure a professional practitioner would advise.

So glad to hear you are in the right place

Told me to keep taking laxido and see a GP, oh well! The pharmacist was too cautious clearly

Oh for goodness sake. Icy water and icy coke zero usually makes things move for me when I'm very stuck & after taking laxido. As does peppermint and green tea.

Also some gentle exercise/rotating my hips and abdomen with my knees higher than my hips while on the toilet helps.

Have you tried a tummy massage? Like you do with babies?

I hope they examined you before sending you away. If your symptoms change or you start being sick, go straight back. They can be far too quick to dismiss constipation which then gets impacted and becomes serious.

Get well soon 😊

Glycerine suppositories are great, I have a redundant colon, so it becomes sluggish, I take laxido, but if I get impacted I have to use a suppository to get rid of what is in the rectum otherwise the softened stool from the laxido can not pass, good luck OP

Yes, please do go back if it gets worse. I had someone in the hospital asking if I'd tried moving around to relieve the constipation....this was after two days of agony, and I was crying and hanging off the bed (the only way to even get vaguely comfortable), and before I'd been admitted had taken probably three times the amount of laxatives you're supposed to to get things moving...

I guess I don't look in agony, but the truth is I never do! Even when I had my appendix removed it almost ruptured because I had really mild pain.

So you've not been able to pass in about a week, have had intense pain in your abdomen and lower back for the last 5 days,have maxed out the laxido intake with no improvement, have tried other medication with similarly no improvement, and finally have had the pharmacist send you to A&E as no medication they recommend is working.....and the response is they are sending you home?!

Have you stressed all the above to them? There's no way I'd accept being fobbed off like that.

Well of course. But I was asking if there was a reason that it couldn't be done at home.