Pros: Takes 30 minutes to 6 hours to work, OTC and very cheap. This product has mg magnesium per serving of Mg citrate and comes in different flavors.
How it works: Soaking in a bath full of Magnesium salts allows the Magnesium to soak into the body through the skin while you relax. Pros: Over-the-counter, cheap, additional benefits including relaxing legs cramps. Many brands come with essential oils including lavender, eucalyptus and rosemary. Cons: No studies to show how long it takes to help with constipation. Be careful not to overheat in the bathtub, as temperatures over degrees can be dangerous in pregnancy.
Bonus: Magnesium salts are known to support the nervous system to help as well as relax muscle contractions, which could possibly benefit women with anxiety or restless legs. They are also recommended to help relieve migraine headaches. How it works: Glycerin suppositories are a solid dosage form that gets inserted into the rectum where it dissolves. This draws fluid into the colon, therefore creating pressure which stimulates movement. Pros: No chance of throwing it up. Fast acting — should work within 15 minutes.
Cons: Some women may not feel comfortable using suppositories. Sugar free candy because the xylitol causes diarrhea. How it works: Xylitol is a sugar alcohol found in fruits, vegetables, trees and grains. Notes: Sugar alcohols are not the same as the alcohol in drinks and considered safe for those with alcohol addictions. It is toxic to dogs and dangerous for people with colon issues including Crohns and irritable bowel syndrome IBS. Pros: OTC, inexpensive, comes in a variety of forms and flavors.
Cons: May take time to build up tolerance to the gas and bloating, there is no determined dose to start. Bonus: It is good for our teeth because it reduces the bad bacteria that feed on sugar in our mouth.
To help with constipation, there has to be fluid along with the increased fiber, so only try this is you are NOT dehyrated! If you are dehydrated and add fiber products, you might end up with sever stomach cramping. HG moms recommend f iber gummies , as they seem easier to keep down. If you find that fiber gummies are causing gas and bloating without relief, it may be due to being dehydrated.
Regardless which product you choose, try to choose a product that is free of unnecessary ingredients including dairy, soy, sugar. Look for non-GMO, vegetarian or vegan, artificial colors, artificial flavors or gluten-free if these are a concern. Also, look at the source of the fiber, to ensure it is safe during pregnancy. How they work: the fiber bulks the stools which increases its fluid content, making it easier to pass. Cons: Will only work in hydrated, as being dehydrated with extra fiber may cause painful cramping,May take days to have an effect.
Bonus: Many fiber products have prebiotics which aid in digestion. One of the oldest methods to relieve constipation, prunes are on the HG mom recommenced list too. How they work: Prunes are full of insoluble fiber and also naturally have sorbitol, which acts in the same way as xylitol. Together, these add bulk and fluids to the stools so they pass easier. Cons: Some people do not like the taste of prunes, they must stay down to work. How it works: Liquid, often saline or mineral oil, is pushed through the rectum into the intestine.
This softens the stools and adds pressure, allowing them to easily come out. Study design. This shows the two 5-week treatment periods during which subjects were randomised to either ondansetron or placebo. Week 1 was for baseline assessment, Each 5-week treatment period allowed dose adjustment until weeks 4 and 5 when no further dose adjustment or rescue medication was allowed.
Symptoms on weeks 4 and 5 provided the clinical endpoints. Symptoms were assessed throughout the study and during the washout period to ensure symptoms had returned to baseline before starting the next treatment.
Frequent visits and telephone contact ensured protocol compliance. Sequence allocation randomisation was carried out by Nottingham Clinical Trials Support Unit CTSU with random permuted blocks of randomly varying size and stratified by centre. The supervising staff obtained a randomisation reference number by a remote, internet-based randomisation system.
All participants stayed blinded until the study, data collection and assessments were complete. The code was never broken. From previous studies 11 the estimated mean SD stool consistency in healthy controls was 3. To detect a difference of 0.
To acount for dropouts we randomised Most had either a therapeutic trial of colestyramine or a test of bile salt absorption using the 7-day retention of selenium 75 -labelled homocholic acid taurine to exclude bile salt malabsorption. Patients gave written informed consent. Women of child-bearing potential tested negatively on pregnancy test and had to agree to adequate contraception during the study. Exclusion criteria were pregnancy or breast feeding, unwilling to stop anti-diarrhoeal medication loperamide or codeine phosphate , prior abdominal surgery other than appendectomy and cholecystectomy, being in another trial or being in the opinion of the investigator unsuitable.
We also studied 21 healthy controls to provide normal values for the transit studies. They completed the same questionnaires and underwent the same transit measurement protocol. They comprised 16 women and 5 men, with median age IQR of 45 23—56 years. Bowel frequency was median IQR of 1.
The hospital pharmacy provided the 5-week drug supply at the beginning of each period. The placebo formulation matched that of the ondansetron in appearance and composition, except for the active drug. The patients were instructed to start with one capsule once a day, increasing daily to a maximum of two capsules three times a day, depending on the response.
Patients attended for a total of seven visits as follows figure 1 : screening visit 1 was followed by a 1-week period when stool and symptom diaries were completed week 1. They were told to increase the dose if the stool form was 6 or 7 and decrease if it was 2 or 1. There was then a 2-week washout which was extended if necessary to ensure bowel habit had returned to baseline. Return to baseline was confirmed by asking patients whether their bowel dysfunction was back to pre-study levels and this was objectively corroborated by examination of the visit 5 diaries.
The second treatment period was identical to the first. Compliance was monitored by asking the patient at each study visit and by a final pill count of all returned medicines.
Personal baseline data were collected at visit 1: age, gender, depression and anxiety scores from the Hospital and Depression Scale, score from the Patient Health Questionnaire 15, 13 perceived stress score from the Perceived Stress Scale Questionnaire.
We used our previously described daily stool diary 11 throughout the study to provide information on stool form Bristol Stool Form score, 17 from 1 very hard to 7 water and pain perception, urgency of defecation and bloating, the last three scored as none, mild, moderate or severe 0—3.
Frequency of defaecation and number of days when pain, urgency or bloating was present were recorded. Bloods were collected for genetic analysis for the serotonin transporter promoter polymorphism see online supplementary appendix for methods and results.
We used the Metcalf's radio-opaque marker technique. The number identified on plain abdominal X-ray taken on the morning of day 4 was multiplied by 1. Regional transit was assessed from the number of pellets assigned to the ascending colon, transverse, descending and rectosigmoid as described by Metcalf and colleagues.
Baseline values were only available for the screening phase so the efficacy parameters except response were calculated for each patient as the differences between the endpoints measured in ondansetron and placebo periods. Frequencies were compared as ratios and treatment effect expressed as percenatges. Analysis was carried out with Stata First, intention-to-treat analysis ITT was carried out with available data.
Second, the data were re-analysed as per protocol PPA. The continuous efficacy parameters were approximately symmetrical and were analysed with linear regression. Preference and response data were analysed with multinomial logistic regression. The results were not adjusted for multiple testing. Of the patients recruited, were randomised as 5 did not complete the screening phase. Those who dropped out had more bloating and more frequent need to go to toilet table 1.
Consort diagram showing patient flow with dropouts and protocol violations. CRP, C-reactive protein. Worse diarrhoea at baseline was associated with decreased effect of ondansetron every 1 point baseline average stool form increase reduced effectiveness by 0. For example, people with less severe diarrhoea lower quartile: average stool form 4. One point increase in baseline stool form was associated with decreased effect of ondansetron by 0.
One concern about crossover design studies is the possibility of a carryover effect such that those who received active treatment first would have less symptoms at the beginning of the second treatment period. They were asked whether their bowel dysfunction was back to its usual pre-study level and this was confirmed objectively from their symptom diaries on visit 5. Average stool consistency in the week prior to starting the second arm of the trial was slightly improved at 5. Thus symptoms at the start of the second period were not affected by the treatment allocation in the first phase Figure 3.
As can be seen, there was very little placebo response and onset of treatment effect and loss of effect on discontinuing ondansetron was rapid, occurring within the first week in both cases. The median IQR dose was 4 2—6. Time course for stool consistency during the two treatment periods.
Time shown in weeks. The graph shows very little placebo effect with rapid onset of treatment effect on commencing ondansetron and loss of effect on discontinuing. Table 2 shows that in the ITT analysis the number of days with pain and average pain score did not change on ondansetron but patients experienced significantly fewer days with urgency and bloating.
Average urgency scores and average frequency of defaecation were significantly lower compared with placebo, though the fall in average bloating scores did not achieve statistical significance. Baseline characteristics did not correlate with the above efficacy parameters. The results were similar for PPA.
Lower numbers reflect patients who failed to take their markers or attend for the final X-ray. For example, it is much more probable 4. Data show that it is more probable 7. Patients with IBS-D on placebo showed significantly faster transit, with values of 16 7 to 29 h compared with 46 12 to 58 h for healthy controls.
Regional transit times are given in table 4 , showing that the most marked difference was in the faster transit through the left colon and rectosigmoid, something which ondansetron tended to correct, shifting transit towards the normal range so that transit times were no longer significantly different from controls. We found no difference in this effect between the three SERT promoter polymorphisms, though there was a tendency for the sl genotype to be associated with a greater clinical effect and the WGTT increase was All responded to dose reduction and only two decided to leave the trial at that point.
Most common Zofran side effects such as headache, drowsiness , constipation , and diarrhea go away when the drug is discontinued.
Zofran has a half-life of three to four hours in healthy adults, but this may be increased to six to eight hours in older adults. This means it takes the body three to four hours to eliminate half a dose of Zofran from the body, so the entire dose should be eliminated in 15 to 20 hours.
Some more serious side effects may take longer to resolve. Some, like serotonin syndrome , severe allergic reactions , or heart rhythm abnormalities , may require emergency medical treatment to get better. Severe heart rhythm problems, however, may produce lifelong complications.
Physical and medical conditions may affect the safety or effectiveness of Zofran , so some people may not be able to take Zofran and others may require dosing changes or closer monitoring for adverse reactions. The U. Food and Drug Administration FDA does not classify ondansetron as a controlled substance, meaning it has no potential for abuse or physical dependence.
Ondansetron is given either as a single dose or for no longer than a few days during cancer treatment , radiation treatment , or surgery.
Withdrawal symptoms are not experienced when ondansetron treatment is discontinued. An overdose of Zofran can be a serious medical emergency or even fatal , so get emergency medical attention if too much Zofran has been taken.
A Zofran overdose will cause symptoms such as temporary vision loss, severe constipation , light-headedness, and fainting. In addition, serotonin syndrome has been reported in children who have overdosed on Zofran. When a drug is never given to people with certain medical conditions , those medical conditions are called contraindications. Zofran is contraindicated in people who have a known hypersensitivity to ondansetron because of the risk of severe allergic reactions.
Zofran is also contraindicated in people who have congenital long QT syndrome because of the risk of serious heart rhythm abnormalities. Healthcare professionals will avoid Zofran or use it cautiously in people with certain medical conditions such as:. There is not enough research about the use of ondansetron during pregnancy or breastfeeding to be certain if it is safe for an unborn baby or infant.
There is currently no evidence that ondansetron has caused birth defects , miscarriages, or harm to a breastfeeding infant. Pregnant or nursing women should consult a healthcare professional before taking Zofran. Food and Drug Administration FDA has approved ondansetron in children as young as 6 months to prevent nausea due to cancer chemotherapy and as young as 1 month to prevent postoperative nausea and vomiting PONV. However, for children younger than 4 years of age, a generic ondansetron intravenous injection will be given instead of Zofran tablets.
People older than 65 are given ondansetron in the same doses as younger adults. However, some older adults may need to be monitored or tested regularly for side effects. Seniors eliminate the drug from their bodies more slowly than younger adults.
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