I started PD Cath about two or three weeks ago, have trouble with consistent draining, PD Nurse indicates it is probably constipation; however I am not constipated at least in the ‘normal’ sense of the word.
Do PD Cath patients require on going use of laxatives ? Seems to me that hemo provides more freedom as the PD Cath has been nothing but time consuming, storage problems and disposal issues.
What do you mean by “constant draining,” Bill? Leakage around the catheter? Are you doing CAPD or CCPD?
Many people with kidney disease take stool softeners to stay regular. The typical dialysis diet is low in fiber and fluid, two key things that help most people stay regular. Certain other medicines, especially phosphate binders also have a tendency to constipate. Having PD fluid in the abdomen can also add to the problem of constipation. However, making sure the bowels get cleaned out can make a huge difference in how well PD solution drains.
Other possibilities so far as poor draining could be that your catheter is not in the right place. If it has moved around in your peritoneal cavity so the tip is no longer down near your rectum, it may not be able to drain as well. Also, it’s possible that some of the holes in the catheter have gotten plugged up with fibrin.
Depending on how long you leave your solution in, your body could also be absorbing some of the dialysate so you don’t get off as much as you should. The peritoneal equilibration test (PET) can tell whether you are a “high transporter” or not. If you are, you may need to have shorter dwell times to keep from absorbing too much dialysate. Here’s a booklet on peritoneal dialysis dose and adequacy that describes the PET. If you haven’t had a PET (a test of adequacy of PD) lately, you might want to ask your nurse to do this to be sure that PD is working well for you.
Finally, here’s a troubleshooting guide for different problems with PD, including draining problems:
Constipation is a frequent complaint of both hemo and PD patients. Colace and Lactulose are pretty freely prescribed on both sides of the dialysis world. Sometimes the constipation isn’t immediately apparent because it’s in the upper part of the intestines. You’re sailing along before you realize that, “hey, I haven’t gone in five days!”. or maybe that should be
I wouldn’t exactly say hemo is less trouble than PD. I’m on hemo myself, but if you ask me, they are both equally troublesome. PD spreads out the trouble more evenly over the day, while regular in-centre hemo concentrates it within 3 four hour periods per week. Daily hemo is better in many ways, but it’s a little more like PD in that you have to do it almost every day of the week (and performing a hemo treatment every day is a lot more complicated than doing PD).
I would suggest that as long as you’re already on PD, it would be better to gradually get all the problems resolved and stay on PD as long as you can, rather than switching to hemo right away. At the very least, that way, you are preserving your potential access sites for any future hemodialysis.
From my experience with PD (mid nineties) my S.O. went through some constipation difficulteis. From your description, I would be concerned with catheter placement. Lois’ drainage problem became serious once peritonitis had set in. Leakage around the site is something to look at. Have this checked quickly by your nephrologist. PD can be the most exiciting modality when done properly. Personally both PD and HHD are the most beneficial when compared to in-center. You obviously have a support system to do PD. Look into HHD if possible but don’t switch in haste. PD is easier in certain respects.