Jane,

Dulcolax is poorly absorbed by the mother and has limited secretion into
breastmilk.  (Hale '96).  Magnesium Citrate has an osmotic effect, bringing
water into the intestines similar to Mag Sulfate.  Uptake into the milk
should be minimal.  (Local pharmacist).  Nulytely just goes through the GI
tract.  You may ask her if she's getting enough liquids that ARE absorbed.
 After drinking four liters she won't be the least bit interested in clear
liquids, but she doesn't want to become dehydrated, either.  You can let her
know that the prep for the colonoscopy is the worst of it, the procedure
itself isn't as bad as she imagines.

My favorite colonoscopy drugs are Fentanyl and Versed.  Fentanyl has a short
half-life.  "In one study of 8 and 9 patients treated with fentanyl...during
delivery, milk levels of fentanyl post administration were undetectable
(colostral milk)." (Hale, '96)
"Versed (Midazolam) disappears rapidly from milk with undetectable levels
after 4 hours.  The authors suggest that waiting 4 hours after dosing would
expose the infant to minimal midazolam." (Hale, '96)  She may want to pump
for comfort.

There are many drugs used to treat IBDs (inflammatory bowel diseases).  I've
tried them all!  The first one is usually sulfasalazine (Azulfidine).  The
research results are mixed and do not make it easy to decide whether to
continue breastfeeding or to wean.  The American Academy of Pediatrics lists
this a one of the "Drugs That Have Caused Significant Effects on Some Nursing
Infants and Should Be Given to Nursing Mothers With Caution."  Some studies
say the drug is safe.  Some say there are theoretical risks of neonatal
hyperbilirubinemia.  Since I was nursing a four-year-old, it was easy for me
to decide to continue breastfeeding.  There are a lot of side effects to
Azulfidine.  There are also enteric-coated tablets and retention enemas
available.

Prednisone, a commonly prescribed steroid, is approved by the American
Academy of Pediatrics for use in breastfeeding mothers.  There are also
steroidal retention enemas available.

The next class of drugs are immunosuppressant drugs.  I took azathioprine
(Imuran).  I did NOT breastfeed while taking this drug.  The benefits did not
outweigh the significant risks.  Dr. Hale posted about this drug 8 Feb 1996.


She may be relieved to know that breastfeeding can help prevent inflammatory
bowel diseases in her child.  There can be a familial tendency to develop
IBDs.  Research is being done at Stanford.  The HMBANA lists breastmilk as
preventive for colitis and Crohn's disease in their "Clinical Uses of Banked
Donor Milk" handout.  There is also the following research:

Koletzko, S, et al.:  Role of infant feeding practices in development of
Crohn's disease in childhood, Br Med J 298:1617-18, 1989

Bergstrand, O. and Hellers, G:  Breastfeeding during infancy in patients who
develop Crohn's Disease, Scand J Gastroenterol 18:903-6, 1983

If she chooses treatment incompatible with breastfeeding, she may want to
look into the option of banked donor milk.  Give this mom a lot of support
and encouragement.

If any of you knowledgeable lactnetters have information about using
breastmilk as a treatment for IBDs, please let me know.  I keep hearing
rumors.  Anecdotal evidence very welcome.  I'm hoping to avoid a colostomy.

Elizabeth Puzar, IBCLC