Should I stop taking Sennosides (senna glycoside) for my rectal prolapse given my history of severe kidney infection, impaired renal function, mobility issues, confusion, memory loss, bowel and urine incontinence, and concerns about long-term side effects?

Urgent Surgical Evaluation Required—Do Not Stop Sennosides Without Surgeon Consultation

You should NOT independently stop taking sennosides before speaking with your surgeon, as this medication was specifically prescribed to manage your prolapse until surgery can be performed. However, your current clinical presentation suggests you may have an incarcerated or strangulated rectal prolapse requiring emergency evaluation, which supersedes any laxative concerns.

Your Immediate Clinical Situation

Your description indicates a surgical emergency that requires urgent medical attention 1:

• 3-3.5 inch prolapse with 6-7 inch circumference that cannot be reduced for one month
• Dark red/purplish discoloration ("blood sausage" color) suggests vascular compromise
• Bloody clots and mucus indicate mucosal ischemia
• Inability to sit reflects severe tissue edema and inflammation

Complete external rectal prolapse that becomes incarcerated poses a risk of strangulation 1. The color changes you describe are concerning for compromised blood flow to the prolapsed tissue, which can lead to tissue death if not addressed urgently.

Regarding Sennosides Safety

The concerns you've read about "irreversible long-term damage within 2 weeks" are not supported by medical evidence:

• There is no clinical or animal evidence that sennosides damage intestinal muscle or nerves with prolonged use 2
• The historical concern about myenteric neuron damage has been scientifically disproven 2
• Over 90% of sennosides are excreted in feces, making them safe even with kidney dysfunction 3
• In pediatric studies tracking 640 patients, the only significant side effects were minor (abdominal cramping, diarrhea) or rare perineal blistering with high doses and prolonged stool-to-skin contact 4
• No evidence of tolerance development exists in the medical literature 4

Why Your Surgeon Prescribed Sennosides

Your surgeon prescribed sennosides because stimulant laxatives increase colonic motility and can help reduce prolapse size by promoting regular evacuation and reducing straining 2. The goal was to:

• Prevent further prolapse worsening from straining
• Potentially reduce tissue edema through regular bowel movements
• Maintain bowel function until surgery

However, sennosides will not "shrink" an already incarcerated prolapse that has been irreducible for one month with the degree of vascular compromise you describe.

Critical Safety Considerations for Your Specific Situation

With severe kidney infection affecting both kidneys and ongoing renal impairment, you need to be aware:

• Sennosides are actually safer than many alternatives because they are 90% excreted in feces, not through kidneys 3
• Magnesium-based laxatives should be avoided in renal impairment due to hypermagnesemia risk 2, 3
• Your confusion and memory loss may affect your ability to manage medications safely

What You Must Do Immediately

1. Contact your surgeon's office TODAY to report:

   • One month of irreducible prolapse
   • Dark purple/red discoloration
   • Bloody discharge and clots
   • Inability to sit comfortably
   • This constitutes a potential surgical emergency requiring evaluation before your scheduled surgery date

2. If you cannot reach your surgeon immediately, go to the emergency department because incarcerated prolapse with color changes suggests possible strangulation 1

3. Do not stop sennosides without medical guidance, as sudden cessation could worsen constipation and increase straining, potentially worsening the prolapse

Addressing Your Broader Medical Concerns

Your severe bilateral kidney infection has clearly caused significant complications:

• Mobility impairment requiring walker/wheelchair
• Cognitive changes (confusion, memory loss)
• Bowel and urinary incontinence
• Loss of sensation for gas passage

These complications, combined with your rectal prolapse, require coordinated multidisciplinary care including nephrology follow-up, physical therapy, and possibly cognitive assessment. The depression, anxiety, and claustrophobia you describe are understandable reactions to sudden loss of independence and require mental health support.

The Real Risk You Face

The immediate threat to your health is not sennosides—it is the incarcerated rectal prolapse with signs of vascular compromise. Strangulated prolapse can lead to:

• Tissue necrosis (death)
• Perforation
• Sepsis
• Emergency surgery under worse conditions

Call your surgeon immediately or go to the emergency department. The sennosides question is secondary to the urgent need for surgical evaluation of your prolapse.