It has been suggested from the Random Question thread that this topic deserved it’s own. Sorry it took me so long to start it, but from the title, it can be assumed that there are other issues which are a problem here. Of course it better to avoid the opiods. But sometimes that is just not an option. I also have little knowledge of the subject. Can’t tell you the difference estool softeners, fibre or anything else. All I know is nothing that I have tried seems to be a good solution and it is already making a bad situation worse. And yes, I have discussed it with primary care physician, gastroenterlogist and every other specialist I have seen. Appears solution are from as mild as stool softeners that don’t do anything and might actually be harmful to suppositories to be used in extreme situations that we don’t want to get to.
So…any recommndations? experts, or just who to ask?
There is some new drug on the market for this very thing. Have you discussed it with the doc? I don’t remember the name, but have seen the commercials.
It’s true that you don’t want to eat a lot of fiber once you are already constipated. Have you tried miralax (with doctor’s okay,of course)? Not just one dose, but spaced a few times throughout the day,and then once a day after you get regulated? Some of the docs in my endoscopy center use this tactic. Again, ask the doc FIRST if this would work. Obviously not an option if you’ve already tried it.
You have my sympathies. This has been a problem for me post-op, and is the reason I’ve said I could never take opioids long enough to get addicted.
I was also going to suggest Miralax. My mom had severe digestive problems after extensive small bowel surgery. She was avoiding solid food and losing weight. The doctor recommended Miralax every day and she has done well with it for 5 years now. It is a simple osmoticant, drawing water from surrounding tissue into the bowel, so no worries about the bulk of fiber.
Only reason I am even aware of this condition is the seemingly incessant commercials I see on TV at dinnertime for some drug - which I cannot remember the name.
I dread the constipation after surgery as much as I dread the surgeries. It’s also why I never take the pain pills as long as I should. I suffer from chronic C6-C7 spinal issues and can certainly understand why people do take them.
I tried the Miralax, but didn’t have near the luck other people seem to have. It gave me bad stomach cramps. Milk of Magnesia works every time for me though, and doesn’t cramp as bad as the other things I have tried.
This is going to be a TMI so I am giving due warning!!!
The last time this happened to me, I ended up having to use an enema - just a cheap squeeze bottle from CVS. Once it became clear that Miralax wasn’t quite working (and the ER gave me the stuff that they give to colonoscopy patients- and that STILL didn’t work!), my GI told me to do the enema. Once things got going again, the Miralax kept it going.
Good luck. I’m sorry… everything about this sucks.
Miralax IS the stuff they give to colonoscopy patients – sometimes alone, more often together with electrolytes (e.g.Golytely). It’s just a matter of how much you take. It is osmotic, meaning it attracts water, and it isn’t absorbed into the body so it pulls water into the gut. Stool softeners work similarly but are milder. But opiates decrease contraction of the gut, so sometimes osmotic laxatives aren’t enough, in which case you need a stimulant laxative. For most constipation we avoid those because you can become dependent on them, but we usually turn to them pretty quickly when people are on opiates, because the constipation can be severe. We use senokot 2 pills at bedtime. If that doesn’t work, you can do 2 pills twice or sometimes even 3 times a day. If that’s not working, get in touch with your doctor before too many days have gone by – the constipation can get harder to treat over time. I’m not surprised that magnesium helped @ams5796 because it also stimulates contraction in the gut, but it’s not safe for people with very poor kidney function.
My daughter used Miralax, Colace, and warm prune juice. It took at least a week to sort things out. You also must drink twice your normal amount of water.
She has another surgery coming up this summer and is dreading the constipation as much as the pain.
@Massmomm, the problem is that many people aren’t proactive, they are reactive. Once you are already constipated, it’s more difficult to relieve. Many of these methods, if started on day one, can greatly reduce the GI problems associated with narcotic pain relief. Make sure your daughter is very well hydrated prior to surgery and start the miralax or other doctor recommended medications from the get go.
I have been just as guilty as the next about that, however. I always foolishly believe that this time won’t be so bad. Silly.
So true. You have to try to stay ahead of it since it can turn into a dangerous situation very quickly. I deal with this on a regular basis since I am a colon cancer patient. It’s tough to stay on top of. I have never been able to use Metamucil or any of the fiber supplements because of terrible gas. Really the only relief has been from magnesium supplements and an occasional enema.
Miralax…no “violent” cramping or expulsion, no (fiber) bulking (Metamucil), no taste, and it really works. Start with 1/2 recommended dose, taken before bedtime to gauge the relief. I swear by the stuff (I suffer from IBSC) -
I have seen some patients on opiates treated with just miralax who required hospitalization and in one case came close to colon perforation. Not saying it doesn’t work for some or even most people, but it doesn’t work for everyone.
Agree with @CIEE83 . The mechanism for opioid-induced constipation is different than ‘normal’ constipation. Miralax is not a… propulsive. The gut’s nervous system is asleep. Osmotic agents don’t help for many patients. In my experience, true laxatives (that stimulate gut action) work, but they can be tough to tolerate. And another vote for good ol’ milk of magnesia (Mg is a gut stimulant, see: mag citrate for scope prep), and enemas (which are osmotic treatments but are safe and cheap and easy, and often quite effective.)
@jaylynn, I just read the insert for Movantik, and it does reflect what you are saying about opioid constipation being an entirely different animal. It calls itself an opioid antagonist that works by blocking opioids from binding to mu-receptors in the bowel. So it doesn’t interfere with the medicines’ binding to the receptors responsible for blocking pain response, but keeps them from exerting their normal action in the gut. Of course, like any drug, possible side effects can range from nuisance to severe. Always a price to be paid.
I know nothing about this medication other than that. I don’t think it’s been around long enough for me to have heard any buzz (bad or good) about it. I don’t work in a unit with lots of patients who are on narcotics.
Have you heard anything of substance about Movantik?