Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Constipation from your Medications: What helps?
Posted in Alzheimer's Dis... by Dr. Sharon Orrange on Jun 30, 2008
Many of you know that Opiates, non steroidal anti-inflammatory drugs, and other drugs, are associated with constipation. Constipation can become a bigger struggle for you than the illness that led you to take the medications. Why does this happen? And what works and what doesn't for treatment of medication induced constipation?

Why does this happen?
Opioids and other medications affect all segments of the stomach and intestine (particularly the colon) altering nerve input to the GI tract which inhibits movement. Additionally, opiates may increase the absorption of electrolytes and water (making harder drier poops), increase anal sphincter tone and reduce sensitivity to the presence of stool. All of these factors contribute to constipation and hard stools. And misery.

What doesn't work?
Fiber and Bulk Laxatives (psyllium, bran, Citrucel, etc.) are generally not effective for the treatment of drug-induced constipation. Period.

What does work?
Stimulant Laxatives: Senna and Bisacodyl (Dulcolax) increase intestinal motility and help with the efflux of water INTO the bowel which improves constipation. SENNA is more commonly used and slightly more effective than BISACODYL (Dulcolax) for opioid-induced constipation.

Osmotic Laxatives: These include Magnesium or Phosphate-containing laxatives and nonabsorbable sugars (Lactulose, Sorbitol, Glycerin) and polyethylene glycol (Miralax). They work by increasing fluid accumulation in the colon and small intestine which improves constipation. These are effective for treatment of opiate induced constipation. Some data show that lactulose is better than sorbitol and that Miralax is better than lactulose.

Emollient Laxatives: These include Colace (Docusate), or mineral oil. However, they are inferior to the osmotic and stimulant laxatives when used for the treatment of drug induced constipation.

Any new options?
Yes--Methylnaltrexone (Relistor) is the newest medication found in recent studies to provide good relief of opioid-induced constipation in terminally ill patients who do not respond to laxatives. Relistor is a subcutaneous injection and represents an important therapeutic option for patients with advanced illness who are suffering from opioid-induced constipation.

I hope this helps.

Dr. Orrange
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27
Dear Dr. O,
I so much appreciate you taking the time to give us this information. My question is what kind of doctor can prescribe Relistor. I have been on a medication called suboxone for pain management as i am also a recovering alcoholic. I am afraid my gastroenterologist will not know of this medication. My last colonoscopy showed my colon does not work. I have already had a partial sigmoidectomy and rectoplexy. I have constipation as a result of multiple sclerosis. Please help I am desperate!
By rebb  Jul 31, 2009
26
I have IBS and have tried a number of remedies, whether it be fiber, a prescribed pill, etc. and the best aide I have now for the bloating and constipation I have from that and as a side effect of some of my medications, I now take Sustinex, a rather new probiotic, which I found at a local supermarket. Works like a charm, with no spasms or nasty cramps.
By flip12flop  Oct 31, 2008
25
Hi! Are their foods that can be added to my diet that will work to prevent constipation?
By Sunflowers21  Sep 06, 2008
24
Dr. O! My mds put me on Amitiza (lubiprostone) capsules , they seem to do the job! I think it is new!
By tennmike1957  Sep 05, 2008
23
I've been hospitalized with impaction twice. Very painful. I am now on Miralax, that I also supplement with 3 stool softeners a day. My doctor told me the Miralax washes, or pushes, the stool out but the softeners will keep it soft. It works for me. I think the over the counter Miralax isn't as strong as the prescription one, but I may be wrong. And yes, any activity will also help to get movement. Walking is best, but I just turn my body from side to side a few times a day and that seems to help.
By 1gr8lady  Sep 01, 2008
22
Somebody pleeeeeese help. I'm really hving problem rite now, use the Magnesium, currently trying new one 4 women, Miralax... HELP !!! Evn' trying prunes, not much help either.... Thanks purrelgato8@comcast.net
By purrelgato  Aug 31, 2008
21
A small dosage of Colace 2x day, had severe blockage about a month ago, vomitted up 'brown stuff', knew I couldn't handle this anymore. I also have a small bowl of Raisin' Bran every morning, all of this has made a big difference. I'm on 3 different pain medications, not to mention my other 7 medications, which subjects me to constipation. So far this is working.
By ACatLover  Aug 29, 2008
20
When I had my hysterectomy awhile go, I was put on an opiate pain killer that caused such sever constipation that absolutely none of my basic cures worked. I have IBS with constipation to begin with, and being on those strong painkillers gave me just about the worst intestinal pain ever!! I could have used a stick of dynamite it was so bad. I know that for me I can only take limited doses of opiate painkillers from now on. Colace did help me, but any fiber treatment never works for me, not even Miralax.

Now I have been using a probiotic to help me with my IBS, but I still have to be very careful not to eat anything too greasy or too spicy. Also, I need to control my stress level which helps.
By flip12flop  Aug 11, 2008
19
I was recently hospitalized due to an intestinal blockage. Don't want to go through that again! All my medications and being partially paralyzed and in a wheelchair are a major factor for me. Anyway, I'm now taking Miralax. And it is keeping things regular. But,it causes me a lot of gas. And it is very hard to find relief. It was terrible most all day yesterday. It started in my stomach and went up into my chest and neck. Does anyone know what is good to take for that? I have this daily at some level.
By TeenyT  Aug 09, 2008
18
This may seem too simple. I've not had to take opioids for 21 months now, but I did regularly for a total of 9 years. Believe it or not, i found a regular diet of Kellogg's Frosted Mini-Wheats really kept me regular and when i didn't eat that, the constipation was much worse. Go figure.
By hmyers512  Aug 02, 2008
17
Bentlyfox: I guess I would give colace a try.
By DrOrrange  Jul 12, 2008
16
I am allergic to polyethelene glycol - brings me out in hives. Lactulose heps a bit, but mostly I rely on enemas when things get too bad.Have you any other suggestions?
By bentleyfox  Jul 06, 2008
15
I use a natural product called aloelax, doesnt cause cramping etc. I take at night at bed time and have a nice normal BM in the morning.
By asilinc298  Jul 05, 2008
14
MANGO...MANGO...MANGO...GERBER BABY FRUIT MANGO THE BEST!
By nemcgrath  Jul 03, 2008
13
Dancingd: Senna should not give you those "sudden accidents"
By DrOrrange  Jul 03, 2008
12
I wish I would have read this a long time ago, thanks. I have been hospitalized twice the past couple years from constipation. a horrible experience! I now take peri colace daily and no longer have the problem! No side effects
By sweetheart1969  Jul 03, 2008
11
Thank you for this article. I am taking seroquel and have been having this problem. I have been using traditional methods (bran, flax seed and bulk fiber) but it never seemed to work as it should. I will have to mention this to my doctor, see if I can get something to help :)

David
By StillOfTheNight  Jul 03, 2008
10
I take bipolar meds,and every single one of them ,has constipation as a side effect.
The fiber and Citraucel have not worked.Sometimes Flax seed oil helps,I'll try the Senna,but one of the side effects of one of my BP meds,is rectal incontinence..I don't want any "sudden" accidents.Would that happen with Senna?
By dancingd  Jul 03, 2008
9
I have degenerative disk disease,scoliosis,3 heriated lumbar disks, 1 herniated disk in my neck along with spinal stenosis, nerve damage to my right leg as a result of a botched rysotomy and a bad case of fibromialgia for over 28 years. Because of that, I have to be on strong pain meds. I wear a 50 mcg fentanyl patch which I change every 3 days, and take 100 mg. of dilaudid twice a day. Obviously, I didn't start out at these drugs or these dosages. I got to the point where oxycodone did nothing for my pain. Also, my pain has increased over the years as my disks have continued to worsen. I also have facet joint syndrome
After trying nerve blocks, steroid injections,and several facet injections, none of that noticabily helped. The medications I'm on now keep my pain level at a tolerable level, but I still have fibro outbreaks. I tried taking lyrica, and the results were miraculous! Of course, I still have to watch what I do.
With all this, I also have had IBS for many years(before my back pain even started). I also have to take several drugs for bipolar disorder, many of which are constipating.
My biggest problem ruining my life is constipation. Twice I went off all my pain meds, and I could poop naturally, but the back pain was so horrible that I would end up in the ER where they'd refuse to give me anything stronger than high-powered asperin. They made you feel like a drug addict. I would end up in bed crying and screming from yhe pain. So sooner or later I would go back on the opioids. Little did I realize how badly the pain had increased until I stopped taking the meds and returned to my pain management doctor.
In a 6 month period of time this year, I ended up in the hospital with impactions. Despite laxitives, I couldn't pass any stool. X-rays revealed that I had stool high in the upper colon blocking passage of any stool.After drinking Golightly and being taken off whole food, it worked both times. I was not looking forward to surgery.
Every 3 days, I have to resort to a laxative, and I'm sick with IBS and cramping all day long. It's a terrible lifestyle.
My problem is that I become immune to whatever laxative that I try. At first it's like a miracle, but after awhile, it stops working for me. Miralax was fantastic until it stopped working. I got to where I could drink 10 glasses a day and not poop the next day. The same thing would happen with all the others-even at increased doses.
I plan to ask my doctor about Relistor. I just hope it's not the same drug I just finished a trial on, because out of all the participants, I was the only one who couldn't poop without the rescue drug(4 tablets of Ducolax(bisocol).Even the doctor doing thr testing for Pfiffer was baffled.
By ElaineBwn  Jul 02, 2008
8
Miralax works great for me. Mix it in a glass of water or whatever you like (it has no taste) and it'll keep you "regular"! It's sold OTC now so no prescription necessary.... Give it a try if you haven't already.
By ImSoSadNow  Jul 02, 2008

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