Chronic Pain Support Group
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As many of you know Opiates and non steroidal antiinflammatory drugs are associated with constipation.
I wanted to post about why this happens AND discuss some treatments of drug induced constipation:
1) Opiods affect all segments of the stomach and intestine (particularly the colon) altering GI neural input, inhibiting motility and increasing fluid absorption. Additionally opiates may increase the absorption of electrolytes and water, increase anal sphincter tone and reduce sensitivity to the presence of stool = all contributing to constipation and hard stools
2) FIBER AND BULK LAXATIVES (psyllium, bran, citrucel, etc) are GENERALLY NOT EFFECTIVE FOR THE TREATMENT OF DRUG INDUCED CONSTIPATION
3) STIMULANT LAXATIVES (senna and bisacodyl... which is dulcolax) increase intestinal motility and help with the efflux of water IN to the bowel which improves constipation. SENNA is more commonly used and slightly more effective than BISACODYL (Dulcolax) for opiod induced constipation.
4) OSMOTIC LAXATIVES: These include Magnesium or Phosphate containing laxatives and nonabsorbable sugars (lactulose, sorbitol, glycerin) and polyethylene glycol (PEG).
They increase fluid accumulation in the colon and small intestine which improves constipation and ARE EFFECTIVE FOR TREATMENT OF OPIATE INDUCED CONSTIPATION. Some data show that lactulose is better than sorbitol and that PEG is better lactulose....
5) EMOLLIENT LAXATIVES: This includes colace (docusate) or mineral oil and are inferior when used for the treatment of drug induced constipation than the osmotic and stimulant laxatives
Hope this helps
Dr O.
I wanted to post about why this happens AND discuss some treatments of drug induced constipation:
1) Opiods affect all segments of the stomach and intestine (particularly the colon) altering GI neural input, inhibiting motility and increasing fluid absorption. Additionally opiates may increase the absorption of electrolytes and water, increase anal sphincter tone and reduce sensitivity to the presence of stool = all contributing to constipation and hard stools
2) FIBER AND BULK LAXATIVES (psyllium, bran, citrucel, etc) are GENERALLY NOT EFFECTIVE FOR THE TREATMENT OF DRUG INDUCED CONSTIPATION
3) STIMULANT LAXATIVES (senna and bisacodyl... which is dulcolax) increase intestinal motility and help with the efflux of water IN to the bowel which improves constipation. SENNA is more commonly used and slightly more effective than BISACODYL (Dulcolax) for opiod induced constipation.
4) OSMOTIC LAXATIVES: These include Magnesium or Phosphate containing laxatives and nonabsorbable sugars (lactulose, sorbitol, glycerin) and polyethylene glycol (PEG).
They increase fluid accumulation in the colon and small intestine which improves constipation and ARE EFFECTIVE FOR TREATMENT OF OPIATE INDUCED CONSTIPATION. Some data show that lactulose is better than sorbitol and that PEG is better lactulose....
5) EMOLLIENT LAXATIVES: This includes colace (docusate) or mineral oil and are inferior when used for the treatment of drug induced constipation than the osmotic and stimulant laxatives
Hope this helps
Dr O.
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My 6mo twin DD's are EBF and just started rice cereal on the first. Everything has been going fine except this morning one of them had a diaper rash (lots of redness around her anus). I read this as one of the signs of an allergy. BUT I did just buy a different brand diaper yesterday (which they have used randomly before w/no issues). Do you think its the cereal or the diaper? Im ready to start...
R E L I E F.
Marcia
I hope you find some relief soon.
Be your own advocate and research all meds your prescribed as well as your diagnoses! God knows your dr sure won't! It took my bringing in Oxycontin OP's passed whole in my BM (10 of them stuck together) to get my dr to believe me that the new formula wasn't relieving my pain and was the culprit for repeated blockages! When the formula changed, it flipped my GI tract upside down causing severe GI blockages because of the added polymers/glue to prevent illicit abuse! The last thing a CP'er needs is a drug with glue in it that causes complete sessation of working bowels!!
Since tapering off oxycontin, I've gone 3 times a day without fail and without the need for a laxative, softner or enema! A month ago I appeared 9 months pregnant suffering a distended belly from constipation! I think that the majority of the time CP'ers are quick to assume they have a another disease or a new health issue when really the drugs are the culprit causing the symptomology!
We are our own best advocates!
Johns Hopkins gave me Senna after surgery so for a monthly use I know that's a good thing to use. I'm trying to find something I can take EVERY day to stay regular/normal.
I'm bumping this because it has many many references. For those searching still for their 'right combo' wean thru the posts and write down the drugs and recommendations and begin your trials (and tribulations) :)
My only question is:
I see above Miramax listed and recommended by Dr. O as better than sorbitol and lactulose. But Tipper said MiraLax so I don't know if these are the same or not. One letter different. Going to go send husband to the drug store now. Best of luck to those trying to find the right fit. Dang am offered a higher med and can't take it due to bathroom troubles. Not fair! I HAVE to get this under control! If I return to doc and say I can't take it he may never try again and I'll be bed bound for life. :(
I tried to message Dr. O and got a form/reply. I wish she would say something about lactulose and fybogel for opiod constipation. She really seems to know so much about it.
I'm afraid to ask my new pm doc. If he thinks I'm having any trouble at all he may change my (working) med or stop it. I don't know him...takes time for that kind of trust to be built up.
I have til the ned of the month to get this worked out. I need to return to the pm doc with no problems and drug test with correct amount of meds in my system without any constipation or issues. In order to be out of enough pain/keep enough pain meds so I can function and leave this bed.
All I want to do is live a normal life.
Dr. O are you out there still?
Any comments about lactulose and fybogel? I forget how I heard about these. Probably from a post. I was so miserable and in pain last night I can't remember.
I know you are all sick to death of this subject coming up yet AGAIN. If so just ignore it and sorry. But with a new doc I don't have anyplace else to turn.
Thanks. Lynne
Dr. Orange:
You posted magnesium sulfate for constipation. I googled it...I can't find that it's used for this...can you give me another name for it? Like you did for milk/mag (same post)?
Sorry people but when you can't go it's kinda front and center...got my full attention :(
Afraid to ask new pm doc. Am totally intimidated by him as he's the first pm doc to help me in a year! and I'm scared he'll change my scripts if I have any complaints. I know I employ him and all that..but when it comes to pain they have no trouble getting patients...no trouble telling people no. I've sure been told 'no' enough. So I'm looking for something otc. Guess I'll try senna a few days and go back to gp and beg for lactulose.