pain meds and constipation

[alan]

It's well known that pain meds (and many others) cause constipation (it's one reason I've had to stop some of the meds I've tried over the years.) When I'm on meds, what can I use to keep the bowels flowing? I'm on an every third day bowel program with the magic bullet, and usually things only come out via digital stim by my caregiver. I take senokots and pericolases every day (extra the night before), take softeners, drink Citrucel daily, drink prune juice, and make sure that what little I eat includes fruit. What's left?

[SCI-Nurse]

Alan, have you met with a dietitian to see how much fiber you are really getting? Often I find people think they are eating high fiber, but are not. A study done at RIC found that while 30 gm. daily is recommended, even after teaching their average SCI outpatient was eating only 8.5 gm. daily.

How much Sennakot are your taking and when? How much fluid to you take daily? Have you tried taking a saline or osmotic laxative regularly (Lactulose or milk of magnesia for example)?

I am sure you don't want to hear this, but you would probably do better if you did your bowel care every other day rather than every 3rd. The longer your stool sits in your intestines, the dryer and harder it gets. (KLD)

[alan]

You're right - I didn't want to hear that. :-)

I'm taking the senokot daily. The night before, I take senokot and a dulcolax. After the magic bullet, we wait up to half an hour for it to start before resorting to the dig stim. Even when the bullet was working properly, I needed digital to get all the stool. Haven't tried the other laxatives you mentioned.

I'm sure my fiber intake is low, as, due to the abdominal pain making me feel constantly full, I can't eat much.

I'm able to drink about two liters a day, most of it in the evening when an aide is here.

[This message was edited by alan on October 09, 2001 at 09:50 PM.]

[rybread]

I just recently had my gallbladder removed and was full of all sorts of pain killers. I was already backed up before I went into surgery so when I got out the surgery, I really need to go but was having a hard time. I had 1 beer the night before I did bowel care and it seemed to flush me right out the next day. I will try it again next time I am backed up. But may be that can help you.

O yeah, just so that you don't think I am a lush, my injury is alcohol related and I only have a drink once every few months

[alan]

My doctor is trying me on lactulose. We're also going to try MSContin again, and get past the 90 mg level I stopped at due to consipation troubles the last time I tried it. That level had no effect on the pains, but I couldn't go higher.

When will long-acting dilaudid be available in the U.S.?

[SCI-Nurse]

Alan, how much Sennakot do you take? You can safely take 3-4 at a time.

For anyone with constipation, I suggest drinking a MINIMUM of 3 quarts of fluids daily, preferably water. Can your aide set up a gallon jug that you can access with a long straw or other set up? We often do this with suction tubing for our clients.

There is no reason that needing to do dig stim is a problem. It is not needed only for people who are constipated. Many people with SCI use only this for bowel care and don't use a suppository at all. Dig stim primarily relaxes the anal sphincter to allow stool to pass (admittedly more difficult the harder the stool) and only secondarily does it stimulate rectal muscle movement to move stool out of the rectum. The suppository mainly moves stool into the rectum so it can come out.

(KLD)

[alan]

I was taking two senokot at a time, with one dulcolax added the night before "fun day" (as we call it.) Now, we'll try the lactulose for a while, since it's now here. So is MSContin - doc wants to try to reach an effective dose this time. I read the posts in the pain forum re the marijuana spray that was tested in another country - why can't we have that here? Blasted "War on Drugs."

I always thought dig stim was something you wanted to use as litttle as possible. Thanks for the heads-up.

Re fluids - I have a container of water next to me, plus every half hour in the evening, the aide brings me juice.

[Scorpion]

Dig stim long termed shouldn't be a problem, as long as you use plenty of lube (like KY) and just be gentle. Bigger stuff than your finger or dig stim tool moves thru your rectum. It's the oral laxatives taken continuously over the long term that can cause problems.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo