pain meds and constipation

Discuss different Pain Management Options; Medication options including side effects and Worldwide variances in names etc.
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

Thanks Carl and Dusty for all the info and instructions, and explanations about insoluble fiber.
Hubby is picking up Benefiber for me now. I assume I take it at bedtime, as that's when I took laxatives. Or is it better to take with meals or in the am instead?
I took a laxative last night, so tonight I am planning to start the Benefiber?

Dusty, thx I will also order the Acacia fiber. Sounds like it works well for those who take pain meds as well as those with IBS or just 'regular' constipation. I think it's smart to try different kinds of soluble fiber to kind of 'trick' your system into functioning well.
It can get "used' to just one thing and stop working well. I found that out with some laxatives over time.

I think fiber is a great idea also, as I don't have true constipation but anal spasm, so hopefully taking fiber instead will help get my system functioning more normally, as I shouldn't be taking laxatives.

Carl, you mentioned weaning off laxatives,..do you think I should : one night take a milder laxative (for ex peri-colace or regular senekot) and then the next night the Benefiber etc? I'd prefer to use only Miralax as a laxative while I'm weaning, but Miralax supposedly doesn't work for 2 -3 days, and one could get backed up by then.
Or should I start even more slowly with the fiber as your mentioned, just a few times a week.. I'm Just so anxious to get off laxatives, as I know it has been wreaking havoc on my system, as confirmed by my PT and the colon doc.
I also take Movantik (new drug to prevent opiate constipation), but I take it only every few days, as for me it seems to 'bring on the constant urge' to poop.) But it's good to have it on hand to prevent possible opiate constipation.
I pray that soluble fiber will work out well, My system has become so used to laxatives (taken since about 2012 when) I started my first opiate meds. I wish I never started them.
Also we can't go up on my pain pump meds to see if I can get more pain rekief, as my system rebelled with constipation...according to my pain pump nurse,.
However I think I more likely "expected" the constipation side effect with added medication, and clenched my muscles more out of fear,
(an emotion that "rules me" due to this anal pain and my worry over when and "if " I''ll be able to sit normally again.
This pelvic floor muscle clenching, for whatever reason worsens the spasm.. which I believe started due to year of unconscious clenching and of a bad habit I had of of staying in the bathroom, trying to push the last drop of pee out! (otherwise I felt 'Not empty')
Forgive me if I told you already, but I was doing this bad habit since age 17 aprrox. and it became a hard habit to break. At age 49, a few years back, I suddenly had the constant urge to pee.
And this whole ordeal began! I was mistakenly diagnosed with IC (Interstitial cystitis) by a doc who was wrong! .. and I became scared and began the researching...then was terrified by what I read about "IC". In reality I had and still have pelvic floor dysfunction.. All those years of clenching to pee, may've been a factor in the sitting pain ( caused by spasm). I still feel that urge to pee, ...but the urge to poop kicked in as well about 6mos ago approx.... so it's all the same dysfunction.
Sorry to digress. ..just wanted to give you the total picture.
My savvy PT has given me things I can do to help with the spasms. which I must start to do religiously.. but I will stop writing now as I have rambled on for too long!

Thx again for listening and for your advice!
It's so appreciated!
Kathy
Dusty_in_Hope
Posts: 119
Joined: Sat Jul 11, 2015 2:11 pm

Re: pain meds and constipation

Post by Dusty_in_Hope »

Hi Kathy

Sorry, I've only just seen your postings.

I take co-dydramol which contains an opioid and both Benefiber and Acacia fibre have be fine for me. (Psyllium husk on the other hand - which is insoluble fibre and found in many fibre products - is the stuff that particularly gives me rock hard stools :( )

I'm also ringing the changes to include aloe vera with fibre http://www.amazon.com/Optima-Health-Alo ... uice+500ml which has been good for me too and I take these chewy cubes every now and again which are convenient to have with or after a meal when out the house; they contain figs and some senna but they don't upset my stomach and work well http://www.amazon.com/Ortis-Ortisan-Nat ... ibre+Cubes

Dusty
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

Thx Dusty,
Im glad it works well for you.
Im going to start the Benefiber, but not sure When to take it...maybe I should take it along with laxative at first, as it may not be enough just yet,
Carl (BlightCP) suggested weaning off the laxatives gradually so guess I won't stop them just yet, Will wait to hear what he says also.
I ordered the acacia fiber. We also have fiber gummies here in the US, so will look for them in the store..
Thx for the recommendation and reply. Hope all is well with you.
Kathy
Dusty_in_Hope
Posts: 119
Joined: Sat Jul 11, 2015 2:11 pm

Re: pain meds and constipation

Post by Dusty_in_Hope »

Hi Kathy
Im going to start the Benefiber, but not sure When to take it...maybe I should take it along with laxative at first, as it may not be enough just yet,
That sounds sensible to me. I found it best to take only a small dose of Benefiber at first (as otherwise it gives some flatulance) and then gradually increase the dose and you should be okay. You could do this at the same time as lowering the laxatives very gradually...a bit of a balancing act at first. Would do the same with the Acacia when you try it.

(Just a short mention - as I appreciate that this is the wrong thread to talk about it - but I've now bought a BackJoy and find it even better for me than the Relaxobak in the car - no pressure on my tailbone to speak of and less pressure on my private parts, so I'm doing a wee bit better thanks. :) )

Hope the soluble fibre does the trick for you.

Take care

Dusty
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

Thanks Dusty, for ur reply and advice about the fiber. It makes sense.
I really appreciate it.

About the Backjoy so glad its helping u with driving.Thx for telling me about it.
I have this device too. It's a curvy thing you sit on, made of a somewhat hard plastic. It has little holes in it. So glad its helping you! and that you see some improvement!
I had a couple quick questions about it but will ask them on the seating- adaptations thread.
Thx again,
Kathy
Dusty_in_Hope
Posts: 119
Joined: Sat Jul 11, 2015 2:11 pm

Re: pain meds and constipation

Post by Dusty_in_Hope »

You're welcome, Kathy :)

Yes, my Backjoy is just as you describe. I've gone to the new thread that you've started about it and tried to answer to your questions.

Best,

Dusty
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

Ths Dusty,
I will go to the other thread to read the Backjoy info you wrote.
Also Thx for all the fiber info!
I have added the Benefiber occasionally-- no changes yet, still getting the' urge' and getting small output at each bathroom visit.
Tomorrow will try the Acacia Fiber.. Also Dusty,thx for mentioning the Aloe Juice; it reminded me that awhile back I drank a brand called Georges,Aloe Juice, which I got at the Vitamin Shoppe for those in the USA; or one could maybe find it at Whole Foods Supermarket.
The one I tried simply tasted like water and I think helped a bit. There was another Georges brand that was thick and tasted yucky, so I stuck with the "water like" one. What is your Aloe Juice like Dusty, and does it help?

Quick question for Carl or Dusty, ... when it comes to laxatives I want to wean as discussed...so to me that means taking less or maybe a milder laxative. I have them all on hand! Plus I take Colace daily to try to keep things fairly soft.
Would you or anyone have a suggestion for a milder laxative to use during my weaning process?
I have tried various ones, but get the same result of urge to "go" quite often during the day.. I must be patient for sure, but would love to just get this "elimination " overwith" in the AM so I would not be haunted by urge all day.
I know this has to do with fear and the central nervous system wind-up it causes.. ie now my brain is not only expecting pain but also that "urge"feeling..
Also I am adjusting my schedule for the day. I spent many months of going to sleep late and then lying in bed dozing for much of the AM in order to ward off the anal pain when I get up for the day. But that meant eating Breakfast late and threw my whole system off as well. So I must get my bodily schedule back to normal, for all things to work normally!
Any thoughts on the above weaning process appreciated!
Thanks again!
Dusty_in_Hope
Posts: 119
Joined: Sat Jul 11, 2015 2:11 pm

Re: pain meds and constipation

Post by Dusty_in_Hope »

Hi Kathy
What is your Aloe Juice like Dusty, and does it help?
The aloe vera juice that I take has soluble fibre added to it. It's quite expensive so I take half to three quarters of the recommended dose in a tumbler of water and then I add a heaped teaspoon of either acacia or Benefiber. It works well and makes a change as I quite like the mild flavour; I just drink the mixture with my meal. This is the aloe vera I take http://www.amazon.com/Optima-Health-Alo ... with+fibre it has fig extract in it and something that the manufacturers call 'fibersol2', which, if my memory serves me correctly is made/extracted from corn. (I avoid gluten and it being made from corn, which is gluten free, made it a good choice for me.)
Would you or anyone have a suggestion for a milder laxative to use during my weaning process?
Have you tried senna? We're all different and react differently to these things, but I've found that senna makes me 'go' without any particular adverse affects...The usual advice applies as far as I'm concerned though, i.e. start with a tiny dose and work your way up, should you decide to try it.

Best,

Dusty
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

Thx so much Dusty,
I must get some Aloe vera juice. Maybe its best to order from amazon to get the brand you use. (tho we all react differently) which makes this issue so hard to figure out.Thx for the link!
I have a question for the group.
I mentioned my anal area is in spasm. My savvy Pt is working on it weekly; Ive had mild improvement, over time but still cannot sit without bad pain, etc, even with cushions.
I must do homework (meditation and self PT) and other things in addition to her good work, in order to eventually get the pain relief I need.
I'm guessing that my anxiety over the severe pain from sitting etc..has caused me to "clench my pelvic floor out of fear and prolonged the pain and bowel issues. Frankly, knowing my genetics etc, it's quite possible that the way I clench my pelvic floor, created the entire problem... who knows?? (similar to how other folks hold tension in their necks etc.)

I have an opiate in my intrathecal pain pump. Dilaudid --which can constipate (but my amount is fairly low for the reason of constipation in my case and because we're not sure the pump is helping.. (another story).
The other factor is my bowel problem -trouble getting things moving normally due again to anal area in spasm (My pain issue in a nut shell)
I feel like I have to "go "when there's no real amount of stool there yet... the spasm again is doing this!
Esp after breakfast or lunch....the food gets the stomach 'moving' and the sensation comes.
So I have a quick question.
My doctor recently suggested Miralax ...it's an Osmotic (sp?) laxative which draws water into the stool . the idea is to help stool to pass through more easily. Docs like this product and often Rx it. Everyone has different opinions and experiences etc, but my doc said it was quite safe for me to double or triple the dose over the period of a day,to get things going. In fact he said it was similar to the stuff docs use for colonoscopy prep (of course in larger dosage!)
(just taking 1 dose would take a couple days for any action. I need to empty daily, so I was fine with his suggestion.)
I think I tried it once before and did ok.
This time I took 3 doses as he said, on this past Tuesday.
(one in the afternoon and 2 at bedtime) when I usually take my laxative.
The next day, WED .. no results- until evening - still small balls of stool bunched up .. not a great a result-- but something.
Note: I take also Colace daily due to the opiate med in my pump.

Wed night: took I took other product from my laxative stash - 1 Sennekot extra (meaning Double strength) and 1 regular Sennekot.
Thursday's results: a loose small bm at first then more as the day progressed, almost like the "runs" But my results were
small soft bits of stool --like tiny snails (pls excuse gross description!), rather than normal 'results' and kind of watery. Guess the large dose of Miralax kicked in! I feel aleep early - while meditating!- and later took an Amitiza (which I belive may also be water based) when I suddenly awoke at 4am and realized I hadn't taken anything yet.
BTW I vary my laxatives as I find the system can get too used to one, and then it may no longer work..
Firday I continued to take my morning Colace which maybe I should've skipped-- in hindsight!
Friday's results- only went once or twice, --- small amounts - now it was pasty peanut butter /apple sauce like consistancy and not enough. (Very gross and Im so sorry and embarassed to discuss this!
I should also mention I take a brand new drug called Movantik -designed to prevent opiate constipation....it doesn't work that well for me, (after trying it out since May) so I take it only every few days).
Today, Saturday AM - I took it... again I got the small pasty output.
Im a small built gal.. only about 115 lbs max, at 5'6' tall. This is genetic.We all don't gain weight easily in my immediate family,tho we have normal appetites.
All of us are slight built with small bones, tho long and lean.
I have a great appetite , love to eat, but I a small belly -- interally ...maybe this small output is normal for me?
I must admit I sleep late and lie in bed reaing in the AM,to put off the pain which kicks in once I arise and also the poop issues once I eat.
So my meals have consist of brunch around noonish - all healthy things--fiber cereal, berries , some bran muffin and/or wheat bread with peanut butter or other spread, and jam.
Dinner is normal sized and well balanced ... but I' m really eating two full meals a day due tothis schedule rather than 3. I try to drink lots of water but find it bloating so admit I don't drink enough. Id prefer other liquids but my bladder is still somewhat sensitive and sometimes still reactions to other beverages.,so I mostly drink water.

Sorry to go on !
To summarize... any advice about the Miralax and how it worked for you would be appeciated .(one dose is too little and takes forever to work! and 2-3 caused the above result.. ( I need to have some daily output to rid myself of this constant urge/pressure sensation caused by the anal spasm. My Pt is great but she has no advice other than doing the homework she gives me..(meditation, And self PT- among other things

This brings me to one more thing. When my pain gets bad I have anal rectal suppositories ( 5mg baclogen/10mg valium) ..I use these supps. usually 2 times daily..If I do self PT (homework -it flares me and I really need those suppositories).
The pain pump has a button I can hit to emit more medication,-- but one hit of it does nothing for my pain so I use the anal supps which provide immediate tho not long lasting relief..They also help quell some urinary urge issues I have on and off.
One doc suggested these suppostories were the cause of my constipation..But I need them to get through a busy day as a mom of 3 and to do my PT homework. Im not sure pushing the button on my pump several more times daily would help and Im scared of further constipation.
Any advice on Miralax and the above drugs .... are much appreciated!
Pls folks ...no horror stories tho, As said I'm anxious and very suggestible, and this would only worsen my clenching and the anal spasming.

Also a little info worth mentioning: many of us with pain pumps are told that intrathecal pumps don't constipate (one of the reasons people get them).
That's based on the person. They do for many for us!... (less of course than oral drugs do) .. but they still can.
My pain doc' s nurse says ALL of her pump patients need laxatives.
The colace doses not help enough.

.Its now Saturday Pm--- shouldn't the miralax be out of my system by now?
Thats all I can think off. So sorry to ramble on Just wanted to provide the total picture, etc.
Thx very much!
kathyd
Posts: 699
Joined: Mon Dec 20, 2010 8:48 pm

Re: pain meds and constipation

Post by kathyd »

To those who read my post above (esp. the moderators)
I am so sorry for rambling on with so much detail. I didn't realize until I saw it myself how long and overly detailed it was.
Pls forgive the details and the length.

I am desperately looking for help with this issue, and thus am hoping to come across someone in the group who went through something similar and finally had a resolution to their "problem".
If I knew where else to look online, I would.
The answers from docs I've seen have been useless.
My PT has ideas that make sense , but in order to get my pain area out of spasm, I need to do 2 forms of self PT which will flare me each time I do them, whilst I'm already flared from her weekly PT.( It often takes a day or so to recover from my post PT pain.)
The idea of self PT is to get the spasmed area to re-learn how to relax.. and eventually stay that way. Its to continue the work she does in our sessions.
Makes sense but very tough to tolerate.

No one... except you guys... (Not even (my experienced Phys Therapist)... can imagine the amount of pain this causes.
Her answer is: grab a pain suppository, use ice and you'll be ok... Neither of remotely help enough, with some of my issues.
My husband has lost patience with my disability, and offers little to no emotional support,
MY kids just need me to be normal which I do my best to be.

I am really in a very tough spot, so I keep writing and hoping someone will read my post and offer some encouragement that they got through this and came out the other side.
Thx, and again my apologies for the super long posts.
Kathy
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