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Posted 11/23/2012 3:44 AM (GMT 0)
I have been using 50mcg of Fentynol patches every 72 hours. They have been working well. The problem is the severe constipation. I won't go into details but it's extremely painful. I have tried adding more liquid to my diet to help but it hasn't worked. I have always had irregular bowel movements but these are on another level! Any suggestions on how to help the process not be so painful. I'm afraid to go because of the enormous pain I have when I try to go. PLEASE HELP!
Posted 11/23/2012 4:50 AM (GMT 0)
The best suggestion is to use OTC stool softeners. Take 2 pills (typical dose) twice a day. It should help.

I have been on fentanyl 75 mcg patches, every 48 hours for nearly a year now, but never had, or have, constipation issues. It really varies from person to person.

I would start the stool softeners immediately if you have them.

David in SC
Posted 11/23/2012 4:57 AM (GMT 0)
I have to definitely agree with this. You need not only a laxative but a stool softener as well. I take one that has both in it. I am not sure if we can say brands of medicines here so I won't do that until I get the go ahead because I don't want to break rules. I will say that you can't ignore constipation though, it can become a very serious problem that can land you in hospital so please take care of this asap.
Posted 11/23/2012 4:59 AM (GMT 0)
Miralax is a softener that works with the fluids in your system, it's not a laxative, and works pretty well. I have a powdered version of it prescribed to me, with 17 grams mixed into a drink of my choice, 2Xs per day. That one really eased the "pain" you're referring to lol. Otherwise, you might call your PMs office and see what they say. They'll probably also advise you to try OTC before prescription strength. I'd try a couple different types before giving up, if you haven't tried them already. If you get really bad, there's the enema option, but I'd save that for a last resort. Good luck.
Posted 11/23/2012 5:31 AM (GMT 0)
Hi Heather,

You're not alone with this. Pretty much everyone who takes opioid pain meds long term has this side effect. The key is to try to stay ahead of it. Eating fiber helps, as does staying hydrated, which you are doing. However, it's probably best to take a non-stimulant OTC laxative (miralax, senna, metamucil, etc) and/or stool softener. I've tried a variety over the years, but what I find works best for me is senokot-s. The brand name is kind of expensive, so I use the generic version (mine is the CVS brand). I find that I have to play around with the dosage to get it right (take more or less each day, depending on how I am feeling/how much meds I've had to take that day).

Taking some magnesium at night may also help, as magnesium acts as a stool softener as well. Of course if you are still having problems, talk to your doctor. There may be prescription options that will work better for you. This is definitely a side effect to be taken seriously, as it could potentially land you in the hospital with a bowel impaction! I hope this helps!

Skeye
Posted 11/23/2012 5:46 AM (GMT 0)
Heather,

I know the constipation pain you're talking about! It's awful! I, too, had always tended toward constipation, but going gluten-free for a month made it 10X worse. I kept increasing my fiber - whole grains, fruit, veggies, bran...it got worse and worse.

I started looking online, because I was desperate for some relief.

What helped me - believe it or not - was to eat more SOLUBLE fiber and less insoluble fiber. (There's a long thread about this diet on the IBS forum here at Healingwell...it's written by a Heather Van Vorous, I think.) I'm sure it's not the answer for everyone, but I'm just throwing it out there as an option to try.

Ok, I just looked at that site and it seems to be gone, but if you just Google her name, you can access it. 

I also take Miralax and Citrucel every day.

Good luck!!

Debbie

Posted 11/23/2012 3:23 PM (GMT 0)
My dr had me taking multiple doses of Miralax every day to deal with constipation. This rarely worked despite the increase in fluids and whatnot. They also do not recommend consistant use of stimulant laxatives, something about the intestines/colon getting used to the laxatives and getting sluggish.

Last March I was in the hospital for a few days due to an obstruction, not fun at all. Gallons of GoLytle, mag citrate and mirlax and nothing was effective. I was to the point that I needed the combination of miralax, daily supositories and enemas if I had any hopes of going. My PM dr gave me a script for Relistor, she calls it the poop shot. It is only prescribed for opiod induced constipation. It is expensive but thankfully my insurance covers it with a small copay. The first few weeks it took 24-48 hours to produce a BM, but now it works for me in 1-3 hours. My hopes is not not need this forever, but as of now its working good.

I wish you luck,
Shell
Posted 11/23/2012 3:43 PM (GMT 0)
I am one who uses Miralax....I drink 12-14 glasses of water a day I only have one cup of coffee and then the rest is all water day/evening...So making sure you are getting appropriate fluids is very important....The great thing about Miralax is it is not a laxative...it works with the water/liquid that you regularly drink to bring fluid into your intestines...

As mentioned...using a laxative is only good once in awhile...As others mentioned...there is natural products like Senna that can help.

Making sure that you are getting a lot of soluble fiber in your daily diet as well...At least 30-40 grams..

I actually switched to eating all Organic a few years ago and this greatly helped my Irritable Bowel Syndrome and constipation....So trying to eat more natural foods and not a lot of things with preservatives, artificial ingredients that do not break down well in our bodies can help..

I remember your other posts in that this Dr. went from prescribing you 3 Percocet a day to the 50mcgh Fentanyl patch...So I can see where this would shock your system for constipation as it was a huge jump in opiates...

Another thing is making sure you are exercising daily for at least 30-45 minutes....I go for a 1.4 mile walk every single evening...It's very important to stay active so that this helps things keep moving as well.

You can certainly contact your Dr. or even speak with your Pharmacist about what to do if you have tried all these things consistently and it's not working. You may need to do a home enema which works well...

Good luck..
Posted 11/26/2012 12:52 AM (GMT 0)
Thank you to EVERYONE all of the information was super helpful and I will definitely try these suggestions. Why do opioids cause this problem? Whats the difference between say Miralax and a laxitive? What's Senna? I have heard that Flax seed can help is that true?
Posted 11/26/2012 1:07 AM (GMT 0)
There are quite a few medications that cause constipation unfortunately...With opiates...it causes the things to slow down in the intestines, as well as digestion of food in the stomach, and dehydration.

That is why it is really important to increase one's water intake for the day. As I mentioned..I drink 12-14 glasses a day (Obviously check with your Dr. if you have any type of kidney issue or can't do this)....

As well as proper exercise each day and eating the right foods will all help things along naturally.

The quick answer is that laxative actually "stimulates" the bowels to contract and move things along. Miralax is an OTC medication that just uses the water/fluid and makes it "easier" to go.

Senna is an herb that works as a laxative...There are other "stimulant" laxatives that are really only meant to be used once in awhile because you don't want to artifically move your bowels so often they forget how to work themselves...And yes..flax seed can also be helpful..

The best thing to do is speak to your Dr. and/or Pharmacist about what is the best approach if you need to add an actual supplement as discussed if all the natural things mentioned aren't working...It's always good to make sure they know about things you are adding to the mix.
Posted 11/26/2012 2:16 AM (GMT 0)
Thank you for the lesson! It really helped me understand what I'm going through. I have to watch the dehydration because I have low potassium and have suffered a low potassium type "episode" which caused me to be admitted into the hospital. I am not a water drinker and I have tried to increase it but it's very difficult. I have stopped drinking ice tea which I have been told can cause dehydration. Enough rambling! lol
Thank you again for all of your insight and knowledge.
Posted 11/26/2012 2:31 AM (GMT 0)
There are so many "flavorings" that you can put in water now to make it more palatible..and if you try to view it as a "life source" that is really crucial the feeling well...then it makes it easier to drink. Not doing so can cause headaches, fatigue, muscle pain, constipation, irritability, etc...It's really amazing the difference I can tell on days I get busy and don't drink my regular amount.

I just carry my own water bottle with me everywhere I go:) I've just been lucky in that I've never been a big soda drinker even as a kid. I have one cup of coffee in the am and then water the rest of the day.

There is a drink out there called Vita-Coco...It comes in a few flavors but contains 460mg of potassium. It is coconut water...I have gotten a few friends hooked on this now! LOL..

Green tea is a good thing to drink for at least a few cups during the day...

Anyway...I think it's like any new habit..it takes some time to get going on it and if you do it in baby steps...it will become a part of your regular day and you'll see that you have some positive benefits from it!
Posted 11/26/2012 4:34 AM (GMT 0)
Definitely talk to your dr. I have a ton of gi issues and have had a crash coarse it all things gi related this past year. I just recently had a gj tube(feeding tube) removed and now have a nj(through nose). With the gi system, one small problem very very quickly steamrolls into a much larger, painful, and embarassing problem.

Miralax is great. It's very very safe. My little guy was a preemie and had gi issues do to this. He took the adult dose 2x daily for years. I'm told to take it 3x daily. Talk to your dr about fiber. It is almost always a good thing to introduce into the diet, but if things are moving too slowly due to narcotics it can also cause a blockage. I don't eat to much by mouth other than small snacks here and there to keep the gi system muscles moving, but I'm told NOT to eat food high in fiber. So please talk to your dr to make sure you won't be creating a bigger problem.

One good thing about the gi tract is that once you get things moving, daily maitainance will most likely keep things under control. If you have extreme pain or no longer pass gas(lovely :) you need to talk to a dr right away. I once went a month without bathroom "success" and ended up 2 weeks inpatient. Not something I would wish to relive.

As Snowbunny mentioned-water can be a great help. Especially with Miralax. It pulls water from your system to make it easier to go.

I hope things improve for you.
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