pain meds and constipation

[andreamartinez]

My friend recommend to try tea and fruit juices. I search different varieties of helpful natural treatment that could not lead being constipated. I found out nopales benefits a lot for my needs. According to research it could relieves constipation and boost immune system for my body. Well, I couldn't argue with that because based from experience, I know veggies and fruits helps alot but it's worth trying.

[kathyd]

To NYT,
Thx for the ideas you posted regarding laxatives. Sorry i's so belated!. You posted these some time ago and I somehow didn't see them till now.
They sound more natural and safe than the over the counter laxatives that have given meunpredictable and often painful results.
I am away from home at the moment, but will try them when I get home. Thx so much for thinking of me.
It's been hard for me to get to the store. as I was only able to drive occasionally, so i hadn't the ingredients on hand for ur other suggestions.
Hubby has been exhausted from picking up the slack, and doesn't like going to the market, until its absolutely necesssary.
But these items I may have on hand.. Thankfully, I have been able to drive more often and bounce back faster, so hopefully may be able to get to the store soon and pick up the items you mentioned.
Thx again!
Katy
Thx againn.

[kathyd]

Thx to everyone,
For any info you sent me,
I'm scared that I have ruined my bowel function by taking laxatives for the past few years that I have been using an opiate pain med.
I have written about this too much! but recently I have had the constant feeling of needing to defecate if I'm on my feet, ...even if I know my stomach is essentally empty. If the anal canal has something there, I can feel it , no matter how small.
A doctor that I trusted (a pelvic pain gyn started) me on methadone for pain in 2012. Her words were" When you take your pain med, take a laxative..Never get behind or you could be impacted". as some of her patients had been. So I followed the advice ever since. She gave me Amitiza.. which worked well for awhile, but then it worked TOO well, and I stopped it. I soon moved on to a pain mgmt doc. In my area it's hard to find one with knowledge or caring when it comes to pelvic pain. Not much changed as far as pain goes. So in 2013 I got a pain pump . I don't know if I was truly a candidate for one, but NYC doctor suggested it, and it really helped an online friend who couldn't sit and had other pelvic pain issues.
We went to a pain doctor - in our hometown.. since my hubby was very tired of driving to the specialists in NYC.
He was willing to give me the pump but his pre- pump test to see if I qualified seemed much too simple. He said I was a candidate, I so went for it. I did not have enough confidence in this doc, so we moved on to a doctor further from home, who has a well known, reputation and also actually calls patients to answers questions...rare these days!!
Ive had the pump for 2 years, I can function but still have a lot of pain when I try to sit ,or even to stand in place for awhile; anytime we tried to go up too far on pump meds I had no significant pain change, but did get the constipating side effect.
We have finally seen some mild progress recently, since I've been working with an experienced PT in my hometown area. She believes I don't have PN- based on her experience in treating patients with it.

This is my question for anyone on a pain pump . Could u please reply on this question? Since there are opiates ( in my case, only one ,and not a high dose, do you need laxatives each night? I also have a low amt of Bupivacaine in the pump.
I was out of town with my family this wknd and every time I was upright I felt the urge to defacate.With me laxatives take a awhile to work ,but when they do they send me to the bathroom 25 times a day rather than just one large result ---It's Feast or famine... My "results" are days of 'bit by bit'. My butt gets raw. In some ways this is more of a problem than the pain itself, as evidenced by my desperate posts.
My PT cannot advise me on meds and pain doc simply says "use colace" Believe me I have done so!
What works for other pain pump patients? Could you pls respond if you would? Our first pain doc's nurse told us that tho pumps constipate to a much lesser degree than oral meds, they do.
I visited the restroom more times than I can count on Friday. So I thought it was best to skip the laxative on Fri night and just take Colace. (The small BMs continued throughout the weekend, so last night again hubby and I thought it best to skip the laxative, esp since we were taking the car trip home today. I was still going this am , but now needed to push for "any" output".
Thankfully I was fine for the trip..Laid down in car.
We got home and urge again started up.Tried but no action.
I had to manually get the stool out( only a small soft amt ) using my finger. I tried a surgical lubed glove but it was too slippery and needed to use a bare finger.. It worked but I can tell I'm still not completely empty, and it hurt!
I don't have hard stools. But the presence of Anything there drives me crazy!--- as this-- the anal canal ---- is my pain spot
I have a msg out to my PT and am waiting to hear, but wondered did I do the right thing? I needed relief asap. I felt I had no choice. The pain is a now less than earlier but I am frightened .I did not want to mess with this area, but i had to get some relief.
I apologize to all RE: this gross subject esp moderators!
Pls pump patients or anyone with medical knowledge, pls reply with what you do with regards to constitation prevention? )

BTW my PT does not feel I have PN but an anus that is in spasm. Her evaluation is that the clenching and years of worry, research etc .. wound up my central nervous system --keeping me in pain.. that's what we're working on with her work and my homework. Meanwhile the pain pump is still in my body for now..
How often does a pain pump patient generally take laxatives? I know our systems are different,
Im scared I got into a bad habit when I followed the advice mentioned above about a nightly laxative for opiate patients. I'm also worried that i hurt myself by dislodging the stool manually. tho the pain has eased a bitl thanfully.
Pls pm me if you feel more comfortable. Again my apologies for a delicate subject
Thanks for any help.
And thx to all for the home remedy ideas..For some reason it takes a lot to get me to "go", and hubby is tired of driving to store, so I haven't had a chance to buy the suggested ingredients, but will try when I am able.
Thx again,
Kathy

[blightcp]

Kathy,

First you are not crazy, I have similar symptoms. Take a look here to see the anatomy of the PN, it clearly shows how the PN controls the anal sphincter and how it is tied into the bowels. You can click on the image to see the different parts of the body.

http://bit.ly/1L1joGy

I have permanent scar tissue damage to the PN and it effects my bowels as well. I also can have a small pebble of stool and feel the need to get it out. And I understand running to the bathroom every 5 min for 3 hours.

In my case I have a very hard time controlling either of the anal sphincters, seeping incontinence was one of my first symptoms diagnosed in 2008. I saw one of the best colorectal Doctors in Boston, he diagnosed the motor dysfunction but was unable to determine the cause. His instructions were:

* Don't use too much fiber, you want stool that is firm but not pelletized, natural fiber is the best course here. drugs and chemicals can cause problems.
* Don't try to digitally remove the stool as you can scar the area long term.
* One of the biggest reason for the laxatives are to prevent hemorrhoids, but in my case they are nothing compared to PN. Granted I don't want to cause them but I will take a little constipation over anal seepage.

* Irrigate with a bulb syringe.
1. Fill a Dixie cup with body temp water, test the hot water like a baby bottle on your wrist you want as close to body temp as you can.
2. Fill a baby bulb syringe with the water by squeezing the bottle and puling the water in, make sure it is completely full.
3. lube the anus you just need a little.
4. Insert the bulb and squese the water into the rectum. You can repeat this once or twice to fill the rectum.
5. slowly go to the bathroom

This does a couple of things:

1. It flushes out those little pieces that drive the PN nuts.
2. It fills the bowels with something to push against.
3. it assists the upper part of the rectum to "pull" the stool down from the rectum.

I will post again with my other thoughts, but you are not alone or crazy I promise.
Carl

[blightcp]

Ok part two,

Normally the puborectalis takes the brunt of the load of holding stool in, and it them relaxes to let the stool descend. And the two anal sphincters are the "seal".

But anal sphincters in my case are "lazy" due to them being controlled by my damaged PN making the puborectalis work too hard.

PN damage is the reason that I cant "hold it in" as easily as most people. One of the reasons that I have stayed in PT since 2010 is to keep the muscles of the bowel in "good" working order. My PT works with me during the internal PT to loosen the muscles that are just too tight and not working well.

As for the pain pump, I just got the order to get fentanyl added to my pump in the next two weeks. According to both my pain Dr. and my pain psychiatrist opiates in the pump will not affect the bowels as it is not taken orally or put in the blood stream. From my understanding you should just need to add fiber to compensate for oral opiates.

In your case I think you may be taking too much laxitives, these are my thoughts on what I would do, but I am not a doctor I would talk to your PCP and work with them to reduce the laxatives.

That said, my suggestions are:

I would slowly cut back on the laxatives, you have used them for so long, let you and your body adjust to the new balance. Try to have your normal diet add the fiber needed, I know this can be a impossible task and not always feasible.

Work with your PT in getting the muscle tone checked for the puborectalis and if she knows how, work on getting manual control of it better.

IF... control of the sphincter is still an issue, you may be a candidate for a sacral stimulator like what I have. Take a look at this:
http://professional.medtronic.com/pt/ur ... ciS9UlREuU

For me the stimulator helps keep the muscle tone on the sphincters and keeps the incontinence at bay. it also helped with the PN pain some but not a lot.

Feel free to PM me too if I can be of any help.

Carl

[kathyd]

Hi Carl,
Thx so much for all your kind suggestions.. I really appreciate it..so much!
Tho each of us is different, in what we may actually disease or dysfunction wise, etc, the pain, some symptoms and the side effects of our meds are similar.
I will PM you to discuss a question/issue I have..
Hopefully it will go through properly.
If you don't receive it I will then respond here on the forum.
Thx again,
Kathy

[Dusty_in_Hope]

Just thought I'd mention that I've recently tried Acacia fibre and found it good. I prefer soluble fibre to 'roughage' like psyllium husk (which I've found sets like concrete in my rectum, what with my rectocele - if you pardon the TMI! ). Anyway, I'm 'ringing the changes' - between eating cracked flaxseeds and Benefiber and taking lactulose (only a small amount of the latter as it makes for a lot of flatulence) and now Acacia fibre - as I've found that my bowels don't like me to stick with one type of soluble fibre. You can get Acacia fibre (which some people, I understand, have found good for their IBS) via both the US and the UK amazon sites http://www.amazon.co.uk/Acacia-Senegal- ... B0002ON8DU. (I'm in the UK.)

[kathyd]

Hi everyone.
Does anyone know if Benefiber is ok for opiate patients to take?
a color-rectal doc said it wouldnnot be a problem..
tho I told her that some types of fiber supplements can make stool like cement for opiate patients..
She was not too savvy IMHO ,so I wanted to check with you guys ..before trying it.
Is soluble fiber (like Benefiber ok for those who take opiates ?
This is what she suggested for me, so I can stop the laxative
Thanks everyone..for all ur advice .Will write again later Off to the market

[kathyd]

Hi Carl and Dusty.
Thx for all of the info you posted for me.. I was offline for awhile..and just saw it. So nice of you to post this for me and offer your support!

I saw a colo-rectal doc today. They treat you like you are a patient from Mars. She said she rarely has a patient like me, who presents normally but has severe pain and BM issues.
She spoke as if patients in such pain, would be crying or screaming.
I don't do that kind of thing in public..but it does not diminish what I feel! They don't get it!
It was mostly a waste of time, but what the doctor did say that concurs with the advice from you guys,
is that it is okay to take Soluble fiber... it will NOT make your stool become like cement , according to her ??
Do you guys agree? Do u take opiates also?

She suggested Benefiber.. Is this product OK and NOT one of the ones that opiate users should avoid?

She examined me and found that all looked normal inside.
Her advice concurred with my PT, that its a true rectal spasm. and not PN causing my Pain, thankfully.

Dusty. I will go into Amazon and check on the Acacia (soluble fiber) you mentioned.
Also this doc said that pain pump patients don't generally gets constipated that often, as that's one of the benefits of the pump.
This I knew, but I have heard they get constipated to a small degree. So that's why I was continuing with laxatives them nightly , but trying to take milder ones.

Thanks again!!

[blightcp]

The Doctor sounds like she is correct, the thing I think she is used to seeing is someone with either impacted colons on one side of the scale or IBS on the other side.

Soluble fiber has two purposes, it has the ability to dissolve into the blood stream and is good for heart health and cholesterol. It will also not form cement and works more like a lubricant instead of adding bulk.

Bennifiber == soluble wheat dextrin fiber
fiber gummies == chicory root fiber

Both of these should work, just slowly adjust these into your diet and work off of the medication and pills. I would adjust in steps maybe once or twice a week. You are going to need to give your intestines time to start working correct again.

As for the rectal spasm, a full or spasming rectum does cause my pain PN to skyrocket.

There was a funeral for a brother of a friend of mine where I grew up yesterday, so I drove home to Maine Friday and left today. As I was driving home from my parents, I was 45 min from home when I hit me. I had to use the bathroom, but I needed to wait until I got home, buy the time I got home I was nauseous and felt like someone was jabbing the PN. It took another 2 hours for everything to settle down.

I think that rectal issues can irritate the PN or make existing issues worse. But I think that I would be hard for the bowels themselves to be the only source of PN.

It was good to get everything checked, hopefully things will get better from here.