Health Organization for Pudendal Education

Hi
I am titrating down off methadone. I am struggling with a weird side effect ..I have much more problem with that constipated backed up feeling at my lower level of medication(20mg) daily than when I was titrating up this past summer..
I now need strong stimulants like Dulcolax (at least 2 to empty enough to feel relief..With opiods its recommended to take the laxative pro-actively along with your meds rather than wait till you feel backed up. Otherwise you could end up impacted etc
What happens now is that I empy out with a decent BM on even several BMS, (some days I spend in the bathroom... a nightmare!
and within a short time I get horrible feeling of constipation pressure again.. It used to happne the day after a decent elimination,,,now this feeling happens the same day! by dinner time...and early evening I have terrible pressure to have a BM but nothing happens
Its a weird painful feeling not the normal everyday constipation.. extremely painful. So to deal I have to take more strong laxative.
I also use hydromorphoe rectal supps for my anal pain..They help only a little but seem to help more than the methadone... Sometimes when get the above feeling of being backed up and urge to poop (but can't) the suppositories seem to relieve the pressure feeling a bit..
By the way, there is something there as I eventually have a BM ,but the vicious cycle just restarts.... its gotten horrible lately on top of my regular anal pain! Its running my life
Believe me I try to eat drink the right foods etc. I may be taking too much laxative but fear the feeling will worsen if I slow it down.
Question: is this urge backed up feeling a side effect of the tirtration off methadone? my doc thinks it is...she had no other advice for me.
Or could it the nerves acting up in a new way?
Im scared as I don' t need this, and can't wait to be free of this awful medication..
Any hopeful advice would be appreciated. Thanks so much and best wishes !

No advice re the methadone, sorry -I do wish I could suggest something helpful - but re your mention of eating and drinking the right things, I thought I would just draw this article to your attention - link here.

There's been a bit of discussion in this thread. See what you think.

Hi Calluna
Wow..thx so much for this link to a great article! It made so much sense to me! Recently, I have been eating LOTS of fiber especially bran (in cereals, muffins, breads etc).
I've had more bran than anything else.. a big dietary change for me, as before I started opiod meds I had barely ever consumed a bran muffin in my life!
After hearing that opiods basically paralyze the colon, I began eating lots of fibery foods (only the ones recommended for folks on opiod pain meds) ...Bran, oatmeal etc topped each list.
I noticed Rosemary and Karyn commented as well on the negative impact fiber had on their bowel habits as well, one said "bran was like lead' etc .
That is exactly how I 've been feeling.. like a lump of lead in my rectum constantly pressing to get out, (just hours after a massive elimination or the "runs" etc) (sorry for these lovely details!! I haven't been able to figure out why the feeling came back so soon. Maybe we've hit upon something here.
all this bran in particular may be causing this "lead like" feeling...I actually sent my husband out to get more bran muffins last night as I panicked when we ran out of them.
I've been eating them like candy.
It makes sense as I had never felt this strange type of constipation /backed up feeling on a regular basis like this, until I started the heavy duty fiber diet. I stayed away from the bulky fiber like physilium seed (metamucil as I knew that could really back me up, but my current diet is doing the same thing.
I wanted to not have to depend on laxatives, but lately I've needed them even more! Hopefully this accounts for the heavy pressure /urge Ive been feeling in the bowels...
What is the best way to keep things moving when you're on pain meds? I've tried to up the water intake.
I use Miralxx a lot (probably too much also) but it doesn't work fast enough so I have found that Dulcolax helps but lately even that takes too long,, (probably due to the ball of bran I've been consuming
Calluna, Im glad you got back to normal regularity once you lessened the fiber.. Thanks so much for this info.. Thanks also to Karyn and Rosemary for their comments on their experience with added fiber.
anyone else have these experience?
Thx again for quick response Calluna and for picking up on my comments on diet I will lower the fiber and see.
Kqthy

K

Sorry for typos... didn't finis proofreading.

Hi Kathy,
I was advised to eat prunes and apricots as tramadol makes me dreadfully constipated. I wasn't told how many to eat so the first day I ate a whole packet of prunes and almost the same in apricots. It worked. . . too well I have never had to run so fast for a good long time! A supermarket here sells a lovely yogurt with prunes (maybe figs too I forget) and seeds, I just add more prunes and apricots to that, or to plain yogurt and a bit of honey.
Definitely best to steer clear of too much fibre, not what we were advised to do a while back.

Thanks Helen,
for your advice. Its amazing how little advice we get from docs on this matter...They just say take a laxative or do whatever it takes to get it out.
I learned about bran from an online list of meds written by a doc.. who had specified the foods and types of fiber one should eat to makes the bowels move when they are so slowed by pain meds.
The list mentioned to stay away from the bulky fibers like Metamucil and phsyilium seed etc. unless you plan to drink gallons of water.
But bran was listed as par of the "good fiber" list
However I bet this list was probably outdated . I think I overdid it as well.

Thanks for the suggestions.I also have IC bladder symptoms as part of my nerve issue, so I ave to avoid some fruits and yogurts (due to acidity)...
However I have been so backed up I just drank some prune juice with Milk of Magnesia.. have to pick the lesser of 2 evils.
Im staying away from the bran until I am off the strong meds.. Glad you were able to find a solution for these issues! It so tough to find a good solution
Thx so much!
Kathy

Hi Folks
I am really scared and freaked out about a side effect of constant feeling that I need to poop even tho I don't.
If you just had a decent BM earlier the same day, and you're having a soft normal looking stools just about every day you can you still be constipated?
I just have this pressure feeling that I have to poop "" as I described in my other post..
Its been building up lately and now its happening every day.
I(I take duc=lcolax and Miralax in combination with each dose of methodone... (I take methodone 2x daily and have gone down halfway from my top dose of 40mg.. My hubby and my doc think this weird symptom is all part of titrating down from the methodone.
I add in other laxatives like Milk of Magnesia, Peri-colace if the above combo dosesn producce a BM .... as the methadone makes me feel backed up almost as soon as I take it during tbe day. Eventaully I may get the runs from all these but if I don't take this laxatives it just keeps buiding...Gross I can feel it backing me backc.. So sorry for details!

My questions ..Am I taking too much laxative?... (Im trying to prevent constipation and impaction, as I was warned can happen with methodone hence I take the laxative along with the meds very proactively
When I started taking the methodone last summer my original doctor rx'd Amitiza with instructions to take it with each dose of methadone...At first it worked okay, Then the Amitiza became too strong and was causing fecal incontinence so I stopped it.. and tried to find other effective laxatives.. Meanwhile I always took a Miralax with each dose, as was my habit even before the opiods as I was mildly constipation prone... Before the opiods I didn't need to take Miralax daily.

Long story short I've never been able to find the right laxative balance either Im "running" to the toilet constanty or I get backed up.
A few times I got very constipated but luckily was able to go eventually with a combo of laxatives ... and was never impacted.
Recently I've have to use the strongest stuff to produce a BM at least 2 Dulcolax... sometimes its too much but if I go down to a milder laxative I feel backed up etc..
Now Im feeling backed up each days as described. I am on only half the amount of methodone I had gottne up to ... It didn't help much with pain. Im taking the titration supper slowly.

What could be causing this? Too much laxative. Too much fiber in diet as mentioned earlier?
Or the PN itself giving me the feeling that I need to defecate when I don't?
I also use hydromorphone rectal suppositories a (max of 2 daily --- but only as needed ) for my main pain issue.... rectal throbbing..

We noted that when I put in a rectal suppository it does calm the pressure, painful constipataed feeling a bit.
Eventually I do poop so there is something there, but Im horribly uncomfortable until I do each day...This is all in addition to my anal /PN pain and urinay urge issues..
Im out of my mind with all the worry and pain.
Any idea what Im doing wrong here or why this is happening would be so appreciated...Im hoping its all the fiber in my diet..which I will reduce
Thx in advance for advice and for prayers for healing!
Blessings to allKathy

A massive Big hug to you Kathy

I can't comment on your medication and laxatives as i don't understand them - just wanted to add that i was also advised to eat figs by my colorectal consultant who advised against the bran.(Helen has mentioned figs too).

Is a Kiwi fruit one you have to avoid ? - just lately i have been eating a Kiwi fruit everyday for nutritional properties mainly - but they are also a mild laxative too.

Rosemary x

First thing! Step - away - from the bran muffins!!!!

Seriously. If you are all stopped up, adding more volume to the traffic jam is not going to help.

Opiate do indeed have a big effect on the gut, they do not exactly paralyse the gut but they do relax the muscle walls and slow it all down substantially - there are receptors there which are affected by opiates just as the pain receptors are affected. And adding fibre, ie more volume to the gut content, thus giving the gut more to cope with, when it is being greatly slowed down, and thus finding it harder to move things along, and so could really do with having less to cope with - well, the result is going to be a bit predictable. Traffic jam.

I'm sure you are doing the right thing in cutting back on the fibre and giving your gut a bit of a rest. Do make sure you are getting sensible amounts of healthy fats. Olive oil is good for your heart and cardiovascular system, remember - and it is also jolly good for keeping the gut moving.

I've been on oxycodone for a bit, recently, up to 40mg a day, and found it very constipating. But Movicol (Miralax on your side of the Atlantic), just one sachet a day, was enough to sort things out.

The feeling of needing to 'go' all the time, even when one has just 'been', yes, that is one that I do remember. That was when I ended up in the emergency room with a blocked bowel.

I was having a normal-seeming BM three times a day, and yet Xray showed that my large bowel was blocked solid, the emergency room doctor said some fairly awful things to me about the situation until I finally got a word in edgways and told him about the prolapse and that I was waiting for surgery. Yes, well.... he stopped scolding me then and started being sympathetic but it was a bit late then.

So yes you can indeed be having normal BM not just once a day but even 3 times a day, and be not just constipated but completely blocked up solid.

So I'd guess -? - that you're a bit blocked up. And that's why you are uncomfortable. Because really it does not feel nice at all. It is hard to identify what feels wrong because the feeling is so widespread - the gut is stretched and this hurts.... The suppositories give pain relief in the right place, of course, which is why they immediately make you feel more comfortable.

I'd suggest doing what you have already said you're going to do - cut right back on fibre to reduce the 'traffic' that is building up, and give your gut a chance to get itself clear. Keep going with sensible fluid intake, keep going with Miralax - how many are you taking a day, by the way? - keep going with whatever else works for you! And make sure you're getting a couple of tablespoons a day of olive oil, one way or another. (Don't just swallow it! Uuugh!)

I hope also that once you get the constipation issues under control that the rectal throbbing will be easier to manage. Because right now the pressure there will be just horrible. Maybe once this is sorted, that will be easier too. I do hope so.

Let us know how you get on.

Oh and by the way - right now, I would suggest that it might be sensible to beware of high-fibre things like figs, prunes, and kiwis. They really are a jolly good natural solution when the problem is short-term. But not so good when you have gone beyond that point and are actually more than just a little bit blocked, because after all they are high-fibre, and they add to the volume - and besides that they are laxative in that they are very slightly irritant, and that can cause cramps. This can be a bit of an uncomfortable combination, especially when you are a bit blocked.

Once things are feeling a bit more normal, then yes, in normal amounts.