Health Organization for Pudendal Education

Hi folks,
I take a low amount of oral opiods for PN pain, plus the2 meds that are in my implanted pain pump ...(I am new to the pain pump and my doc started me very low dose, so it will take quite awhile to get to a therapuetic dose. I will post when changes occur.

Meanwhile I 'm struggling with constipation issues from the opiod drug combination.. that problem in turn annoys the PN and has caused severe urinary urge issues to return .... the muscles may be messed up from the bowel issue and maybe causing my severe bladder pressure.. So I need to get the bowels to be regular.

Does anyone have a safe recommended laxative regimen that works for opiod constipation?
I have tried various "hit or miss things" for awhile that do work but its lot a of waiting and discomfort. (that has caused the above issues).

I am waiting for an Rx for Amtiza to be called in .. from my pain doctor). Meanwhile what dose of Amitiza is best to start with? (once a day of twice.. Are 2 pills per dose too much? It takes a lot to get things moving for me.
I currnently have an bottle of 24mcg. I used one i pill in the past. But with my current group of meds. one pill won't get things going (when you first start--- it could take a few days. I want to drink more fluids (water but with IC,, sometimes that worsen symtpoms.

I can't risk getting backed up so I usually take a few over the counter things as well..to get things moving. My doc would rather I stick with the Amita and Lactulose and get slowly off the other over the counter stimulant laxatives... I understand his reasons and the risks etc.
Lactulose. again takes a few days to work. I will follow his ideas, but does anyone have any advice how to up the dose of Amitiza and how to start Lactulose safely. but effectively? I know its an individual thing, but opiod induced constipation makes it hard for lots of us establish a normal pattern and I must fight off "back up" first and fore-most

Any ideas thoughts would be appreciated. Linzess has also been mentioned by some, but for me, I would need to take it with another Laxative as again one pill alone would not cause action for days while mixing with other stimulant laxatives could be too much. I use Miralax regularly..Its good but again not enough for me.. I wish it were!
Thanks for any guidance!

I tried Relistor-- An injectable medicine, ..it worked right away but also made me so nauseous, felt faint, sweatng chills very sick...I wouldn't want to try it again! ( It was probably due to other laxatives already in my system mixing,,, but it was a BAD experiecnce!

Any ideas for a good safe laxative regimen, as per the drugs above? ( I know we re all different and I am thinking of doing 2 Amitiza..)
I try to drink more water but have a catch 22 issue ....more fluids irritate my bladder..

Thanks everyone in advance!

Hi Guys
I don't wantto belabor my point but I am desperately trying to figure out a bowel regimen. I take opiod pain meds and need a strong dose to get things going..thx to all who offered me tips .... itsso appreciated.
My situation is much different than regular constipation....Opiods actually "stop your gut from working" Peristalsis or "pooping doesn't occur on its own and needs strong stimulants.
IE a dose or 2 of one laxative or with a piece of fruit won't do the trick ,, and you cant add extra fiber as it becomes like cement in the gut of someone who takes opiods.
I am trying to drink more (I have IC/bladder issues and can't drink many beverages due to acidity, but am trying to find other ways to get more fluids in my diet...

At the same time the goal is to have a normal BM per day... to help calm the PN.etc

I am in a repeat cycle in that I need to take a combo of laxatives to get action...it takes a few days to the point where my nerve is very irritated and Im feeling a lot of pressure both anal and bladder..
Then I finally go and have a horrible day or hours of diarrhea....like one would have while preparing for a colonoscopy.. After that the nerve is worse than ever and symptoms increase...then the whole cycle repeats itself
I am so ill my system can't handle this cycle (the pain is incredible without adding to it.. there must be a happy medium!
does anyone here find that opiate meds stop their colon from working well and they need strong laxative?

IF so could you please tell me how you handle this? I know its individual but I need help if anyone has dealt with this...I have been on opiates for well over a year and I believe the system can become tolerant of laxative and need more.. but today I used too much. I am very scared of getting impacted and ending up in the ER (docs have told me horror stories and scared the "blank" out of me!

Has anyone treid Linzess? Its a new product -- a bowel reguator. If so, you take it in the am but I need to add in more laxative to have a BM....but with linzess and a laxative you have to be careful not to overdo (diarrhea again!!) What laxative do you take with IT? to have normal BMs?
Any tips from someone who has these issues I describe and come up with a system ....would be so great!! Many folk here take pain meds. Have you dealt with this issue? Any help would be so appreciated.
Thx!!! in advance.! I really need your help
Kathy

This is a very importrant component of pain control especially if you have PNE. You really have to stress this to your physician. There are new meds evidently like Targin that is a combo of Oxycodone and Naloxone ( This inhibits the constipating effect of Oxycodone.) There is also something called Relistor, a subcutaneous injection that prevents constipation. At any rate you will have to be very assertive with your MD. I have found that I have to drink water constantly, eat plenty more fruits and veges--way more than I was used to. A stool softener with each meal and only oatmeal and nuts for brkfst has regulated my GI system finally. It will take time for you to find your own regimen. Have faith you'll get your own system!

Miralox is commonly recommended by doctors because it isn't a laxative. I use Miralox, Sunsweet now has a prune juice with extra fiber 4 0z, and Colace twice a day. Plus, drinking lots of water. I still struggle with constipation but it does help.

I usually take Miralax nightly, and I have been both of the other drugs you mentioned. I drink water all day, I place Nunnn tablet in a 16 oz, bottle of water.
The Nuun (Electrolyte tablet), you purchase them on Amazon, REI, or sport authority. They have magnesium, sodium, and other electrolye's in the tablet.
Drinking this has helped immensely, they make bowels move a lot better. Just a suggestion...

Senna, Ground Flax seeds, water, vegetables, fruit.

Hi Everyone
Thx for all of your great suggestions and responses...All sound good and I will give them a try.
That Nunn supplement sounds greats..Will check into it. I suspect I am lacking in electrolytes.

Also Thx, Jackel, the Targin is a med I was very interested in and I had asked previous pain doctors about.
They basically blew me off and gave some useless excuse like "It's not available. If it was I would know about it" . I didn't buy that useless excuse at the time, and was disappointed. It sounded like a good option for me. I moved on to another doctor.
Now however, I am pursuing a pain pump .. so I can't do it the Targin currently.
The drug that prbly causes the most constipation is my oral methadone which we're hoping to get rid of soon (I am on low dose for now)..
It would be great if my doc could take me off that ,and put me on Targin until God willing I don't need orals anymore..
I will ask him about that, as well as my nurse who is very interested in cutting edge meds for pain. I hope my doc listens to us. Sometimes that's the hardest part!
By the way I tired the oatmeal fruit combo and that along with the laxative I took in the past few days worked finally. I must force myself to drink more water ..sometimes hard when you have bladder issues, but in the long run it helps.

Thx to all for your ideas!
Kathy
Kathy

HI Jackel,
I just had a a quick question for you or for anyone who knows about Targin the combo med of oxycodone and naloxone which offers pain relief while fighing he constipation component of opiods.

I mentioned this to my infusion nurse. .(she doses my pain pump ..we are not yet at a therapuetic dose ... a slow process,, and I still have to take low amount of oral methodone to get by..I printed info for her about Targin as a better oral option to combat my constipation, as we think the methadone is the culprit.
She said that naloxone in the Targin mix apparently reduces the pain relief element of the drug, and of course our goal is find something that will give me enough relief so that I can do normal daily life things like driving ,or to sit long enough to eat a meal.
I guess the naloxone makes the oxycodone less effective ,,as she said something about this combo being given to recovering addicts?

Is the case does with regards to pain relief?
I thought it would be great if it helps relieve constipation, but not if it compromises pain relief.
Just wondered if this is true or if maybe my nurse just does not know enough about it?? (tho she is quite savvy from what I know of her.)
Thx to anyone who can help!
Kathy

For what it's worth, I've found that brussel sprouts and apple sauce help keep things moving.

Thank you, Dave
Every suggestion is worth hearing! I appreciate the response.
Regards
Kathy