Oh... The Pain (in the rectum!)

[Anaxis]

Okay, so I've come to grips with the plain & simple fact that I'll likely be on some form of powerful opiate for the rest of my life.  I'm looking at it like how some people need to take insulin, blood-pressure, anti-seizure, etc medication to survive or have a decent quality of life.  I realize that I'm entirely dependant on opiates to take the pain away.

But...  There's one big thing that makes life just miserable.....
Constipation.  Bad.

Right now I'm at 9-days without a bowel movement, and the last time (last thursday!) it was absolutely horrible, much worse than previous times.  I absolutely dread having to try and take a dump, because it means two things; one, I'm going to be in the bathroom for better than an hour; two, I'm going to have to AGAIN manually get the stool out with a finger.  Anymore, I don't even hesitate.  If it feels like trouble, I start digging.
Hell, it's embarrasing, and most of all, disgusting.  Afterwards I go scrubbing my hand with a green scrubby-pad, pine-oil cleaner, bleach, goo-gone, oxy-clean, and then I spray two kinds of fabreeze on my hand....  and still, I can smell the **** on my fingers for at least a couple hours!

I regularly take Colace, which is a stool softener, but it does no good even if I double-up on my daily doses, as my stools are still rock-hard (like old stale clay actually, gross I know).  I've tried taking dulcolax (bisacodyl) and even maalox, but instead of making it easier/less painful to go and more frequent, it makes a bowel-movement come on so fast & hard that even with me digging it out, I still end up with a badly bleeding & sore butt.  Once I took Citroma (Magnesium Citrate), and it literally tore my guts up for the better part of a day; but I took it after having to manually get some stool out, and an hour after drinking the mag citrate, I had horrendous diarreaha.

So what do those of you who suffer from a similar difficulty do?  Is there any OTC remedy that'll make stools so soft that even when a BM doesn't happen for a week, it's an easy proposition when it does happen?  I guess mag citrate does work, but I hate that it tears my guts up for so long.  

[hobbity]

Well not trying to be mean but if you stop taking the meds for about 2 days you will  assuredly have diarrhea.  No doubt about it.  Then maybe you can restart the meds again.

There are many otc laxatives and colon cleansers that are considered safe if you don't go with this route.  But if you are going to be on opiates the rest of your life your doses are going to be going way up due to tolerance.  I would suggest to keep them low talk with your doctor on a plan.  Good luck with this.

[Heather3418]

I have Multiple Sclerosis and I HAVE to take something for pain everyday.  Constipation is a REAL problem.  I have been diagnosed with MS for 13 years.  I not only take two stool softners a day, but also eat plenty of fiber, through grain cereals, lots of fresh greens and add fruit to my diet.  You really do NOT have to take all these over the counter medications to get the relief you need.  Add to all of that, plenty of water and healthy exercise and you will find that you will get back to normal quickly.

Activia is a new nutrtional food on the market, which I hear also helps regulate the digestive system.

Try a week or two of what I suggest, from someone that USED to suffer with constipation and see how much better you feel.  I wish you the best of luck.

I also suggest a call to your doctor to discuss this matter.  What you are describing is sheer hell.

All the Best,
Heather
MS Forum

[worried878]

fiber and water...also...when your body rebels against what u r taking/putting into it...it will let u know..sometimes a re-evaluation can be in order

[january43]

So sorry to hear about your issue RE: stuck poop....
This happens to many of us who are on opiates for pain control..and yes there are lots of other pills you can take to deal with it, however I second the information Heather with the MS forum has given you.
Assess your diet--if it;s the traditional American diet, please consider changing it-to something healthier.
You can get Activa but it's an expensive form of yogurt--just a store brand yogurt with asidolphous (thats spelled wrong) -it's a natural forming bacteria that will help your stomach and with constipation.  If you have several 6oz yogurt servings for a few days, you will loosen your bowels-promise.
Also, fruit--fresh peaches are great for you and everywhere now, greens-eat your salads, get a good bran cereal and ad fruit to it...lots of water, fresh juices.
Stay away from fried foods, processed stuff and eat healthy for a few days.
Oh-and buy a box of disposable gloves so you don't have the stinky fingers---
I had this issue also and after changing my diet I not only lost weight, I don't have any BM issues.
january43

[Anaxis]

Thanks for the advice....  even though I've already been doing that stuff.

Good Diet?  Check.  
I've not been on an American diet for about 12-years.  I eat LOTS of potassium-sticks (banannas), at least 3/day; and when I can afford them, I also get pears, oranges, prunes, and/or strawberries.  I eat nothing but whole-grain cereals, pastas, breads, and veggies (fresh-leaf spinach is my fav).  Yogurt is another one of my favorites; I regularly buy it plain or vanilla in big tubs, and add diced pieces of fresh fruit.  I do the same with cottage cheese, adding fresh fruit to that as well.  And regular cheese.....  I used to chow down on Emmentaler (Swiss), Camembert (on toast w/ raspberry jam), Schafskäse, Tilsit, Havarti, Gruyère, Gouda, and good 'ol xtra-sharp cheddar.  But that was when I lived in Germany; here Stateside it's harder & more expensive to find the good cheese.  But regardless, I heard that eating a lot of regular cheese can stop a person up bad.
Rarely do I eat beef, pork, or chicken; instead fish is what I go for, and if I do feel like eating red meat I only make small amounts.
I almost never eat "junk" foods; i.e. frozen dinners (including tater-tots & fries), cookies, pastries, soft-drinks, etc.  When I do, it's once in a great while & in very small amounts (i.e. one or two cookies).

Fluids?  Check.
I can't stand just plain water, so I drink tea instead (camomile, green, black oolong, chai, roobios, earl grey)....  at least four or five 1L mugs each day.  I usually go through a jug of prune-juice every three days as well, if I can afford it.

Exercise?  Um....
That's a problem for me.  Lately I've been trying to ride my cruiser bike more, but I still can't do it for longer than 10min.  Same thing with walking.  Or standing, for that matter.

Lately I've been drinking a goodly amount of milk-o-mag....  and last week I tried a Fleet enema.  But that was a disaster.  It helped almost immediately, but the BM was so hard & fast that I seriously thought I'd need stitches.  That wasn't the worst part though.  After waking up the next day, I had a very unpleasant surprise.  However, for three days or so I felt really good from not being all stopped up.
The milk-of-mag seems to work only 1/2 of the time.  To ensure that it works I have to drink almost 1/2 the bottle and two full glasses of water.  But even then the beginning of a BM is still like a solid rock; I just have to get past the first part, the rest is easier to pass.
And yes, I got wise & invested in a bunch of exam-gloves, which makes things a lot less gross.

I'm just really worried about developing a serious fecal impaction, necessitating the use of an apple-corer or equivalent.  :rolleyes:  basically, I've heard that serious constipation from heavy opiate use can result in needing surgery.  But I CAN'T go off my pain meds, otherwise I'll have a lot more than constipation hurting me.

[worried878]

I had to help someone the other day...break up an impaction from narctics..and not a abuser at all...cancer victim/short term narcs/ but it is not even part of my job///but  no one else would do it right so i did///grosses most out so i "went in" and broke it up for him,,,,,friday he was so happy and out of pain from constipation//..he hates the narcs and doesnt want to take them///refreshing//the pain from.the constipation and what we had to do to relieve it was worse in his opinion..he told them...no more!  and he meant it.....if this is gonna be part of ur life as chosen then the things like this are part of it.....enemas on a regular basis...fiber pills or laxatives will possibly be part of ur life to have narcotics as part of ur life...give and take..that is  life..give and take

[ithink]

9 days - thats great! congratulations. You've beaten the physical withdrawls and now will have to deal with the mental cravings.Get yourself  on a good aftercare program ;)

[HenryS354]

I hear ya man!

Back in my methadone days (700+mgs a day) There were times I would literally go weeks without a BM.  The longest was a little over 4 weeks and landed me in the ER.  They gave me an IV drug that causes muscle spasms in the intestines, and let me tell ya it was aweful pain, but they gave me this handy numbing gel to help things along.  

I cant tell you how many times I ended up with black eyes from broken blood vessels in my face, and passing out from bearing down so hard.

I would reccommend an over the counter laxative called Mira-Lax.  Its new OTC used to be prescription only.  The active ingredient is Polyethelyne Glycol...  Its taken every day and can be mixed in ANY liquid and is completely tasteless....

Within three to four days it will produce a BM, and I will warn you... You are going to have to get those rocks out first, and thats the unpleasant part.  Once you get that out stay on the Mira lax, and you will be home free.  That was the only thing that saved me!

Unfortunatelly, I did screw up my intestinal tract from the chronic constipation that even now after being off methadone for almost a year, Once a week is very regular for me.  The doctors are telling me this is ok as long as I have no stomach pain or other symptoms.  And despite the once a week issue, no rocks, just "Regular" BM's

Keep us posted and good luck!

[Anaxis]

Um....  not 9 days off of opiates.....  that's 9 days without a BM.  O_o
I wish I could go 9 days without having to take narcotics!  As I've said before, I've become resigned to the fact that opiates, and my having to take large amounts every day, is going to be a part of my life for a very long time....  at least until I can get a surgery or treatment that isn't going to have a high risk of debilitating side-effects.  As it stands right now, the only surgery option available to me has an 80% chance of leaving me with serious sexual disfunction/impotence (not that my sexual ability hasn't been negatively impacted already), incontinence, partial paralyzation/nerve damage, etc.
I see having to be on opiates as like having to be on BP medication or similar.  I don't get much of any kind of high anymore; it's like drinking a couple cups of coffee, and I've never "nodded off" before or now....  even though I take 210mg of morphine daily now.  It's just the horrible constipation which makes things so much worse for me.  If I drink a lot of milk-of-mag and take Colace regularly, things start moving along....  but first I have to get the rocks out!  Once those are out of the way, I'll have about a week of regular, easy BMs.  But after that, the rocks return, and I'm back to square-one.  Ugh.