Solving the constipation side effects of opioids

[frozenborderline]

For context I shall put that i have no other options at this point than taking opioids for pain. I have exhausted most of the other issues.

Also i dont think that my hemorrhoids and constipation are solely bc of opioids but i worded the title that way bc the opioids may have been last straw for that symptom. Which i did have pre opioid, but wasnt quite as bad.

A few other variables effect my gut motility and constipation: being inside and in bad air , with toxic mold , always makes it worse, even when it's not awfully toxic air , just mediocre. My neck being bad makes it worse. Often getting saline helps, which is weird and seemingly non connected, so it makes me think that the dysautonomia makes it worse and getting proper blood flow even helps with shitting.
One thing that's a bummer tho is that no matter how much fiber and magnesium I have it doesn't stop me from having hard stools, which then cause painful, long lasting bowel movements which cause bleeding. I guess really high doses of magnesium

Besides some of the obvious reasons I avoid ERs, like fear of getting sectioned and abuse by doctors, I really dont love the idea of a full examination "down there", plus after a half year of trying to get proper pain medication and only starting to get prescribed it recently makes me worry that if I go to the doctor with constipation and hemorrhoid problem after finally being prescribed pain medications I need , they'll use it as a reason to take me off the meds , which will put me in bad pain without necessarily solving the issue entirely. But also it's just embarrassing to be thoroughly examined down there.
I eventually do need to do it though.

I guess like I said, very large doses of magnesium helps with stool softening a little bit, and some other things help with motility. Also oral naloxone/narcan is supposedly not absorbed systemically while still blocking opioid gut receptors so it supposedly helps with this problem a LOT. But all in all, this still concerns me greatly ad a problem and its painful. If I could soften my stool at all. i think the problem would be better. If I could somehow be horizontal less of the time despite the great pain induced in my neck by being upright, I would maybe be golden. And if I could camp currently, it might help make a crucial difference in this problem.

So any of you guys have a solution for this? I'm willing to try enemas, or stool softeners , or yogic gut exercises. Also if permanently removing 4he hemorrhoids via a minor surgery helps I would do that but I'm guessing the gut motility is the root of the issue and they may come back if I dont treat it
Do coffee enemas help with motility?

Also would an inversion. table help with this problem? As I see it it could make it so I can go upside down and maybe thus ensure blood flow and gut not being horizontal and stuck, while not making me sit up increasing strain on my neck. I've used them with great relief on my neck before but it was long enough ago I'm not sure its effect on my gut motility, and additionally my neck issues were less severe then. But the concept seems sound.

Also wondering if there are mechanical things such as lubricant of some kind (could use natural lubes such as coconut oil), or some kind of use of gloved fingers helping push out particularly difficult bowel movements
I know it really sounds gross. And it embarrasses me to talk about but I need to consider anything when it comes to this problem.

The yoga thing I'm talking about btw is basically a slightly more formalized version of sucking in ones stomach over and over again, basically manually stimulating your digestion and movements.

Also is there any risk with big doses of magnesium for bowel movements, besides the diarrhea it could cause?

And is there a way to stimulate bowel movements or soften or break up stools from the nether end, like with a specific enema or type of enema ? I'm wondering bc it seems like one doesn't always know if one is going to have a difficult bowel movement. But when one does and is dreading it, it seems important to try and prepare and avert it. But is there a way to do so?

 

[katabasis]

I'm sorry you're having this problem. I also suffer from gut motility problems and I know what a nightmare it can be to stuck on the toilet, struggling with one of nature's most basic functions.

I'm wondering, what kind of magnesium supplement do you take? It's true that magnesium is an osmotic laxative, but some forms of magnesium, such as citrate, amino acid chelates, etc. are fairly bioavailable, meaning they do not remain in the GI tract to have that osmotic effect. If you want to use magnesium as a laxative, magnesium oxide and magnesium sulfate are among the least bioavailable and will be the most effective. You can also take more of these without the risk of hypermagnesemia since it is so poorly absorbed.

There are a few pharmacological suggestions I have, but it might be more challenging to get them without a doctor. I agree that it's a risk to tell the doctor who prescribed you the opioids - ideally, they'd understand the necessity and just work on solving the constipation, but we can't guarantee that. It might be less risky if you looked for a separate GI doctor, and framed the problem as being multifactorial, relating not just to the opioid use but also the dysautonomia. Perhaps if you were comfortable with lying you could understate or even hide your opioid usage. Constipation is such a common problem that it's not exactly suspicious to have it.

Stimulant laxatives are definitely indicated for opioid therapy-associated constipation, though they are somewhat dependence forming. Senna is the most common OTC stimulant laxatives, and you could probably buy bisacodyl from one of the more lenient online pharmacies even though it's technically not OTC. Another good option is methylnaltrexone, which is similar to your naloxone suggestion, though it is more commonly used in oral form. This one would probably be hard to get without a prescription. If you saw a gastroenterologist, they might also suggest lubiprostone, plecanatide, or prucalopride, which are all decent options.

 

[bensmith]

I have this issue sometimes too. Having to dig it out. I eat prunes everyday or it happens, might try that.

 

[pamojja]

Also is there any risk with big doses of magnesium for bowel movements, besides the diarrhea it could cause?

Hypermagensemia could become an issue. Though in my case with sever Mg-deficiency, where only monthly Mg-sulfate IVs overcame the painful muscle cramps, about 30 of them only lowered my serum and whole blood Mg-levels further. Due to pandemic reason not being able to get any further IV since January, I try to keep the muscle-cramps away with now 3 g per day oral elemental Mg. If you decide go that high, do monitor serum and if available RBC Mg-levels.

The other thing with definitely liquifies every stuhls is high enough pure ascorbic acid powder by titrating to bowel-tolerance: http://doctoryourself.com/titration.html

But don't use caps or tabs for such high doses, because of the not so heathy binder and fillers.

 

[Tammy]

Celery juice in the a.m on an empty stomach. If you don't have a juicer you can make in a blender but need to strain through a nutbag. (you just want the juice only without the fiber). It's pretty powerful!

Also Papaya helps me with constipation.

 

[Judee]

Often getting saline helps, which is weird and seemingly non connected

That could be connected actually. You need to have sodium chloride to make hydrochloric acid in the stomach.

My suggestions are:

1) fish oil if you can tolerate it.

I used to take this in my teens and 20s:https://www.amazon.com/Twinlab-Cod-...28959&pd_rd_wg=ZN90N&pd_rd_i=B005U944M6&psc=1
I would try to research ingredients to make sure you can take it. They used to have an orange flavored one too but I don't see that. Also find a cheaper price. That one is too expensive.

2) Mycopryl is also caprylic acid but made from palm oil and it helps with this issue as well. You could probably even do both if you can afford to. (Plus, if you have candida issues this will help with that.)

3) Homemade electrolyte. This kinda goes with the quote and my first idea. Many of the laxatives are mineral salt based so I think it also works like that.

My recipe is 3 parts organic sugar, 2 parts salt (I use half & half sea salt and table salt), 1/2 part Morton's lite salt (which has dextrose ). I take 2/3 tsp in about 12 ounces water and drink the whole glass down at once. (Only if you can stand to.)

4) This next one worked very well for my Mom after the one time when we also had to take her to the ER for this issue: https://www.amazon.com/Swan-Citroma...eywords=lemon+laxative&qid=1626235237&sr=8-12 (But the ingredients which I cannot find on that site are not great.)

5) This also worked but again the ingredients are not my favorite: https://www.amazon.com/Basic-Care-C...jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQ==

6) Lastly: https://www.amazon.com/Esi-Ten-Herb...hild=1&keywords=10+herb&qid=1626235384&sr=8-2
Works pretty well and also many of the reviews confirm. (Sorry it's in Italian. I put the pic of the box from the US at the bottom of this post. Hope you can read that.)

I hope you can find something. ER visits can be the pits.

The first thing I would say to try is the fish oil though. The emulsified version makes it a little more tolerable to swallow. It's still not great but being able to swallow spoonfuls might help more quickly than caps.

Plus it will soften the stools in a healthy way and also has anti-inflammatory properties.

I also agree with the others who mentioned magnesium oxide and prunes/prune juice.

Sorry for the long post.

 

[christiankatz]

For context I shall put that i have no other options at this point than taking opioids for pain. I have exhausted most of the other issues.

Also i dont think that my hemorrhoids and constipation are solely bc of opioids but i worded the title that way bc the opioids may have been last straw for that symptom. Which i did have pre opioid, but wasnt quite as bad.

A few other variables effect my gut motility and constipation: being inside and in bad air , with toxic mold , always makes it worse, even when it's not awfully toxic air , just mediocre. My neck being bad makes it worse. Often getting saline helps, which is weird and seemingly non connected, so it makes me think that the dysautonomia makes it worse and getting proper blood flow even helps with shitting.
One thing that's a bummer tho is that no matter how much fiber and magnesium I have it doesn't stop me from having hard stools, which then cause painful, long lasting bowel movements which cause bleeding. I guess really high doses of magnesium

Besides some of the obvious reasons I avoid ERs, like fear of getting sectioned and abuse by doctors, I really dont love the idea of a full examination "down there", plus after a half year of trying to get proper pain medication and only starting to get prescribed it recently makes me worry that if I go to the doctor with constipation and hemorrhoid problem after finally being prescribed pain medications I need , they'll use it as a reason to take me off the meds , which will put me in bad pain without necessarily solving the issue entirely. But also it's just embarrassing to be thoroughly examined down there.
I eventually do need to do it though.

I guess like I said, very large doses of magnesium helps with stool softening a little bit, and some other things help with motility. Also oral naloxone/narcan is supposedly not absorbed systemically while still blocking opioid gut receptors so it supposedly helps with this problem a LOT. But all in all, this still concerns me greatly ad a problem and its painful. If I could soften my stool at all. i think the problem would be better. If I could somehow be horizontal less of the time despite the great pain induced in my neck by being upright, I would maybe be golden. And if I could camp currently, it might help make a crucial difference in this problem.

So any of you guys have a solution for this? I'm willing to try enemas, or stool softeners , or yogic gut exercises. Also if permanently removing 4he hemorrhoids via a minor surgery helps I would do that but I'm guessing the gut motility is the root of the issue and they may come back if I dont treat it
Do coffee enemas help with motility?

Also would an inversion. table help with this problem? As I see it it could make it so I can go upside down and maybe thus ensure blood flow and gut not being horizontal and stuck, while not making me sit up increasing strain on my neck. I've used them with great relief on my neck before but it was long enough ago I'm not sure its effect on my gut motility, and additionally my neck issues were less severe then. But the concept seems sound.

Also wondering if there are mechanical things such as lubricant of some kind (could use natural lubes such as coconut oil), or some kind of use of gloved fingers helping push out particularly difficult bowel movements
I know it really sounds gross. And it embarrasses me to talk about but I need to consider anything when it comes to this problem.

The yoga thing I'm talking about btw is basically a slightly more formalized version of sucking in ones stomach over and over again, basically manually stimulating your digestion and movements.

Also is there any risk with big doses of magnesium for bowel movements, besides the diarrhea it could cause?

And is there a way to stimulate bowel movements or soften or break up stools from the nether end, like with a specific enema or type of enema ? I'm wondering bc it seems like one doesn't always know if one is going to have a difficult bowel movement. But when one does and is dreading it, it seems important to try and prepare and avert it. But is there a way to do so?

I've had this problem all my life and have taken high doses of magnesium for years with hardly a break from it, and I don't know of any bad effects. I take 4000 mg every other day. I know it's an extraordinarily large amount. I use Swanson brand Triple Magnesium. Plus I take ColonMax by Advanced Naturals (all on Amazon). Occasionally I'll take Cascara Sagrada, which is super effective or senna, but I build tolerance quickly to the herbs.

I've tried coffee enemas, but it's too stimulating for the nervous system, and it didn't seem helpful. Fiber doesn't work for me, even Benefiber made it all worse. Water, water, and more water, as you've heard over and over.

Sorry about your problem. I know it's such a frustrating one. I hope you find help. By telling doc about this, they prescribe Miralax, which is useless to me.

 

[frozenborderline]

Occasionally I'll take Cascara Sagrada, which is super effective o

I have some of this

Does it interact poorly with any of the other meds?

One major problem is that even sitting up with collar for as long as it takes to use the bathroom hurts my neck badly. Unless I have quick easy bowel !movements it causes bad neck pain and makes it s whole ordeal. I can sit up okay with right dose of pain med but that's a Cath 22 bc it would then cause constipation. Unless the whole low dose narcan orally thing is legit

 

[christiankatz]

I have some of this

Does it interact poorly with any of the other meds?

One major problem is that even sitting up with collar for as long as it takes to use the bathroom hurts my neck badly. Unless I have quick easy bowel !movements it causes bad neck pain and makes it s whole ordeal. I can sit up okay with right dose of pain med but that's a Cath 22 bc it would then cause constipation. Unless the whole low dose narcan orally thing is legit

I've never noticed any reaction with other meds. I don't take cascara sagrada often because I build up tolerance to it quickly. For me, cascara sagrada is quick and easy with enough magnesium.

I use magnesium and ColonMax every other night, and it works pretty well, and it's quick and easy.

I also agree with @bensmith Prunes work wonders if you eat enough of them.

 

[frozenborderline]

@rpapen77

 

[Viala]

For me diet change made a great difference in digestion. I recall you wrote somewhere that diet change didn't work for you, but it may depend on a type of diet. I was on keto and gluten free diet first and my digestion quickly improved a lot, no more problems with bowel movements. I don't think staying on keto and a lot of fats and animal protein is good in the long run though, but it can help with digestion at a time. Diet like this changes our microbiota and it works better, but first I would try going gluten free and dairy free, I know some folks here reacted badly to keto, fats are proinflammatory in general so it can be risky to make a change like that.

You can also try acupuncture, there are several points on the body which are related to stomach, intestines and digestion. I was once strongly constipated just like you and acupuncture worked like a charm. I knew an acupuncturist who taught me how to use needles on my own, but pressing the points with something like a blunt pencil can help as well. Usually the points where there is a problem are much more sensitive than surrounding skin, although it is still a bit tricky sometimes to find them on your own. I would also check what in the medicine you take is responsible for causing constipation, is it the active ingredient or maybe some filler, some of them can cause problems like this.

 

[frozenborderline]

What if I'm solving the constipation but the hemorrhoids and pain and swelling are still there. It sort of scares me, like I worry its a worse problem than hemorrhoids and its all so embarrassing and both physically /pem wise stressful to get it checked out and psychologically stressful

 

[frozenborderline]

I have read that hemorrhoids can be a lifelong problem and that they can cause obvious big swelling plus pain , and I've had different degrees of this for years and had s prostate exam once, and stool sample once, so I'm trying g not to panic.

 

[bensmith]

I have had hems off and on for years. For me at least it hasnt been a spiraling problem. I know how scary it is to not be able to poop! Sorry bud hope it comes soon.

 

[frozenborderline]

So is it normal with them to get some swelling and bulges down there


Also wondering if it is emergency I need to go to ER to deal with or if I can just get info urgent care in the next. couple weeks

 

[crypt0cu1t]

If you find a solution let me know. Opioids are the only thing that help me but the constipation is brutal.

 

[frozenborderline]

Cholase. Movantik/naloxegol

 

[frozenborderline]

Okay so heres the deal. I'm contemplating this while having a really painful post tethered cord surgery (my second surgery in two months, of course high dose opioids) bowel movement. The two problems are motility (how much and frequently your gut moves) and the composition of your stool , how hard it is, affected by fiber and stool softeners etc.

I have been on cholase for months. It softened my stool a lot at first , like even to the point of near diarrhea. That's fine, far better than the opposite. But now it barely works. It probably prevents my stools from being rock hard but they are still very firm. Maybe they are a normal amount of firm and my hemorrhoids and slow motility and pained back muscles make it seem worse, make what in a normal person would be an okay bowel movement into a nightmare. Anyway on that note (stool softeners etc) I plan to talk to my doctor, although any advice would be welcome.
Second thing is motility, and if you are on high dose opioids one of the best things is the simplest, the movantik, blocking opioid receptors in the gut. I have used it sparingly bc theres a small but non zero chance it can increase your pain even though its supposed to not cross blood brain barrier and only work in the gut. And I've had it slightly increase peripheral or nerve pain, but it wasnt even close to causing precipitated withdrawals or level of pain I had without opioids so it's a subtle effect.

But it fucking works. I would risk slightly increased pain and just have to take more pain meds later if it means not risking the GI ISSUES high dose opioids cause. That stuff is serious as much as it probably seems humorous to those not dealing with it. I actually, as someone who is fairly pro opioid, think that the GI issues may be the biggest problem. Even then they are mostly a problem at high doses and compounded by other issues, but they do certainly become a problem at those doses

So in my experience senna, for motility, is fucking weak stuff and if you are on opioids movantik will be the cure for motility issues.

This is such a problem for me in the two or three weeks ahead , bc while I plan to taper soon, I'm only a week out from surgery and csnt yet I still have bad incision pain and muscle pain.

 

[kangaSue]

Prucalopride, pyridostigmine or low dose naltrexone are other options that all have effect as small bowel motility agents.
In the grand scheme of things though, most people I know of with chronic constipation, slow transit constipation, colonic inertia, or whatever you want to call it (and they number in the hundreds) find that it takes a combination of stool softeners, motility agents and stimulant laxatives to keep things moving - no one med is everything for anyone in the long term - so you can try mixing it up with the likes of Epsom salts, high dose vitamin C (to bowel tolerance), magnesium citrate etc, and/or arginine, citrulline or any nitric oxide booster which also draw more water into the bowel.
Bile acid and its composition has a significant impact on your bowel motility too so worth trying TUDCA, ursodeoxycholic acid or taurine too to see if improving the balance between primary and secondary bile acids helps with bowel motion frequency.

 

[frozenborderline]

pyridostigmine

I reacted poorly to it. I think maybe bc of my organophosphates poisoning

low dose naltrexone

tricky to use with opioids. I take ultra low dose which Is different range.

Wondering if epsom salts better than milk of mag. Gonna try taurine and vitamin c.

Right now I need a stool softener intensely