Morphine constipation help

[wantokporo]

Only taking 7mg of morphine. In my third month. It is helping my PLMD but the constipation is horrible, and also sedation/fatigue has set in, and while I can drink caffeine it doesn't seem to have any effect. (I wish I had stayed at 4mg--it was helping less but I had more energy and controllable constipation.) I have been unable to make miralax work well. I was up to 4 caps daily and nothing, then doc added lactulose which did clean out some (despite diarrhea still very bloated and full of shit) but caused terrible nocturnal leg cramps. Now I am incontinent, wearing diapers and wondering what can be done. This is complicated by my having a resected bowel from Crohn's (it is dormant thank god). Also taking 300 mg of magnesium citrate (and have at times, out of desperation, used glycerine suppositories, drank 2 mag citrate solution bottles, and a fleet's enema). Drink tons of water, traveling now but usually exercise a lot daily. It is also hard for me to completely turn around my diet from 50 years of being a "rapid transit" person with an empty gut to reintroducing high fiber foods, along with others I have been unable to digest for decades, all to no avail.

[Joolsg]

I'm sorry to hear that. You've found a solution to the PLMD, but gained another problem.Can you ask your doctor to consider a small dose of naloxone? It is added to Targinact to prevent gut absorption of Oxycontin and prevent constipation. Your doctor may think it will help.

I would suggest increasing the magnesium, having brassica every evening ( cauliflower is excellent for constipation) and consider buying a good probiotic like Symprove. It can help all sorts of gut problems.

I really hope you can find a solution. Opioid induced constipation is a real problem.

[Elaniemarie in reply to Joolsg]

adding fibre in the form of fresh fruits and veg, plus keeping well hydrated help, porridge is good too.

[ChrisColumbus]

The following needs further discussion with your doctor to determine whether these treatments are suitable in the light of your resected bowel/Crohn's.

A couple of pieces I've read on opioid constipation recommended as a first stage either polyethylene glycol (Macrogol, MiraLax, ClearLax, Golytely), which I see you've tried, or anthraquinone/ anthracene-9,10-quinone (Hoelite, Morkit, Corbit). They then suggested adding a stool softener such as lactulose, which your doctor has tried.

The second stage was to try naloxegol (Movantik, Moventig), methylnaltrexone (Relistor), or naldemedine (Symproic, Rizmoic).

Beyond this, the possible third stage was lubiprostone (Amitiza).

If your doctor will not or cannot prescribe these drugs Joolsg has made other suggestions.

Good luck

[wantokporo in reply to ChrisColumbus]

Thanks to both of you for your input. I am blessed with running -- almost accidentally -- into a former anesthesiologist turned pain medicine doctor who has been willing to work with a lost cause patient (me)...but he doesn't know a whole lot about gastroenterology and I doubt I could find anyone with the mixture of specialties I need. Today, another day of incontinence, has made me think this morphine experiment is over. I am incontinent and have painful constipation and loose stools (I guess that comes with the incontinent territory). Incontinence reduces normal existence quite a bit, even worse than sleepless nights and exhausted days. Also in the last six months, since pregabalin stopped working (after several years of more or less successful treatment--the only thing that has worked for my PLMD) I have developed hypertension. Of course, many of these issues don't come with post-it notes about their causes, but I would believe that at least some of the hypertension is caused by the stress of insomnia and the number of drugs that I have tried and failed to tolerate during this past period because of a wayward liver enzyme (CYP 2D6) that makes it so difficult for me to tolerate drugs. I have built up a lot of anxiety around trying drugs (and I am also blessed to be beginning a mind-body psychology therapy program--called Menda--in the new year that I hope can reduce some of this anxiety and hopefully some of the hypertension). (Just the dietary adjustments for PLMD, hypertension, and a resected bowel are crazy-making by themselves.) Guessing I would say that the lactulose I took once three days ago -- which correlates with the incontinence -- may have caused this and that (insert prayer here) it might go away in a day or two, although there has been some relief to this belly-full-of-shit for over a week with it. I guess that might make me think of continuing the morphine experiment. Unfortunately I do not think my nice pain doc can really guess what might work best. The first time the constipation got unbearable he suggested mag citrate solution followed by fleet's enema in the a.m. That was truly ugly; it did work but is not repeatable. All comments appreciated...

[Shumbah in reply to wantokporo]

My heart goes out to you ,

Is it possible that Buprenorphine would stop your PLMD it hangs on to less receptors in the brain and the bowel impact would be less. Caution as to how much fibre , fibre can cause chronic constipation in some people .

Some of my remedies I add when all else fails is this Chinese hack I learned was to boil pears and they most leave them in there juices over night and eat daily yes it may take a few days , I have also founded adding daily oils to my diet has a really good impact , I take I table spoon of organic sesame oil in the morning ,

Evening I table spoon of dr Gundry olive oil and , bullet proof MTC oil this seems to get me well lubricated I have food many other incredible gut health benefits from the oils .

Castor oil gives a good clean out and not being sugar related would not aggravate other conditions.

I have to be very careful because Fibre backs me up.

The answer to these questions may hold a key 🔑 .

What’s your age ? , because being female there are other things that can come to play as I have recently found out the hard way .

Were you having issues prior to surgery ?

And your bladder you say incontinent now is this correct ?

Also castor gives a clean out , but not a long term solution

[Tim61]

Hi Wantokporo, ,

I don’t now if you’re able to take any cereal products with your Crohns condition, but you could try Flaxseed, or Linseed , you don’t have too take large amounts, look online; has helped my Constipation due to the small amount of Morphine I take daily. Hope you find a solution, not very nice to suffer with. Prune juice has also helped. Happy Christmas.

[wantokporo]

Hello, friends,

I got lucky!! On our travels, while suffering my incontinence/constipation/diarrhea, we stayed with family, one of whom had just had a knee replacement and was taking opiates. For relief from the constipation he was eating bran muffins. They worked for me and for the last three days have been adjusting the amount of bran that keeps me sort of regular. Because of my resected bowel I was hoping I might find a constipation fix from the many foods I have not been able to tolerate for 50 years. So far so good! I almost can't believe it. Now the issue is daytime sedation: on the morphine it is almost as bad as the methadone was. I am able to use caffeine during the day without effecting my shaky legs, although the coffee is not helping, nor green tea -- both of which usually do. So my plan is to cycle through various teas and guarana. Any thoughts on this side effect are appreciated. (Oh, the nice pain doc said I took too much lactulose, which caused the big mess for 5 days.)