Opioids Kratom-Induced Constipation Help?

[tweakedonmeth]

Hey guys,

This thread might be a little gross, but this is for the betterment of opioid eaters everywhere, goddamn it!

I've recently begun experimenting with kratom for recreational effects, and I've learned that I enjoy it a LOT. The biggest issue that's almost ruining this drug for me is the constipation that was present even after the first dose (was taking between 2.5 and 4.5g each dose, 1-3x a day). My bowel movements remained manageable for around 3 weeks, was "cleared out" every 3-4 days with no discomfort.

On the third week, I used oxycodone at 30mg doses every night for 5 nights, and 2 days after that stint I took a low dose of kratom extract. Long story short, I didn't have a bowel movement larger than a bon bon for over a week and a half, it felt like my intestines were literally dormant and were just sitting in my body like a big sack. tried 6 different laxatives, ended up going to urgent care with severe stomach pain.

Complete cessation of opioids for 4 days, plus 10oz of a Magnesium Citrate drink (mine was 1.75g/10oz) mixed with a capful of miralax and orange juice before bed, and then a hot cup of coffee the morning after is what ended up fixing me. I had purchased an enema, I was that desperate. Try that before giving up.

Now, obviously my guts don't like opioids and the wisest course of action would be to not take opioids, but if I were to continue my kratom habit, are there any surefire ways to maintain normal/semi-normal bowel movements? I imagine IV opioid addicts aren't letting their colons rupture, is my experience unusual in terms of how badly my bowels stopped responding? Is there an option that doesn't require you to stop taking opioids, as the CT rebound withdrawal made it extremely difficult to function normally.

TLDR; Kratom and small oxycodone binge induced severe constipation that caused a doc visit, mag citrate+miralax+coffee fixed it after ~2wk. Seeking tips on dealing with opioid bowels day to day to prevent problems like this from forming in the first place, or at-home methods to clear yourself out with unresponsive guts.

 

[DeathIndustrial88]

Kratom can cause added constipation because when you take those capsules or powder form, you're also consuming a shit ton of plant fiber.

The best thing you can do is take that miralax daily while you use your opioid of choice. That's what I had to do when dealing with buprenorphine constipation.
It will keep your stool softer & help you go at least once a day. But some times you'll have to take it for 1-3 days before it actually works. So it's best to just use it on the day's you plan to use an opioid.

Exercise, water, probiotics, prebiotics, magnesium & miralax.


If you ever end up in a situation where you haven't gone in 3 days or more again, drink that magensium citrate or Milk of Magnesia as it's called.
Be sure to drink water with it & keep your electrolytes balanced.

Prune juice is also another good natural laxative that will have you clearing your guts out either in a few hours or by the next day. Prune juice saved my ass (no pun intended) many times back in the day.


Stay away from certain types of fiber. If you are dealing with opioid constipation, increasing fiber can actually lead to an impaction or a bowel obstruction. Because fiber will bulk up the stool & make it even more hard to pass. Which opioids already do. So you want to stick with stool softeners & things that will increase your gastro-motility.

Psyllium husk (metamucil) actually killed my mom, because she was dealing with constipation & wasn't aware that psylium husk was a fiber that will bulk up your stool even more & it caused a tear in her colon.

"In the past, it was common to administer oral fiber supplements containing psyllium (Metamucil, Benefiber), especially to patients who had decreased oral dietary intake. However, research has shown that fiber supplementation is unlikely to prevent or manage opioid-induced constipation and can actually make it worse."
- https://www.oncnursingnews.com/view/fast-facts-for-the-frontline-opioidinduced-constipation


Your experience isn't unusual at all either, btw. Constipation is one of the biggest side effects of opioids. And when it comes to kratom, you're also consuming unwanted plant fiber, which then makes the constipation worse than if you were just taking a regular pharma opioid alone.
Maybe stick with the extracts of kratom, for less severe constipation. And if you do plan to use, make sure to take miralax daily while you use.

Also, when you go to poop, try putting a foot stool or something in front of you on the toilet, to put your feet up on. The way people take shits in the modern world is actually unnatural. We use to do our business out in nature in a squatting position, which helps the muscles push easier. So having something you can put your feet up on can help lessen some of the straining it takes to go to the bathroom.

Probably always a good thing to keep an enema/douche on hand if you're planning to be a long term opiate user. Pumping water into your asshole generally causes your rectum to expel whatever is inside of it.

Most opioid addicts are accustom to the constipation because it becomes less severe the longer you use, due to tolerance increase. So if you're the type of person who can feel kratom, I'd imagine your tolerance isn't very high & that you aren't using every single day of your life. Which means any time you go back to using an opioid, you could potentially have to deal with this problem. For example, when I got on buprenorphine, I dealt with constipation like every other week. But now that I've been on buprenorphine for almost 8 years, I never really get constipated from it & am able to go every day (without needing any laxatives or anything), because my body is use to it. It still pops up once in awhile, but I just quickly remedy it before it gets to be too long without going. This is why you don't see hardcore junkies & opioid users rupturing their colons, because at that point they are dependent on the opioid & their body has adapted.

I've dealt with your exact issue from tramadol, heroin & buprenorphine for the last 16-17 years. All of these tips are what got me through almost 2 decades of using. Thankfully never ended up with an obstruction or bowel impaction.
So I hope this helps! Good luck!

 

[tweakedonmeth]

I appreciate your well-worded response, it's extremely helpful!

Most opioid addicts are accustom to the constipation because it becomes less severe the longer you use, due to tolerance increase. So if you're the type of person who can feel kratom, I'd imagine your tolerance isn't very high & that you aren't using every single day of your life. Which means any time you go back to using an opioid, you could potentially have to deal with this problem.

What's confusing about this to me is how long my bowels were responding just fine for, there was no impaction or anything that induced my almost full 2 weeks without a BM. I assume it's somehow related to the short binge of oxycodone I did while already dealing with very mild constipation from the kratom, maybe I "primed" my intestines to get extra pissed off when I shoved a full antagonist in there or something.

Kratom can cause added constipation because when you take those capsules or powder form, you're also consuming a shit ton of plant fiber.

Which is also why this confused me. I actually took 10-15g kratom in a 4 hour period a few days after trying it out (was not used to the ceiling of effects, I understood why it's still legal after that) and had a normal BM a day or two later despite continuing to take kratom multiple times a day. Maybe the fiber somehow built up in my system over time, I don't know, but it's hard to imagine that the excess of fiber I was consuming from kratom capsules was the catalyst for 2 weeks of laxative-unresponsive intestines.

Senna-S (2x), Docusate Sodium (1x), Miralax (maybe 5 caps total), Magnesium Citrate (2x), fruits, vegetables, caffeine, nicotine, cannabis, physical exercise (daily), and 4 full days with 0 opioids at all and I still could not pass stool "unassisted"

I guess it's a tale as old as time, love the high, hate the trade off. I'll definitely try taking Miralax with my doses and see if that helps keep things functioning normally in the future.

 

[tweakedonmeth]

Sorry, forgot to add - any idea how long would be advisable to wait before starting up on the kratom again? Is there some known "timeline of gut recovery from opioids" study floating around??

 

[DeathIndustrial88]

No problem!


Yeah it could very well have been the oxycodone that topped it off.
2 weeks does seem a bit excessive! I feel for you dealing with that. In my 16-17 years of using, I don't think I ever went more than 4 days without pooping. But that's cause usually by day 3, I start chugging the milk of magnesia, prune juice or taking miralax.

I think there could be various variables as to what made yours so bad & unresponsive for two weeks.
Do you take any other meds? Even your diet could play a role.

Kratom also isn't regulated like over the counter meds are, so it's possible you could be ingesting contaminates or other byproducts with your kratom, which could also effect your gut.

Whenever I've tried kratom, even in low doses & despite not feeling any opioid effects, I can usually guarantee I won't be able to poop the next morning.
I'm not exactly sure why either, unless some of it's alkaloids are only peripherally active (like loperamide for instance). It does this to me even when I have a tolerance to much stronger & much more potent opioids, like heroin & buprenorphine. So I truly believe there's something else at play with kratom that causes constipation.

Plant fiber could help some one poop at first, but yeah, if you continue to take it, your next bowl movement will be big & hard, which can eventually start to cause a back up. So it's possible that first time you took it, you were still able to go, but then when you continued to take it, it made all your subsequent stools start to back up.

Lol I'm not sure of any studies like that out there (not off the top of my head anyway, all though I'm sure studies like this have been done), but generally speaking, once the opioid has left your system, it should go back to normal. Might take another day or two depending on the opioid too.

Do you have anything like IBS or any gastro issues in general? Cause these can also be exacerbated when using.

There were times in my early days of using where I would get incredibly constipated & worried that I would never shit again.

And then there have been times where I was able to go every day, despite using a full agonist for days at a time.
So it's probably gonna be too complex to get down to why you were fine during one binge & then not during the next. But over all, the best thing to do if you plan to keep using, is to stay ontop of it & take preventive precautions. Chronic constipation can be brutal, even deadly. It can also lead to intestinal paralysis.

To re-iterate though, although 2 weeks seems a bit excessive, especially just from some kratom or oxycodone, it's definitely not unusual to deal with constipation on opioids. They even have prescription opioid-antagonists designed to block opioids from attaching in the intestines, but not the brain, just because of this very real & common side effect.

 

[emkee_reinvented]

Hey guys,

This thread might be a little gross, but this is for the betterment of opioid eaters everywhere, goddamn it!

I've recently begun experimenting with kratom for recreational effects, and I've learned that I enjoy it a LOT. The biggest issue that's almost ruining this drug for me is the constipation that was present even after the first dose (was taking between 2.5 and 4.5g each dose, 1-3x a day). My bowel movements remained manageable for around 3 weeks, was "cleared out" every 3-4 days with no discomfort.

On the third week, I used oxycodone at 30mg doses every night for 5 nights, and 2 days after that stint I took a low dose of kratom extract. Long story short, I didn't have a bowel movement larger than a bon bon for over a week and a half, it felt like my intestines were literally dormant and were just sitting in my body like a big sack. tried 6 different laxatives, ended up going to urgent care with severe stomach pain.

Complete cessation of opioids for 4 days, plus 10oz of a Magnesium Citrate drink (mine was 1.75g/10oz) mixed with a capful of miralax and orange juice before bed, and then a hot cup of coffee the morning after is what ended up fixing me. I had purchased an enema, I was that desperate. Try that before giving up.

Now, obviously my guts don't like opioids and the wisest course of action would be to not take opioids, but if I were to continue my kratom habit, are there any surefire ways to maintain normal/semi-normal bowel movements? I imagine IV opioid addicts aren't letting their colons rupture, is my experience unusual in terms of how badly my bowels stopped responding? Is there an option that doesn't require you to stop taking opioids, as the CT rebound withdrawal made it extremely difficult to function normally.

TLDR; Kratom and small oxycodone binge induced severe constipation that caused a doc visit, mag citrate+miralax+coffee fixed it after ~2wk. Seeking tips on dealing with opioid bowels day to day to prevent problems like this from forming in the first place, or at-home methods to clear yourself out with unresponsive guts.

After daily kratom use my bowel movements, that where for as long as I remember not right. To sticky, constipation and abdominal pain. All past the revenue. After taking Kratom religioulsly 3/ 4 times a day. My bowel mowenment's became like they are suppossed to be. Btw Oxycodone never caused me constipation either at 15 mg a day.

Ok diet helps. Vegetarian, fiber's and pre and pro-biotica help. But Kratom solved my intenstinal problems for good. Never had any troubles, as long as I don't ingest Milk protein or red meat. But I know the consequences these foods have on me.

Maybe add some Plums to your diet.

 

[emkee_reinvented]

Kratom can cause added constipation because when you take those capsules or powder form, you're also consuming a shit ton of plant fiber.

The best thing you can do is take that miralax daily while you use your opioid of choice. That's what I had to do when dealing with buprenorphine constipation.
It will keep your stool softer & help you go at least once a day. But some times you'll have to take it for 1-3 days before it actually works. So it's best to just use it on the day's you plan to use an opioid.

Exercise, water, probiotics, prebiotics, magnesium & miralax.


If you ever end up in a situation where you haven't gone in 3 days or more again, drink that magensium citrate or Milk of Magnesia as it's called.
Be sure to drink water with it & keep your electrolytes balanced.

Prune juice is also another good natural laxative that will have you clearing your guts out either in a few hours or by the next day. Prune juice saved my ass (no pun intended) many times back in the day.


Stay away from certain types of fiber. If you are dealing with opioid constipation, increasing fiber can actually lead to an impaction or a bowel obstruction. Because fiber will bulk up the stool & make it even more hard to pass. Which opioids already do. So you want to stick with stool softeners & things that will increase your gastro-motility.

Psyllium husk (metamucil) actually killed my mom, because she was dealing with constipation & wasn't aware that psylium husk was a fiber that will bulk up your stool even more & it caused a tear in her colon.

"In the past, it was common to administer oral fiber supplements containing psyllium (Metamucil, Benefiber), especially to patients who had decreased oral dietary intake. However, research has shown that fiber supplementation is unlikely to prevent or manage opioid-induced constipation and can actually make it worse."
- https://www.oncnursingnews.com/view/fast-facts-for-the-frontline-opioidinduced-constipation


Your experience isn't unusual at all either, btw. Constipation is one of the biggest side effects of opioids. And when it comes to kratom, you're also consuming unwanted plant fiber, which then makes the constipation worse than if you were just taking a regular pharma opioid alone.
Maybe stick with the extracts of kratom, for less severe constipation. And if you do plan to use, make sure to take miralax daily while you use.

Also, when you go to poop, try putting a foot stool or something in front of you on the toilet, to put your feet up on. The way people take shits in the modern world is actually unnatural. We use to do our business out in nature in a squatting position, which helps the muscles push easier. So having something you can put your feet up on can help lessen some of the straining it takes to go to the bathroom.

Some of it is good info but with other part's there are some thing's that miss or are imo wrong described.

-Fiber get your shit going. White start and meat constipate, barely or no fiber's in that. So the fiber in Kratom would be beneficial.
-Kratom causes constipation because its an Opiod, and that is a general side effect of all Opoid's. With or without fiber.
-My problem with Miralax is I don't believe modern medicin is very good either as it besides solving the constipation creates other unwanted side effect's.
-Gastro motility depends also on your food. Does it contain the right fiber's and pre-biotica. Fiber's good bacteria need to eat. Red meat is imo the most constipating especially in a dish with carb's, fat's and little fiber (vegetable's mostly).
-Prunes I discourage as its so laxating it hurts. So if you use it no more then needed. You will thank me.

That some fiber's should be avoided is new to me, but that we shit wrong is real.

 

[fairnymph]

I won’t consume Miralax as I don’t consider it safe.

Personally, I have had much luck with psyllium husks (very high fibre), MgCl added to my water (but start with a small amount & be very consistent - don’t take it irregularly or it can cause gas & other issues), and nicotine when I’m in a pinch. And of course, drink lots of water (3-6 litres daily), exercise, & a high fat/animal protein keto-based diet will all help. I don’t really need any supps living a healthy lifestyle, even on a fairly high dose of h 24/7.

Red meat is NOT constipating! Processed grains, white bread, rice etc are the worst.

 

[DeathIndustrial88]

"With opioid induced constipation –
Never recommend over the counter fiber supplements (e.g.;
Metamucil, Citrucel) (AKA Pysllium husk) for first line treatment."

"avoid fiber supplements if constipation is opioid induced."

https://equalhope.org/wp-content/uploads/2022/01/02-CSOC-FU-Constipation-v.016.pdf

There are plenty of research websites stating how fiber can be dangerous if your constipation is opioid induced. People who deal with occassional irregularity are fine taking fiber & will probably even benefit from it. But some one dealing with opioid-induced chronic constipation shouldn't be bulking up their stool even more.

Of course I can find 50 other websites that say otherwise. So the jury must still be out.
However, since my own mom died from a blockage caused by equate brand metamucil, I think it's pretty irresponsible to recommend fiber to some one dealing with opioid induced constipation & who already have hard/big/compacted stools from their constipation.


I'm reluctant to call kratom an "opioid". It has constipated me even when I've had high tolerance to real opioids. Which tells me it wasn't just kratoms weak opioid effects that caused it. That'd be like me taking heroin everyday & being regular & then one day taking hydrocodone & complaining that hydrocodone is making me constipated. It's just very unlikely.

The fact that the FDA & DEA still allows kratom to be sold tells me it's pretty weak stuff.

"-Kratom causes constipation because its an Opiod, and that is a general side effect of all Opoid's."
I mean, you spelled "Opioid" wrong two different times, in two different ways, but yes, please tell me how I "wrong described" anything.



From the American Gastroenterological Association Institute -

"Fiber is a bulking agent that has both soluble and insoluble forms. Soluble fiber, including both dietary (eg, oats, certain fruits and vegetables) and supplemental forms (psyllium, calcium polycarbophil, and methylcellulose), is more effective for constipation compared to insoluble fiber.
31
However, because fiber is a bulking agent that does not affect colonic motility, it has a limited role in OIC, except possibly in persons with fiber-deficient diets"

https://www.gastrojournal.org/article/S0016-5085(18)34782-6/fulltext

PS : Miralax is an osmotive laxative. It draws water to your colon. Which will then soften your stool. There may be some questions regarding it's toxicity over the long term, but in general, drawing water to your colon is a lot safer than bulking up your stool even more if you have opioid-induced constipation. Hell, when I had to have a colonoscopy done, I had to drink tons & tons of polyethylene glycol (miralax) to clear out my entire stomach. And that was about 10-15x more in a 24hr period than what is needed to keep yourself regular doing opioid use.

People should do whatever works for them though, by all means.

 

[fairnymph]

When I was using 1g of high quality h 24/7 for years, & had very severe constipation, I had no problems at all with psyllium husks, other than not always taking them regularly.

Polyethylene and similar glycol have not been adequately researched in terms of safety and I personally cannot take them or even put them on my skin dilute concentration, so I’d rather take things that people have been using for millennia than synthetic petroleum derived toxins.

 

[fairnymph]

Oat fibre I also have found to be quite helpful, but sadly I could no longer tolerate oats unless unless they’re sprouted.

 

[Kingoffrogs]

Kratom always makes me shit my brains out unless I take 6-10 grams, but if i take 3-5 grams I usually just shit it all out an hour or 2 later, kind of similar to the diuretic effect provided by coffee.

 

[emkee_reinvented]

magnesium

Good one! Magnesium Citrate in a overdose, or Magnesium (Hydro) Oxide are very effective laxatives

 

[emkee_reinvented]

Oat fibre I also have found to be quite helpful, but sadly I could no longer tolerate oats unless unless they’re sprouted.

Contain's both insolveable and solveable fiber's, alot. The last one Beta-Glucan's are besides very healthy also pre-biotic.

Oatmeal made with Oatmilk Aranga palm sugar and extra vierge Coconut butter. Mmm.

 

[Didgital]

Theoretically, you could switch to extracts which tend to not have less side effects, but I think most MOR agonists can cause constipation. According to trainspotting lol.

 

[jasperkent]

Years ago when I was taking methadone daily I had some constipation issues. Likewise, high doses of hydro/oxycodone did the same but not as severely.

I've been taking kratom daily for about 4 years now (no other opioids) and I never get constipated. I drink a lot of coffee and a lot of water. I eat some kind of fruits and/or vegetables every day. I usually eat whole grain bread. For breakfast I usually eat oatmeal or bran flakes. I don't "work out" but I do ride a bike and stay active at my kitchen job.

I don't know exactly what I'm doing right, but it works for me. I haven't taken a laxative in 10 years (in my methadone days).

Hope this helps.

 

[tryptakid]

My experience with kratom is that it does not constipate me to nearly the degree that heroin did - I went weeks without shitting, and other than diminished appetite, experienced no real discomfort until I got dopesick and had to face the music. Kratom will constipate me for a few days at its worst, and I'll feel pretty uncomfortable eventually.

I find that it sort of tips the scales when I'm already on the more sedentary side. If I"m not getting enough exercise and my diet is low in fiber, kratom just adds another variable that increases feelings of being bound up. If I'm exercising regularly, and eating a good mix of beans/veggies on a consistent basis, I may add a little bit of supplemental metamucil and that seems to help quite a bit. I also make sure to drink an extra glass of water, and use more water than recommended for the metamucil. Even then, there have been times where it has taken a few days for fiber supplementation to start working - I can absolutely see where using metamucil to try and deal with true opioid constipation would be ill advised.

I've had struggles with regularity my whole life - didn't even learn about fiber until I was almost 30 and realized I was probably only getting 1/4 the recommended daily amount. Kratom is definitely an extra challenge in that arena, but exercise and diet modifications are sufficient at addressing it.

 

[Cream Gravy?]

I’ve found that daily psyllium husk use and reduced dosing when I don’t need to be “high” just “get by” helps a lot. I take 1/4 of the daily recommended psyllium each morning, drink some coffee and then dose kratom starting after my last bowel movement. Works pretty well.