Opioids Rectal Admin. of Dilaudid w/ SEVERE Constipation

[jamesBrown]

Yes...I have UTFSE and haven't found much info on my specific problem.
I have been prescribed HIGH doses of Fentanyl( 200 mcg/hr every 24 hrs for 5 yrs but am now down to 37.5 mcg/hr ) along with Dilaudid 8 mg 6 times daily for about 7 yrs now....among other, non-constipation causing, meds as well. The opiates I'm prescribed cause EXTREMELY SERIOUS constipation. I usually "void" every 3 days or so but as of now it has been 7 days since my last bowel movement. I have tried enemas, laxatives, stool softeners...the works...with no luck WHATSOEVER. My doctors are aware of the situation.
Long story short, I want/need to rectally take my next few Dilaudid doses but am understandably extremely concerned about my stool absorbing the medication and, thus, negating the effects(medicinal or otherwise).

I have experience using drugs rectally but never with a constipated bowel. I was hoping to hear some personal knowledge/experience on this particular subject so I can try to figure out whether or not the odds are in my favor concerning my bodies ability to successfully absorb the meds despite my extreme blockage.

Any help is greatly appreciated,
jB

[ I apologize if this is the wrong place to post this thread. If so, please move to correct forum. I haven't used BL in quite a long time and have forgotten how many things work ]

 

[d1nach]

It depends on where the obstruction is. Idk how else to put it if you could have rectal sex I doubt it. Your intestines is like 28 feet long and if you used a enema and that didn't reach the stool then I doubt the drug would.

However, are these pills meant for oral I'd be worried about the inactives damaging the walls of the anal canal by dehydrating like if you've ever tried putting starch directly in your mouth it dries up. The anal canal isn't like the stomach where there's a large amount of fluid and a thick mucous coating. Instead it's only a weak mucous barrier (because the stomach mucous is designed to protect u from HCl) and with very little water which then if dries can crack like your lips on a cold day where sometimes it lip bleeds then the harmful bacteria in the stool could enter directly into systemic circulation making you very sick. Or if your obstructed long enough in one area eventually the price can become hypoxic and start dying

 

[jamesBrown]

Umm..I'm not sure what your experience/knowledge is concerning rectal administration of drugs(including pharmaceuticals), but I would be making a liquid dose out of the pills for this particular ROA. Which, as far as I know, would not raise concerns about dehydration of the intestines.
Proper rectal administration(as far as I've always been told), always includes injecting a liquid "concoction" of whatever drug(s) you are taking. And it most definitely does not include just shoving a pill up there(unless you are very old school), as putting a pill up your ass, dry, would greatly reduce it's ability to be absorbed, and you might even end up just shitting the pill back out completely intact.
Now, I can't tell if that's what you meant in your response or not, but if you were thinking that I was going to inject a liquid solution up there, and you were STILL worried about my intestines drying up etc, then can you explain why you think that could possibly happen since it's a liquid solution instead of a whole pill or even pill powder?

 

[d1nach]

I pictured you just shoving a pill up there youd be suprised. If its a liquid you should be fine.

 

[jamesBrown]

I'm bumping the thread since it has now been 8 whole days since my last bowel movement and I have thought of another question...

Does anyone with experience dosing medications/drugs rectally know if I need to inject the liquid solution of my hydromorphone 'somewhat' deep in my ass(that sounds so weird to type/say) in order for it to work? And by "deep" I mean the full length of your average 1mL insulin syringe(w/no needle tip obviously)....so about 3 to 4 inches or so depending on how far the liquid gets squirted. Or can I inject my solution directly into the "space/area" right inside my asshole(which would keep it at least a short distance away from my SEVERE blockage slightly further up my intestines)? I'm not sure if there are enough veins in that area to successfully absorb my hydromorphone solution, which would be about 32 mgs of Dilaudid in 1mL of water(I have a MASSIVE tolerance and can't get high even if I wanted to....I'm simply trying to use the Dilaudid rectally to increase the BA and as a result, not have to use as many pills in order to get pain relief....which would help me save money with buying my prescriptions).

And as a reminder, I have experience using drugs rectally(opiates)....just never with this level of constipation, or constipation at all really.

Thanks to all,

jB

 

[DixiChik]

I don't know if this is any help, but I have severe GI issues from both disease and chemo to treat disease. I know bowel obstruction up close and personal. I would "think" that if you've got a colon full of stool, your rectal admin would "waste" your medication.

Have you tried remedies to empty your colon first? Magnesium Citrate w/3 or 4 Dulcolax is my GI doctor's preferred method for cleansing prior to colonoscopy. It's brutal, but quick and does the job. There are many other things to use, but most require a "wait and see" approach...with a need to stay near the toilet. The MC is $1.50 at Dollar General and Dulcolax is $5, so well worth the results.

Perhaps once the fecal matter is evacuated, you can plug your med and get the relief you need.

I'm sorry you are in pain. I can certainly empathize. Hope this works!

 

[jamesBrown]

Thank you VERY much DixiChik for the advice! I appreciate it.

I have not tried Magnesium Citrate, but I thought about it. I have tried laxatives and stool softeners, but they ALWAYS cause quite extreme GI pain and a feeling in my gut that is impossible to explain but is VERY uncomfortable. And since I am severely disabled and was bedridden for over 5 yrs(now i can walk a little bit with a cane), and I have lost ~45 pounds bc I'm constantly nauseous as a a direct result of my INTENSE pain originating in my lower spine where my disability started(spinal infection resulting in L4 and L5 discs turning into 'goop')....I am now only ~120 lbs at 6' tall( I was 165 lbs before my disability ).
I think I might as well give Magnesium Citrate a try...since nothing else seems to work. But since I have even done several fleet enemas where I kept the enema liquid inside me for over 30 minutes and then tried to 'void' but only the liquid comes right back out without ANY fecal matter, I have a hard time believing MC will fix the problem.
I guess I'll just have to continue taking a tasteless powdered fiber supplement(generic Mucolax) since it does not cause any GI distress like the stool softeners and laxatives....and pray to the GI gods for relief.
It's just I really need to try this rectal hydromorphone soon, so waiting for results is not my strong suit right now.

Thank you again!

jB

 

[DixiChik]

I'm sorry to hear about your disability, but happy to hear you have regained a modicum of your mobility!

I'm certainly no expert, but I've been in situations that are too bizarre to be believed...by those who are blessed with normal bowel activity. I can assure you that the MC will blast through granite like dynamite. Adding the Dulcolax will shorten the fuse, so to speak.

I'm not one to sugar coat, so I won't say belly pain isn't possible (cramping and urge to go). However, if you are results-oriented and short on patience...it's worth it to get results. Sadly, wait and see won't help constipation.

The Fleet enemas don't help my issue much. I have to keep a medical grade enema kit handy. Warmer water with some mineral oil seems more effective. I too have experienced the "liquid only" return result from bottled enemas. That usually indicates either the stool is impacted and too hard OR there's a blockage. PLEASE don't let that happen before you take action.

If you are taking Miralax, BE SURE to drink MUCH water. Otherwise you will be dehydrated AND constipated. Trust me...I know. I ended up in the hospital with a partial bowel blockage in 2015. I'd been religiously taking the generic Miralax, as well as trying all other OTC products to get relief. I have a crimp where my transverse converts to transcending colon (think crimped water hose). Surgeons will no longer touch me, so it is what it is.

Again, I hope you get some relief.

 

[jamesBrown]

Thank you again DixiChik!

I actually was originally diagnosed with an intussuscepted bowel( this is when part of my intestine folds over another section of my intestine ) when I was going from hospital to hospital to Dr to Dr, trying to find out what was causing my UN-FUCKING-BELIEVABLE spinal/back/body pain. This was when I had my spinal infection but NO doctor believed I actual had a medical issue because I was a 21 yr old male screaming and crying like a baby because of the intense pain. They all(including the nurses) AUTOMATICALLY assumed I was faking the pain to get drugs so they actually refused to test me and look at my spine or do any blood tests. As a result of this, it took me over a month to find a doctor who believed me and finally agreed to give me an MRI and when he saw my infection he personally called me immediately, apologized, and told me to get to the hospital. What sucks is that if the doctors would have simply tested me in the beginning I would have only needed a couple weeks of oral antibiotics and my spine would have been fine......Instead, over the course of that month my spine turned into goop as I said earlier and has made me permanently disabled.

But my original point was that before the doctors believed me, they still acknowledged that I was severely constipated( BC i was at that time), and so they gave me an enema and within 8 minutes I took a shit that LITERALLY( this is no exaggeration ) FILLED THE TOILET UP to the point where my shit was practically at the level of the toilet seat. It must have been a 5 pound shit. The nurse even took a picture of it cuz he couldn't believe it.

Anyway....I think I WILL try the MC since you told me it worked so well for you.
Thank you so much DixiChik. And any more input is appreciated, especially concerning the rectal hydromorphone.

Much appreciated,

jB

 

[Red Moon]

I can't help you with the rectal administration of anything, but... for constipation, Miralax, senna laxative, and magnesium citrate are the best things out there. Aside from senna laxative these are what they use to clean you out for colonoscopies, and in my experience there are no other laxatives and no stool softeners that do a damn thing for constipation. I really do not recommend taking fiber supplements, either. People always say they're good to keep things moving properly, but what they really do is bulk up your stool. I don't think that's going to help your situation at all. It sure as hell never helps mine, and I don't even do opiates...

 

[d1nach]

I doubt that one ml of water would reach the stool. U can visualize this by spirting 1 ml onto a table it doesnt go very far or onto a peice of meat. But if your going 8 days without pooping omg I have bowel issues and let me tell you doctors could give me iv heroin and that wouldnt reduce the pain from that level of constipation. I was constipated for a few days longer then that and I actually went to the hospital because I started feeling psychotic like I couldnt think focus I couldnt find words and if you said whats your favoriate color or some simple question id look blanklyy at you pause for a. Very long time forget what u asked or finally answer slurring

 

[d1nach]

The . Worse part was the doctors thought u was lying because thry said "its impossible to not poop that long youd be in too much pain tobe here right now" like wtf im saying im in so much pain im hallucinating and u think im making shit up. I dont want pain pills I legit thouught I was dying ffs this opiate thingvhas reslly gotten out of hand

 

[kleinerkiffer]

If you haven't shit in 8 days it's time to go to a doctor

 

[jamesBrown]

If you haven't shit in 8 days it's time to go to a doctor

I have.
As I said in an earlier post...the "doctors are aware" of my situation.
Problem is, constipation has been a constant part of my life since I was first prescribed these strong opiates. SO my docs are VERY used to me being extremely constipated and after trying to help me out with the situation by prescribing/recommending etc...with little to no results, they just kinda gave up and told me to do my best as far as eating right or making sure I get enough fiber. So when I informed them of my current situation, there wasn't much they could do or say that I didn't already know.
And another big issue with this is the fact my pain causes so much nausea that it's literally impossible to eat without taking some of my Marinol or smoking/eating cannabis products. And even then it's still hard to eat any more than about 1 small meal a day. So it's difficult to get "the right kinds" of food into my system that would help with regular bowel movements.

 

[MDPV_Psychosis]

If you haven't shit in 8 days it's time to go to a doctor

:/

I've dealt with constipation all my life. Started when I was a kid (long before I ever used opiates) like 7/8 years old iirc. I guess I just have always had a slow moving bowel system.

When I'm totally clean of opiates it's normal for me to go about once every 3 days.

When using opiates I normally go about once a week and occasionally even once every 8-10 days.

I'd agree that, for most people, you should start to worry if you haven't gone for over 8 days. I say that because when I was on suboxone I would regularly be unable to go for well over 8 days. I'd notice odd symptoms start to develop when it had been really long since my last bowel (10-12 days +) movement: I'd feel sick and lethargic especially when first waking, My breathe would be especially foul, my thoughts would be foggy and I'd suffer from headaches.

The single best prevention for severe constipation is too keep yourself hydrated. Because you are taking opiates/opioids your bowels will move slowly resulting in larger more compact stools. In my experience, staying hydrated helps keep things moving (albiet still much slower than normal, but atleast moving). If you let yourself get dehydrated then your body will pull every last drop of water it can out of your bowels. This causes your stool to become intensely compact and dry. Things slow WAY down even more which causes your stool to compact even more as your body tries to move it along but with more friction than normal.

Once this happens your screwed. At this point, drinking more water (and/or taking laxitives) will help only to lubricate your bowels... You will still have a lumpy, dry, massive clump of stool to pass (often will be like passing a pine cone). The key, in my experience, is to stay properly hydrated so things stay more pliable and keep moving.

 

[DixiChik]

JB...Have you tried the MC yet? I was hoping to check in this morning and read that you've gotten relief. Chronic pain is a curse without belly issues. Sadly, they often ride shotgun.

Many folks don't take this seriously. Those often are the same folks who make butt biscuits on the regular. They take this shit for granted, literally, like eating and sleeping. I don't. I can't or I'd be dead. I make the "walkers" and "biters" look healthy!

Yes, I have an irreverent, often macabre sense of humor. It's a survival mechanism.

My problems are not opiate-related. I am a testament that the human body can go 11+ days without a bowel movement. That's with Senna, Perdiem, etal. I've had to resort to Linzess 290 per day since my partial obstruction. It's horrifically expensive and often doesn't work.

Wal Mart sells a "hot water bottle/enema kit" in their pharmacy dept. It's this big red rubber 1950's looking douche bag apparatus (concealed within a tidy yellow/blue box) But...It's only $5 and can deliver copious amounts of warm water/mineral oil into your colon. I personally find myself having to administer multiple 32 oz. warm water enemas/release with no results/repeat. BE CAREFUL not to overfill your colon...slow and easy..."Say HELLO to my little friend". Sometimes the stool is so hard and dry, it "sucks" the water in and keeps it (yep).

A general surgeon who performed 2 hemi surgeries for me suggested daily enemas. He explained that even though I have the splenic flexure issue (high in my left side) where the stool gets trapped...the enema can cause the colon to spasm. This movement can potentiate motility. I ordered various kits online, but have found the standard hospital issue plastic "bucket" kit best for me. It does the job, can be easily disinfected after use (yes, germ-phobic) and hidden in the bathroom cabinet.

He looked at my CT scans when my colon was monstrously distended. He shrugged and said it can expand to 9" diameter before rupture. Gee, thanks. Meanwhile...what will you list as my cause of death, Doc?

Increased fiber can cause "hay turds" that totally block your slow motility. One size DOES NOT fit all. What works for "A" can make matters worse for "B". I too have problems with malnutrition and malabsorption. I too have nausea and projectile vomiting. I would not wish this on my worst enemy. I empathize with your plight.

I too have begged asshole-ish doctors to "FIX THE PROBLEM". I was told at the ER, following my CT scan that "You have a colon filled with stool and a bladder filled with infection". He sent me home with script for Lactulose and Cipro. I was emergency admit within 2 days, with a 6 day hospital stay. Fuckers made me drink gallons of colon prep and enjoyed watching me suffer. My husband got my referral to GI group in Jackson, but my colon surgeon from 1994 no longer practices due to Parkinsons (63). My cancer surgeon from 1994 retired in 2010 and has since died. I am royally fucked.

I've been across 3 states from UMMC to UT to Vandy begging for help, not drugs, but HELP! Make that 4 states, counting endo surgeon consult in St. Louis this year. He suggested I see a general surgeon...cock-sucking sack of worthless monkey shit "specialist surgeon for women with endometriosis" says this to a woman with stage 4 disease. I'm 22 years post multiple surgeries to remove multiple organs, castrated at 33, bone death from chemo, yatta yatta. I can't eat, sleep or shit.

Sorry to drag you off into my ditch. You don't need that. I sometimes feel I could go Negan on these mofos, knowing their apathy and incompetence made me what I am today. IF ONLY they'd listened...will be engraved on my tombstone.

FWIW, there's a scripted injection called Relistor for severe constipation. I cannot afford it, though I have no doubt I need it. Perhaps your insurance would cover the costs if it worked for you. Also, Zofran helps my nausea.

If I can help just one person...

 

[CruelBri]

this might not have anything to do with your situation, but for some reason when i tookl SUBUTEX IV, constipation gets bad... like 8 day no poop bad... Then i switched to, Rectal Bupe and my constipation GOT WAY BETTER.... like it went away and i was pooping everyday, IDK why.

also, your best bet is to, STOP taking the meds for a day basically... go into a slight withdrawal and then u should be able to poop. withdrawals make me feel like i wanna shit my brains out, and i usualy do , and it becomes very liquidy for some reason...


I would drink a ton of water, and not take ur meds on an OFF day when you have nothing to do, wait till you feel sick, and try and poop.

ALSO a game changer that helped me is the Pooper helper thing... where you sit on the toilet and put a mini trashcan under you that you can put you legs on, to help put you into our NATURAL pooping position which is squatting. this i have been doing everytime, it basically allows your bowels to straighten, instead of being KINKED. Look it up.

 

[d1nach]

I use an enema everyday. If you use a enema with high volume IE more then like 4 ounces I use 0.9℅ sodium chloride. Which is a fancy way of saying one 16 ounce water bottle one tsp or 1/3 a table spoon. Of table salt. Your blood requires sodium to function properly whenyou put water into your rectum it's able to take up sodium and cause hyponatremia. By keeping the sodium in the solution equal to that of your blood it keeps it even. Technically I use 0.9 ℅ nacl sugar alcohol 1.5 ℅ - 6 ℅ milk protein 4% glycerol 1℅ hydrogenated vegetable oil 1℅ mineral oil 1% chloresterol saturated fat 1.5℅ vegetable oil 5 to 12.5 ℅ but really all u need is salt

 

[d1nach]

I have no idea if plugging opiates make constipation worse but if that was the case couldn't the opposite like phenylephrine be delivered to the colon in much lower doses to cause contractions

 

[jamesBrown]

Ok guys. Thanks for ALLL of the kind advice I have been recieving. Especially DixiChik since it seems her advice was what ended up fixing(sorta) my problem.

I apologize for not responding in the past couple of days. I was partly busy with family and I also wanted to see this whole process thru before I reported back to you guys with my experience/findings.

So I am going to start writing a post explaining all that I did and how it worked so hopefully people can learn from my experience. But basically....I'm F*****G "cured". At least for now.....thanks to all of you! You have NO IDEA how much of a relief this is.

I will post back when I have finished writing about it.

....but long story short....I clogged the toilet....success!!!!!