Is there a Big & Dandy or Small & Handy for managing opioid constipation? Any tips on assisting with bowel regularity with opioids? Two weeks post-surgery, my friend is still using large doses trying (and failing) to manage their pain. Their constipation is bad enough that their abdomen is becoming distended, and their health care providers are beyond useless. Any recommendations would be exceedingly welcome.
Opiate constipation is something that is talked about a good bit over in BDD/OD. I have experienced it a whole lot. Here is my advice:
First, get some stool softeners and and osmotic laxative. Dusocate sodium is the standard OTC stool softener, and it's safe to take a lot of. What I used to do is take a handful, like 8-10 of them, twice a day (or once a day). It will take some time to work, but this will help soften it up so it isn't like shitting literal bricks once it does come out. The osmotic laxative (miralax is ideal, it's like polypropylene glycol or something, which you mix into a drink) works by lubricating the GI tracts by bringing water into it. The combination of these two will help things to get moving, and also not hurt horribly when it comes out. And drink a lot of water and make sure you are consuming plenty of dietary fiber. A stimulant laxative can help move things along, but it can cause serious cramping.
Once things are moving, this next bit is miraculous. Get some psyllium husk powder, and take 2 teaspoons a day. it's a fiber supplement that additionally forms a mucilage structure, so it bulks stools up and also makes them soft and lubricated. it is VERY important to take it with adequate water, you have to mix the dose with a full 8 to 12 ounces of water and drink it. If it's taken without being mixed in adequate water, it can form a solid gel that can actually cause temporary blockages. This is why you should wait until AFTER things have started moving again from the stool softeners and osmotic laxative, so it doesn't bump up against a poop rock, stop, and make things worse.
Years ago, and also when I started on suboxone this time, I was experiencing terrible constipation from opiates. I would only have bowel movements every 3-4 days, and it was like giving birth to bricks, there was blood and terrible pain, and then I couldn't sit comfortably for 2 days afterwards... constant pain and itching. Once it finally started feeling better, along comes another. I went through this for years and caused some damage (I'm quite sure) which never fully healed. Then I figured out the above regimen, and it changed everything. Despite being on 8mg of suboxone a day (and as much as 16 when I started - keep in mind in the past, even 2mg a day would stop me up badly), I have totally normal bowel movements. Every morning after I wake up, I sit down and it comes out effortlessly. Sometimes I even have a second one in the day. It's been life changing to be totally honest, I used to fear going to the bathroom for years of my life, because of opiates.
Getting the current fecal matter out may be painful, because stool softeners will only work so much against stuff that's already in there, but if you give the stool softeners adequate time to work (8 to 24 hours... it seems pretty variable), it should help. Caffeine can take the place of a stimulant laxative. Another thing that can help lubricate is mineral oil (sold as a laxative).
3-4 days of half hoping I poop that day, half dreading it. A half hour on the toilet, sweating and in agony, to pass a massive, rock hard , what feels like spike-covered brick of waste. Then days of pain and discomfort, and repeat. I sure wish I had done something about it then.
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