Morphine Constipation

[bowell]

Sorry if this not a nice subject

T2 using Metformin & Glicazide
Constipation was never an issue with Metformin anyone who uses it may well know

From an accident I now need to take 2 kinds of Morphine and Gabapentine this results in very bad Constipation :?

Both my GP and Pain Team
have given me senna tablets and Lactulose Solution (tastes like coffee)
I have tried that powdered stuff that's like drinking jelly that did not work for me ,made me sick
needed far too much of it

Now before you all jump up and down. Yes I know Lactulose is a artificial sugar
But it works for the Constipation ,, bad for BG levels

However most if not all things I try to help have an effect of bringing my BG up far too high
my diabetics has taken more of a back seat with all the other things going on
now I need to get my BG back levels under control

Question
Is Anyone else using morphine and having problems
this kind of constipation is compaction so you need some heavy duty stuff all the time

ie Whole can of prunes will not do anything only rise BG levels far too high same with figs

What do you use ?

 

[sugarless sue]

If you can tolerate it and there is no medical reason against it try adding a teaspoon or two of oil to your diet. This may help and will not raise your Bg levels in the process.

 

[cugila]

Here is a post I did recently about Laxatives.........you need to discuss this with your GP as the one you are prescribed might need changing to a more effective one such as a Stool Softener Laxative rather than the present Osmotic Laxative and Senna. Some of what is in my post here would appear to apply to you.

Ken

All Laxatives are not the same.

Manevac (Senna) is a stimulant laxative that increases intestinal motility and can often cause abdominal cramps, they should be avoided in intestinal obstruction. It really is only speeding the process up rather than softening the stools which is probably what you need. If they don't work then an Osmotic Laxative should really be considered. Something that softens the stools and allows an easier bowel movement.

It may be that what you have been prescribed just isn't suitable for you and your particular type of constipation. This one also isn't really advisable for DIabetic's because of the sugar content. Ask for a sugar free laxative. One that softens the stools rather than one that just encourages the bowel to just empty. Movicol is a good example........an Osmotic laxative.

There are four types of laxative and each type works in a different way.

Bulk-forming laxatives
Bulk-forming laxatives contain fibre and act in the same way as the dietary fibre that you eat.
Bulk-forming laxatives increase the bulk of your faeces, making them heavier and softer. The extra bulk encourages your bowel to contract and move your faeces through so that it can be passed.
Bulk-forming laxatives can take a few days before they are effective. They are taken by mouth (orally) as powders, granules, or tablets.

Stimulant laxatives
Stimulant laxatives speed up the movements of your bowel. They usually take between six and 12 hours to work. Stimulant laxatives come in many different forms, including tablets and liquids, which are swallowed. They are also available as suppositories and enemas that are inserted into your rectum (back passage).

Osmotic laxatives
Osmotic laxatives help to make your faeces softer by increasing the amount of water in your bowels. Like bulk-forming laxatives, they usually work after a few days.
Osmotic laxatives come in several different forms, including powders, liquids and enemas.

Stool softener laxatives
Stool softener laxatives work in a similar way to osmotic laxatives; they add water to your faeces to lubricate it, making it more slippery and easier to pass. They are taken as capsules, or enemas, and usually take one to two days to work.

There are also many other things that can cause constipation, you really need to ask for a referral if what the GP prescribes isn't working. You shouldn't have to suffer in this way. You should drink plenty of water, at least 2 litres daily and eat fiber rich foods such as fruit, vegetables and cereals as well. Exercise and upping fats sometimes (not too often) also can help. They all help the digestion and the GI processes work better.

Here is the link to more information about constipation and possible causes:
http://www.cks.nhs.uk/patient_informati ... laxatives#

It is quite possible that a different type of laxative as listed above may cure the constipation. Do not take over the counter laxatives either. Get this investigated further.

Ken

 

[Angeldust]

Yeah, it's horrible.
Nothing works for me because of my stupid stomach. Have you tried anything milder like bisacodyl?
The epsom salts made me vomit.

My gastroenterologist put me on Targinact, it's oxycodone with naloxone added to it to prevent constipation. I hate opiates fullstop and avoid them when I can but I know sometimes you don't have a choice.

 

[bowell]

Thanks for the replies

for interest My GP has now explained it to me and why

Opiates,, Morphine stop the muscles in the upper gut from working ,so will not push it down , a traffic jam starts
Opiates also have a second effect to draw water from your Poo making it very Hard , just like lead walnuts so you get a double hit going on

Not one single laxative with fix this However a mixture of two types
To Fix Opiate Constipation.

First you need Stimulant laxative (senna) to start the muscles in the upper gut from working ie push it down your system
Second you need Osmotic laxative (lactulose Liquid) to draw water from your body back into your Poo

This is not a one take fix you need to keep taking it as the lactose takes over 24hrs to start to work

For me it tastes like coffee so ok and only need around 5ml 2x a day
and I rather take the small blip in BG level than the pain with constipation


Stimulant laxative:
Senna works by encouraging the bowel to contract and move the waste products along the bowel, helping you to go to the toilet.


Osmotic laxative:

lactulose works by increasing the amount of water that is secreted within the intestines. This effect helps to produce softer, easier-to-pass stools Unlike other laxatives that are recommended for temporary relief, lactulose can be taken daily for decades. It is safe for people of all ages,

DO NOT USE
Bulk-forming laxative ,
(wheat bran and ispaghula husk Fybogel Sachets ) because they have no direct intestinal propulsive action,
have little to offer in the management of opioid-induced constipation, and can make the situation worse
A note of caution: fibre and bulk-forming laxatives partly work by absorbing water (a bit like blotting paper).


Opioids act on the myenteric plexus in the intestinal tract, reducing gut motility, causing constipation. The gastrointestinal effects of morphine are mediated primarily by μ-opioid receptors in the bowel. By inhibiting gastric emptying and reducing propulsive peristalsis of the intestine, morphine decreases the rate of intestinal transit. Reduction in gut secretion and increases in intestinal fluid absorption also contribute to the constipating effect

 

[cugila]

Good job he took the time to explain the differences as were pointed out earlier.......some GP's just see the word 'Laxative' and that's what you get ! Hopefully you are on the right stuff for you. It's worth beraring it in mind if anybody else is having problems with prescribed Laxatives not being effective,
there is more than one type.

Ken

 

[leather_ferret]

Coming to this discussion a bit late,

I too am on opioids, between 100 and 300 mg Morphine /day (depending how stroppy my pancreas is at the time), plus amitriptyline, pregabalin and fentanyl .

I have tried most 'laxatives' and have found that far and away, Movicol is the best for me.
During periods of heaver Morphine usage, I often take Senna as well.
I also have a fairly high fibre diet and find that this helps too, and do make sure you take plenty of fluids every day.

Some GPs are not too keen on prescribing Movicol as it is quite a bit more expensive than many of the alternatives, but in my mind, worth every 'penny spent' ... so to speak )

It is standard policy on the pancreatic unit at the Hossie I was at, that as soon as a patient starts on any opioid, they are automatically started on Movicol. It goes in one end and comes out the other chemiclayy unaltered will not affect sugar levels,

There are also new opioid combination drugs that include naloxone. These are getting quite good results..... ie Pain relief without getting bunged up. I have not tried these yet as I have a 'system' that works for me and am loath to change it.

Hope this helps

Dave

ps, Movicol is a waxy substance called polyethylene Glycol (PEG) and happens to be the same chemical being used to preserve the ship 'Mary Rose'
Maybe I'll last forever too ?????

 

[terrywinkle]

For the constipation, try reading this article, it may help.

hometreatment.net/home-remedies/digestive-and-urinary-problems/home-treatment-for-constipation/