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Therapeutic Pain Management Medical Clinic

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FAQs about Constipation and Chronic Pain

The following material is given as general information only, and is not to be considered as medical advice or consultation. 
For any questions or futher information, please contact your health provider.

 

Download PDF version of the FAQs

 

bullet What is constipation?
bullet It is normal to have between a few bowel movements per day to two or three bowel movements per week.
bullet Because of the serious problems that can occur from constipation in the patient with chronic pain, the goal should be one soft bowel movement every one to two days without cramping or straining.

 

bullet Why do patients with chronic pain have problems with constipation?
  1. Inactivity and lack of exercise can slow down the bowel. Exercise stimulates bowel contractions. Because of pain, many chronic pain patients are not active.
  2. Medications frequently cause constipation. Some of the medications that frequently cause problems in pain patients are:
bullet Opioids (narcotic pain medicines) such as codeine, Vicodin® or Lortab®, Darvocet®, morphine, Oxycontin®, methadone, Dilaudid®. (There are the most notorious for causing constipation)
bullet Tricyclic antidepressants such as amitriptyline (Elavil®)
bullet Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®)

                            Other medications that can cause constipation include:

bullet Iron supplements
bullet Calcium supplements
bullet Diuretics (water pills)
bullet Some anti-cancer drugs
bullet Some anti-hypertensives (drugs used to treat high blood pressure)
bullet Antacids that contain aluminum
bullet What are other causes of constipation?
bullet Inappropriate laxative use
bullet Drinking too little water
bullet Too little fiber in the diet
bullet Diabetes
bullet Hypothyroidism (low thyroid function)
bullet Bowel problems such as diverticulitis, irritable bowel syndrome, bowel obstruction
bullet Neurological problems such as a stroke
bullet Depression

 

bullet Why worry about constipation?

            Constipation can be painful. In the extreme, it can lead to complete blockage and serious medical problems.

 

bullet Who should be on treatment for constipation?

            If you take opioid pain medicines on a regular basis, you should be taking medicines on a regular basis. If you take opioid pain medicines               around-the-clock, you should be on bowel medicines around-the-clock.

             Again, the goal should be one soft bowel movement every one to two days without cramping or requiring straining.

 

bullet What do you recommend for preventing constipation?

If you&

Take&

& are taking only an occasional pain pill

&Colace® 100 mg pill by mouth twice a day

& are taking pain pills routinely

&Senokot-S® 2 tablets by mouth at bedtime

&have no bowel movements in any 24 hour period

&Increase to Senokot-S® 2 to 4 tablets by mouth two to three times a day

&have no bowel movements in any 48 hour period

&Dulcolax® 2 to 3 tablets at nighttime and up to three times during daytime (take this in addition to the Senokot-S®)

&have no bowel movements in any 72 hour period

You need to be checked by your doctor to make sure you dont have a blockage (impaction). In addition, you will need to take additional laxatives such as

bullet Magnesium citrate, 8 oz by mouth, or
bullet Lactulose 45-60 ml by mouth, or
bullet Fleet® Phospho-Soda enema

Note: For simplicity, we have used trade names for drugs. Generic drugs may be cheaper and work just as well. Your pharmacist can help you.

 

bullet Do you recommend bulk laxatives, such as Metamucil®?

    No. In patients on large doses of opioid pain medications, bulk laxatives (fiber laxatives) can lead to a high blockage, which can be serious.

 

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