Opiate induced constipation

I’m a retired nurse, a chronic pain pain who uses buprenorphine patches for pain and I’ll try to explain. The treatment for your OIC in my opinion would not be a medication, it would be fluids and foods not another drug that may be a tier 4. I have been on narcotics for pain since 1988 and control my potential GI issues with fluid and roughage in foods I eat. I also walk 2 miles a day which helps move food downward through your gastrointestinal system. Your GI system breaks down nutrients from food and liquids in the small intestines and the excess fluid that is left over aides at making your colon slippery. If you don’t have sufficient fluid in your system on an ongoing bases you become constipated.
I looked into Relistor and it’s indicated for “advanced disease” meaning constipation and for those who have failed a home laxative program. If you haven’t seen a GI doc it is recommended is you’ve done everything I’ve suggested. Also, a GI doc might have other recommendations too. Good luck.

Thanks Jena,

Actually, it was my GI Dr who prescribed Relistor. It is very expensive but I have a one-year supply paid for.

It helps a little but I still need help from a stimulant laxative. The Relistor also makes me dizzy and that is one of the top side effects.

I may just go back to Motegrity which stimulates the intestines. And believe me, I eat a lot of fruit with high fiber content, I eat muesli and all bran and I take Miralax every day. So when Ido get BMs there is no straining at all.

But it's all or nothing. If I don't periodically use stimulant laxatives, mu diet alone won't do the trick. Very frustrating and one thing about gettin older (69 y/o) that I really don't like.

I’m 71 and have been on narcotic pain meds since 1988 and have never had an issue with constipation. I believe the reason is my water and fruit intake as well as walking. I’ve always been a walker and now walk 2 miles daily. How is your activity?

@jenatsky
I know this is old, but this was the most recent discussion I could find related to my situation. So you're a nurse too? Have you ever heard of Silver Fern™ Brand supplement called Motility? https://www.silverfernbrand.com/products/motility
It was recommended to me by a functional medicine Dr that I saw for my gut health and hormonal issues. (I have been on MAT for opioid recovery for almost 20 years, and for about the 1st 15 I ate what I wanted... and now that I'm getting older, it's back-firing on me) GI health was never addressed by my MAT Dr, nor were we ever even warned about the possibility of GI side effects. And now I have chronic constipation. When I take Miralax and Senna, it works but I'd obviously rather not have to rely on them. (And I have obviously changed my diet drastically, but I fear the "damage is done" so to speak) I have my colonoscopy next month, but I wanted to try something.... anything other than traditional laxatives. Just curious if you've ever heard of the Motility.... that's pretty incredible that you've been able to be on opioids that long without developing an addiction or any other GI side effects... good for you!

@sunshinedevine Yes you are correct I’ve been on an opiate of some kind for over 30 years and funny I’ve never considered it as a abusive drug. I don’t have an addictive personality my wife who is a psychologist tells me. The same reasoning was probably behind my not becoming an alcoholic during my first marriage when I was consuming too much alcohol. I didn’t need any assistance from. products following my first colonoscopy and now I do the cologuard test and haven’t needed a scope.

Hi jenatsky,

I am an alcoholic/addict (sober 14 plus years now) and I agree, from what you describe you do not have the makeup of an alcoholic or addict. People can be heavy drinkers, and as is evident in your case, use opiates without, becoming addicted to the stuff.

One question - my understanding was that people, addicts or not, build up tolerance for opiates, so that they require higher and higher doses. It doesn't sound like that's happened to you, fortunately. I'd like your thoughts on that if you have time.

As for a colonoscopy versus Cologuard, I think the colonoscopy is better in that it can detect and remove polyps before they become a problem (malignant or benign tumors). I think Cologuard only tells you if cancer is present or not.

I'm 71 now and have a colonoscopy coming up next year. My understanding is it will be my last, as the GI Drs only require testing up to age 70.

Thanks jenatsky.

Joe

@heyjoe415 in reference to your comment about becoming tolerant is basically correct but there lies the difference between dependency and addiction. Dependency is taking your meds as prescribed with possibly periodic increases in dose over years. After narcotic pills I was started on buprenorphine patch 15mcg and after 2 weeks it was increased to 20mcg where it has stayed for about 6 years. I also walk 2 miles daily and do stretches 2x daily and the gym 2-3x week. I find that exercise helps diminish my pain. Addiction is as you described needing an increasing higher dose as you use. Studies have found that those of us who use narcotics for pain control don’t usually become addicts.
As for cologurd your comments are correct. But we don’t live forever and at 73 if I have a missed polyp for using cologuard I’ll live with it or not. We have no children to concern ourselves with so decisions are jointly made from a realistic view. My spouse is a psychologist who practices from home completely remote. She healthy and takes no routine meds. I’m the one with the crappy back. You are also correct in that a colonoscopy can find 95% of polyps but I’ll take my chances. Take care Joe.

Hi!
It is vital that you drink enough fluids while taking medications, especially enough water for that is essential to prevent rock hard stools, especially while taking medicine that has can cause constipation as a side effect. To make sure you are drinking enough WATER…take your body weight and divide by 2. For example, 130 lbs equals drinking 65 oz of water daily. Also, if you are not drinking enough water, all that added roughage is only adding to your constipation. It also helps to add walking, yoga, or low impact exercises to your routine…even 15 minutes twice daily, if you are able.
Hope this encourages you and you are feeling better soon.

@jenatsky So you think seeing a GI Dr or is GI Dr same as a Gastroenterologist?

They are one and the same.