Help! The Constipation is Worse than the Pain
Regular bowel movements sound heavenly to those who suffer with severe constipation. In fact, chronic pain can at times be a minor problem compared to the bloated, backed-up feeling after going days without a bowel movement. Certain steps will help to alleviate the constipation. Each step is increasingly aggressive. And depending on how severe the problem is, you may need medical help. Follow each successive step to help relieve your constipation problem.
Step 1: Change what you eat and drink. By avoiding drinks that cause dehydration like alcohol and coffee, you can start to aggressively hydrate your body with water. Dehydration is the most common cause for constipation. Adding more fiber to your diet with fruits and vegetables also helps too.
Step 2: Try some herbal remedies. Certain nutritional supplements like senna and flaxseed oil can effectively stimulate the bowels to move. Even some teas are marketed to support bowel health like “Smooth Move Tea”.
Step 3: Use less medications. Many types of medications used to treat chronic pain also cause constipation. The more of these types of constipating medications used, the more likely the constipation will be severe. Because side effects to medications are usually related to dose, the more medicine that is taken then the more severe the problem will be. In turn, the less medicine that is taken then the less severe the problem will be. Just reducing the dose by twenty percent can make huge difference in how often the bowels move.
Step 4: Try some over-the-counter laxatives. If none of the above steps have worked, then it is time to get a little more aggressive with use of medications designed to stimulate bowel movements. Polyethylene glycol is found in powders like “Miralax”. This powder causes water retention in the bowel which produces a laxative effect. Bisacodyl which is found in products like “Dulcolax” causes the bowels to actually move more. For that reason, people experience more cramping with Bisacodyl than they do with Polyethylene glycol. Of note, docusate sodium which is found in “Colace” is not a laxative but it does soften the stools especially when taken with plenty of water.
Step 5: Consider prescription drugs. If the constipation is severe, chances are that prescription medications might be necessary. Two oldies but goodies are Magnesium Citrate and Lactulose. An initial full dose might be required to get the bowels jump-started followed by daily small doses to keep it moving. The newest medication on the market targets constipation caused by opioids. It is called Relistor. This daily injection can be a real life-saver for those with chronic pain taking large doses of opioids to control the pain, yet struggling to keep the bowels moving.
Step 7: Attack the problem from below. Suppositories and enemas can also remedy the problem. At times, medications taken by mouth are just not enough and an attack from the bowels below is necessary. Rectally applied remedies step may require assistance from a health care provider.
Step 8: Manual fecal disimpaction. If all else fails and the bowels are severely impacted, a gloved finger may be needed to start scooping the poop. This step absolutely requires medical assistance and sometimes sedation.
Each of these steps is designed to keep you from miserably suffering from constipation. The earlier you start following these steps the less likely you will end up needing step six, seven or eight. Constipation usually happens to anyone experiencing chronic pain but it does not have to significantly impact your life.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.