My story is kind of complicated so I'll try to give the short version- but the background I feel is important to this issue.

I am a chronic pain sufferer and have been on opiate therapy for the past 2 1/2 years. I have managed the constipation that the opiates can cause with stool softeners, prune juice, bananas, coffee, and Senokot when necessary. Until lately, this regimen seemed to do the trick. About three months ago, I decided to give the much-hyped Miralax a try, and I was quite pleased. I was able to take the Miralax only and have somewhat regular movements with no bloating or pain.

Fast forward to a few weeks ago. For some reason I became really constipated, going only once every few days with hard small stools that were difficult to pass. I figured that the Miralax was obviously not doing the trick anymore, and I decided to add back the stool softeners. I started out with 3 of the stool softeners and just a small portion more than normal of the Miralax, and I let this pattern continue over a week-long period to see if I could get some relief. When nothing happened, I finally resorted to an enema which cleaned things out a good bit but I am certain that it didn't get everything. Now, normally when I do an enema I expect to not be back to normal for a few days. This has always been the case with me and is one of the reasons I only use them for emergencies. In the meantime, I upped the Miralax a bit (still just one and one-half dose per day) and upped the stool softeners to 5 a day and added one Senokot for good measure. Well, this had the result of giving me something akin to diarrhea. The reason I say "something akin to" is because it is loose, watery, but it's never very much and is always punctuated at the end by a lot of gas. This started on Thursday evening and it is now Sunday with the same results. This occurs anywhere from 2-4 times a day, with no solid movements at all in the meantime. I feel like I have gone from one extreme to another, but even the diarrhea isn't enough to make me feel completely evacuated. On top of everything, there are tiny black specks in the toilet after each episode that I've never noticed before. I've read that black stuff can mean bleeding in the upper tract and of course this has me terrified.

So, sorry for the long post, but I welcome any advice from those who are experienced with what I am going through. I have stopped taking everything because I don't want the diarrhea to get worse. At the same time, I don't want to end up with hard stools again either.

Anyone have any ideas for me? Thanks in advance!

Russell,
I read your post 3 times to make sure I didn't miss anything.
Pain meds can be very difficult to deal with because they all cause consitpation to some degree-- some more than others-- and I know you do what you have to-- to have some kind of life w/o debilitating pain. And, I am sorry for you having the problems.

As you may know laxatives are habit forming and can make your intestines lazy and not be able to function with out them.

Mirilax is an osmotic type of laxative that promotes water to be secreated to the colon to initiating a BM -- you may be depleting your body of water with this type laxative -- resulting in harder stools that are not readily passed.

Senokot (senna) is a stimulating laxative that irritates the intestine walls -- stimulating contractions (peristalsis) for a BM.
And, of course you know what stool softeners do.

I think the biggest problem with taking laxatives over a long period is that your intestines can be damaged so that you don't get good nutrition for optimal health.

I am a big believer in fiber therapy for regulating your BMs.
You need both soluble and insoluble fiber for normal BMs along with an adequate amount of water and a moderate amount of exercise.
The soluble fiber absorbs fluids that bulk up your stool resulting in stools that are more readily passed w/o much straining and the insoluble fiber cause the intestines to contract to pass stool along your intestines.

Since we are all individuals and eat so differently, the balancing of soluble & insoluble fiber along with water can vary alot.

There is a post in the Information Archive thread at the top of this page about Normal BMs-- page 2 post# 8 -- by far not complete but may be worth reading.

I wish you well---Harry

Thanks for responding to my message Harry. I appreciate the advice. I have been thinking about making some sort of change over to fiber only, but I am so confused when I go to the drug store by all the choices. For example, you say I need soluble and insoluble fibers both. Is there one particular fiber supplement that I should take that would include both types? And, do you think that if I took the proper amount of supplements along with drinking sufficient amounts of water each day, that I would be able to stop using the laxatives? I am on quite large doses of the opiates, and the doctor said I would probably need laxatives for as long as I was on the medication. I want to trust him, but I have heard different opinions about this.

I will read the post that you recommended, but I just wanted to ask these few questions while I was thinking about it. Thanks again for the response, and I hope others in my situation will share their experiences as well.

russell,
I hope by now you have read the post that I suggested about Normal BMs in the Information Archive.

There is no magic supplement that contains enough insoluble and soluble fibers except by eating properly -- And alot of people just eat too many processed foods that contain very little fiber.

The problem with most people and BMs is they don't consume enough soluble fiber in their diets as well as drink enough fluids daily. So, their stools are offend hard to pass -- resulting in constipation along with hemorrhoids, fistulars and diverticular problems.

I think by taking fiber supplements and a good diet w/ fluid along with pain meds-- you may not need alot of laxatives.

What kind of problem are you taking alot of pain meds to cure and is it a long term problem??

Your intestinal health is extremely important for a quality life with optimal health.
Remember Death begins in the Intestines including the colon.

I wish you well ---Harry