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2stuffed 06-26-2004 12:33 PM

constipation help please!
Ive searched this board about the subject im posting about, but i cant find help for my situation. I do not have any pain, but i could not find any help in the add/rec page. any way heres my problem. I have been on opiate maintianance for over 2 years now. 1 year methadone 100mg and now ive been on Suboxone for a year now for the first 6 months i was taking 16mg and was doing fine as far as the BM goes, but about six months ago my doctor has raised me to 24mg a day. for some reason the first 4 months where not that dad, i mean i have problems ever since i started taking methadone, but untill about 2.5 months ago it has gotten very bad, i have tried just about all the over the counter meds and cannot get regular and it seems to be getting worse, im having to take larger and larger doses to get any BM at all. Ive talked to my doctor yesterday and he did not seem to be very concerned. He said that the Buprenorphine in the Suboxone is very potent and very constipating, ive even tried to cut down from 24mg daily to 16 mg it doesnt help and after about 3-4 day i start to have w/d and have to move back up to 24, Basically what my Doc says is you can take large doses of the stool sofeners and fiber pills, but the use of stimulants and enemas you will get hooked on them and they will stop working. on average im taking about 250 - 275mg Docusate sodium and some fiber pills. any help will be great.

Shoreline 06-26-2004 02:20 PM

Re: constipation help please!
Hooked on Laxitives, That's a new one, Opiates slow the bowels, that doesn't change and you don't get used to it. There are meds that can help and there is a recipe from hospice care to make a fruit paste that I haven't heard anyone say it didn't work, I'll try to find it.
Ive been on high doses for years and it can be managed without being hooked, what a load of cra#, No pun intended. The prescription med Kristalose works well, Miralax is another alt. , let me find the fruit past recipe and post it.
Hang in there, there is an answer, Dave

Shoreline 06-26-2004 02:29 PM

Re: constipation help please!
Yakima Fruit Paste
used in hopice care for terminal high dose patients

DOSE: 1-2 tablespoons per day

1 pound prunes
1 pound raisins-pitted
1 pound figs
4 oz senna tea (look in your health food store, it looks like a bunch of leaves)
1 cup brown sugar
1 cup lemon juice

1. Prepare tea-use about 2 1/2 cups boiled water added to tea and steep 5 minutes.
2. Strain tea to remove tea leaves and add only 1 pint tea to a large pot, then add fruit.
3. Boil fruit and tea for 5 minutes.
4. Remove from heat and add sugar & lemon juice. Allow to cool.
5. Use hand mixer or food processor to blend fruit mixture into smooth paste.
6. Place in plastic container and place in freezer. (Paste will not freeze but will keep forever in freezer).
7. Spoon out what you require each day.

Enjoy eating it straight off the spoon.
Spread it on toast or add hot water and make a drink.

* If the fruit paste is not working (you are not having bowel movements) then you need to increase the amount of fruit paste you are taking.

* If the fruit paste makes you have very loose stools then you need to cut down on the amount of fruit paste you are taking. Perhaps even taking it every other day in some cases.

Another recipe

*3 1/4 cups cooked prunes
*2 cups apple juice
*2 cups prune juice
*1 cup bran
Puree the ingredients and refrigerate the mixture.
Start with a 2 or 3 ounce serving 3 to 7 days a week.Adjust the amount and frequency to achieve a normal stool pattern.
The large amont of sugar may cause difficulty for some diabetics.But for those who can handle the extra sugar,this can be good medicine.

2stuffed 06-26-2004 07:19 PM

Re: constipation help please!
Thanks for the help. what i ment by getting hooked is, that if you start taking perscription laxatives and enemas over time it will take more and more until they dont work very well anymore. but not addictive like crack or something, just that they will get to where they dont work. anyway. if one goes for 2 weeks or more without a BM, seems to me that is not good for you, ive been taking large doses of over the counter laxatives and they dont seem to be working, so ill try the paste recipie you told me about. thanks

Kissa 06-27-2004 06:52 AM

Re: constipation help please!
Actually people do become addicted to laxatives, everyone is different. While one person may not become dependant another one may. Some years ago I recall watching a news show, like 20/20, who talked about this very subject along with other OTC items that people were using for weight loss.

What I have found to work is be sure to eat 20 - 30 grams of fiber every day. I eat a very high fiber cereal, breads and various veggies. It will take a few days to become regular but once you are you should be fine. If you stop eating as much fiber you will revert back to the constipation. I haven't tried the fiber pills at all so I really don't know if they are as good as it being in food.

30mg of fiber in food a day is easy if you know what to look for. Beans have the highest source of fiber in them. There are some new carb smart type breads out there that are actually very high in fiber. Look on various labels when shopping and always opt for higher fiber items. Prunes are very high in fiber which is why the paste should work. You can get the same effect as the paste from bulking up the fiber I would think.

The only thing to know is you will get gassy, this is fairly normal, most vegetarians can attest to that :)

Good luck

Shoreline 06-27-2004 08:06 AM

Re: constipation help please!
Hey Kisaa, I saw the same show, Laxatives are used by patients that have weight disorders lke anerexia and Bolemia SP?. If your constipated from opiates, that will end as soon as you stop taking opiates. It's simply a side effect and there is no such thing as tolerance to laxitives, If your dose increases and you become less active you may need more to get things moving, adding other meds can also increase the problem, But thinking at some point you will reach a point where no laxitive will work is as rediculous as thinking at some point no opiate will work.

When OTC's do not help anymore the prescription drugs will help and when they fail, Yakima fruit paste is used in Hospice care around the country on people that use the most opiates and are the least active and it does work, It's just a matter of finding the right amount. Too much can be a problem so finding the amount that works for the individual is unique but it does work.

As far asOTC, Magnesium citrate is used in Xprep kits, It's very harsh and dumps lots of fluids into your bowels and will work, It's just very unplaeseant but available without a prescription. The longer you let things go the harder it will be to get things going.

Bulk fiber is not a large part of controlling opiate induced constipation, If your constipated from a med that stops the contractions of the bowels, Fiber will not cause those contractons to start, it just builds up more and more bulk. Softeners and stimulants work better than fiber on opiate induced constipation.

The paste looks like alot to make but it last for months when kept in the frezzer, so you spend a couple hours evry 6 months making a batch of paste, It tastes like jelly and works. It can be expensive,but no more expensive than a large bottle of brand name Senekot S, so you can cut everythng in half and still have enough for months.

Good Luck, Dave

2stuffed 06-27-2004 10:35 AM

Re: constipation help please!
Im going to try the paste today and see what happens, but i would still like to know the length of time between BM's is ok, like 10 days or 30 days, right now im at about 15 days since anything has happened. iguess ive never had this problem befor and dont know if its serious or not.

Kissa 06-27-2004 10:53 AM

Re: constipation help please!
Tolerance may be impossible but dependancy is common for someone who uses laxatives on a regular basis regardless of the reason they are using them. That is what I was talkign about.. dependancy, sorry if you misunderstood.
Prolonged use can damage the intestines. Fiber will stimulate the contractions as noted below. The base of your paste, which probably will work well, is in fact fiber that you get from prunes, remove that and I'm guessing it isn't as effective.

I know that the constipation is generally caused by the medication, there are however other reasons as well that cause it such as severe IBS. Not saying this is the case, just pointing it out.

Worse case scenario, if for some reason the paste or fiber doesn't help there is a medication that is used for women with IBS that have severe constipation, you take it prior to eating. It does work in men as well, my husband used to take it. I will cause you to move your bowls on a regular basis.

here is some information regarding Constipation from a very well known web site. There is also a very interesting study that was done regarding both dependancy and tolerance if its ok to post I will otherwise just search goofle for laxative dependancy and you will find an interactive textbook on the first page.

General Illness Information

Medical Term:
Common Name:
Description: Constipation is a condition in which a person has hard, dry stools causing difficult, uncomfortable or infrequent bowel movements. In most cases, constipation is harmless, but can indicate an underlying disorder.
Acute constipation begins suddenly and noticeably. Chronic constipation begins insidiously and persists for months or years.

Causes: Causes for constipation are listed below:
Insufficient fiber in the diet. Fiber adds bulk, holds water and creates easily passed, soft feces.
Inadequate fluid intake.
Inactivity; depression.
Hypothyroidism; hypercalcemia.
Anal fissure.
Irritable bowel syndrome
Back pain.
Chronic kidney failure.
Colon or rectal cancer.
Side-effect of certain drugs e.g. antidepressants, iron salts, aluminum hydroxide (contained in some antacids), bismuth salts, narcotics and tranquillizers.

Prevention: . Eat a well-balanced, high fiber diet.
Exercise regularly.
Drink at least 8 glasses of water a day.
Signs & Symptoms
Hard feces.
Infrequent bowel movements, sometimes accompanied by abdominal swelling.
Straining during bowel movements.
Pain or bleeding with bowel movements.
Sensation of continuing fullness after a bowel movement.
Abdominal bloating.

Risk Factors
Use of certain drugs, including: belladonna, calcium-channel blockers, beta-adrenergic blockers, tricyclic antidepressants, narcotics, atropine, iron, antacids.
Sedentary life style.
Poor diet
Illness requiring complete bed rest.
Extremes of life (very young and very old)

Diagnosis & Treatment
General Measures:
Set aside a regular time each day for bowel movements. The best time is often within 1 hour after breakfast. Don't try to hurry. Sit at least 10 minutes, whether or not a bowel movement occurs.
Drinking hot water, tea or coffee may help stimulate bowel.
Attempt to eliminate medications that may cause or worsen constipation.
Enemas if other methods fail

If constipation persists for 3 or 4 days, use a non-prescription, disposable enema for temporary relief.
For occasional constipation, you may use stool softeners, mild non-prescription laxatives or enemas. Don't use laxatives or enemas regularly as this can cause dependency. Avoid harsh laxatives and cathartics, such as Epsom salts. The best laxatives are bulk-formers, such as bran, psyllium, polycarbophil and methylcellulose.
Three main classes of laxatives are : 1) Bulk forming agents, 2)Osmotic laxatives, 3) Stool softeners.
Bulk forming agents--(bran, psyllium, polycarbophil and methylcellulose)-- Increased bulk stimulates the natural contractions of the bowel and also bulkier stools are softer and easier to pass. Bulking agents act gently and slowly and are among the safest method to promote regular bowel movements These agents are to be taken in small amounts at first and the dose is increased slowly until regularity is achieved. Bulking agents should always be taken with plenty of fluids.

Osmotic laxatives--appropriate for short term use. Osmotic agents work by pulling large amounts of water into the the large intestine making the stools soft and loose. These laxatives work within 3 hours and are useful for treating constipation rather than for preventing it. Usual dose is 15 to 30 ml. once or twice daily. Some of the osmotic laxatives are listed below

Milk of magnesia 15-30 mL twice daily
Magnesium citrate 15-30 mL twice daily
Phosphate of soda 15-30 mL twice daily
Lactulose (Chronulac) 15-30 mL twice daily
Sorbitol 15-30 mL twice daily
Alumina-magnesium (Maalox, Mylanta)
Polyethylene glycol (MiraLax) 17 g in 8 oz of water once daily.
Stool softeners e.g.Docusate sodium (Colace) 100 mg twice daily
Stool softeners increase the amount of water the stools can hold ,thus increasing the bulk which in turn stimulates the natural contractions of the bowel allowing the softened stools to move easily through the bowels.

Stimulant laxatives such as senna, cascara, bisacodyl and phenolphthalein are often used to empty the bowels before diagnostic procedure and to prevent and treat constipation caused by drugs that slow the contractions of the large intestines, such as narcotics. Prolonged use of stimulant laxatives can damage the large intestine.

Exercise and good physical fitness helps maintain healthy bowel patterns.

Drink at least 8 glasses of water each day
. Include bulk foods, such as bran and raw fruits and vegetables, in your diet. Increase fiber to approximately 15 gm/day
Adding prunes and prune juice to the diet may be beneficial
Avoid refined cereals and bread, pastries and sugar.

Possible Complications :
Hemorrhoids; laxative dependency
Hernia from excessive straining
Uterine or rectal prolapse.
Spastic colitis; bowel obstruction
Chronic constipation.
Depression in severe cases.
Fluid and electrolyte depletion: laxative abuse
Rectal ulceration ("stercoral ulcer") related to recurrent fecal impaction
Laxative abuse

Usually curable with exercise, diet and adequate fluids.

2stuffed 06-27-2004 12:30 PM

Re: constipation help please!
Wow thanks for all the info, im going to try that paste, i am just worried because i cant cut my dose down without getting sick, ive try to go from 24mg to 16mg, but after about 3-4 days i start feeling really bad but after 30min or so after i take that last 8mg ill feel so much better. ive never had such a problem with my bowels befor, so i guess i was just worried, but if it is normal i guess as long as im taking SUB. this is haw it will be.

gailbelle 06-28-2004 04:36 AM

Re: constipation help please!
Hi 2stuffed,
I have ibs-constipation due to my narcotics. I asked my Dr. if I could try Zelnorm. I saw the commercial on TV. She gave me some samples to try and it took approx. 4-5 days to actually work (like a miricle.) It comes is 2 strengths. 2mg and 6mg. I take the 6mg. I can take one in the morning or one at night. If your Dr. allows you to try this, be patient, but not like now so patient that nothing happens.
Have a Godly day!

2stuffed 06-28-2004 06:08 PM

Re: constipation help please!
gailbelle, ill ask my doc, but he seems to think otc stuff will do, but ill ask anyway.

catlover1989 05-04-2011 02:41 PM

Re: constipation help please!
I have used so many different supplements to help with constipation and none of them really worked. Then one day i decided to try Fiber One cereal; I figured I'd give it a shot since nothing else seemed to help and I was amazed at what it did for me! One bowl of Fiber One every morning and I have gone from going once or less a week to multiple times daily and it's completely natural! I can't believe what it did for me and it might be able to help you, too. Everyone's body is different but I highly recommend that anyone having trouble with constipation try Fiber One cereal. I've gone from a frustrated woman searching the net for solutions to a woman who has finally found the solution. I normally wouldn't comment on message boards or anything but I felt I had to share this so that maybe people with the same problems I used to have will find relief. Good Luck!

LeftCoastie 05-26-2011 04:27 PM

Re: constipation help please!
It's been awhile since the original post, but obviously some people are still interested from one perspective or another. I, too, had problems from my pain medications. I'd become an expert in unclogging toilets. My relief came from Activia yogurt (2 pkgs a day) and water, water, water, water. I hope everything is moving along well for all who sufferer this particular side-effect.
It's not like there isn't enough to deal with, right?

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