Opinion please.....

[Angie Daughter of Bill]

I have a dilema with my Dad. His pain meds are causing TERRIBLE constipation. He is taking 60ml of Lactulose two times daily. This is NOT helping. He goes 4 or 5 days without "going". When he does go, it's because he finally gave in and used a Fleet's Enema.

Dad is taking Oxycontin 40mg two times daily. In between the Oxy doses he is taking Lortab 7.5mg about every 4 or 5 hours. Here's my question....... would it be better for Dad to up his pain med dose so that he has to take fewer pills. (Maybe like Percodan or Percoset between the Oxy or some sort of immediate release pain med for the rough times) Or, should we stick with what he is taking for pain and change the Lactulose to something else??

Dad is not eating much at all due to feeling sooooo full all the time. Dr. Joe, what seems to work for your patients??

We will certainly be asking Dad's onc. about this, but I do like to have myself armed with a few ideas. Thanks in advance........as my Dad says, "It's rough when your pooper don't poop!"

Angie

[teresag]

Pretty much any opioid (narcotic) painkiller is going to cause constipation. Percodan or Percocet are not more effective than Lortab (Vicodin), and they also cause constipation, so I doubt that is the answer. It might be wise to use an enema regularly, like every 2 days, before the stool becomes hard and difficult to evacuate. Let's see what Dr. Joe thinks about that.

The senna is not a bad idea either. And of course, drinking plenty of fluids is very important. - Teresa

[Angie Daughter of Bill]

Thank you Teresa. I guess I should also mention that Dad has a very weak stomach. He won't touch, smell or eat a prune. He was gagging just trying to open the bottle of Lactulose. He hadn't even smelled it or tasted it yet. Maybe apple juice? Lots of apple juice. He does drink LOTS of water. Probably 10-12 glasses each day. He doesn't sleep much, so all night he is drinking water. Bless his little heart. It seems that what takes care of one problem creates a new problem.

Thanks again!

Angie

[kimblanchard]

This is a common and very hard problem. You should definitely do whatever works best to relieve his pain, constipation is a "class" side effect that occurs with all narcotic pain medicine.

I generally approach this in steps and usually start with Senekot-S 2 or 3 tablets twice/day and supplement with Milk of Mag as needed. If this is ineffective, I usually go to Miralax which is a prescription laxative that you can take a couple times/day, it is pretty gentle. Also eating prunes or prune juice often is very helpful. The enemas are a last resort although occasionally necessary. Of course drinking as much water as possible helps as well.