Patients with chronic pain often have constipation as a side effect of their disease and medications. Constipation may produce nausea, vomiting and abdominal cramping pain. The strategy for managing constipation from chronic opioids is to follow a regimen on a routine basis to counteract the constipating effect of the Opioid medication. For many patients, a diet high in fiber (certain fruits, vegetables and cereals) is sufficient. Many patients find that laxatives are necessary, however. The following laxatives have been found to be effective:
- Milk of Magnesia
- Dulcolax tablets or suppositories
The laxatives should be taken in whatever a dose is necessary to provide regular BMs. DO NOT WAIT FOR A CRISIS. If your bowels have not moved for a number of days, you may try a higher dose than usual of your customary laxative or Magnesium Citrate. If constipation is associated with severe nausea or vomiting, use an enema (commercial Fleetâ€™s enema) and/or suppository to relieve the obstruction from below. If these measures are ineffective, seek medical attention. Guidelines for Managing Constipation
- Increase fluids to at least eight glasses per day.
- Eat a diet high in fiber.
- Avoid foods with white sugar, pasta, pastries, cheese and rice.
- Exercise regularly.
- Establish regular times for evacuations (usually after a meal).
- Drink a warm liquid one-half hour before breakfast to stimulate bowel movement.
- Sit in a modified squatting position for evacuations by placing feet on a stool.
- Avoid laxative and enema abuse.
- Legumes (dried peas/beans)
- Whole-grain products
- Oat bran
- Bran cereal
- Whole-grain products
Tips on Increasing Fiber in Your Diet
- Increase fiber slowly to give the digestive tract time to adjust and to avoid flatulence and cramping.
- Increase fluids along with fiber to prevent constipation.
- Obtain fiber from a variety of sources.
- Eat whole-grain food because processing tends to decrease fiber content.
- Choose fruits and vegetables with edible skins and seeds.
- Eat whole-grains such as barley, bran, brown rice, buckwheat groats, cornmeal, popcorn whole wheat and wheat germ.
- Store whole grains carefully; they are more perishable than refined grains.
- Consult your physician regarding the amount of fiber needed in your daily diet.
- Avoid medication after bran cereal because bran can block medicine absorption.
- Do not take fiber supplements unless prescribed by a physician.
Fiber Content per Ounce of Food
- Fruit: 2 grams
- Whole-grain products: 2 grams
- Vegetables: 2 grams
- Cereal: 3 grams
- Starchy Vegetable: 3 grams
- Bran Cereal: 8 grams
- Legumes: 8 grams
- Nuts and Seeds: 3 gram
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