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 to treat constipation, however. The following laxatives have been found to be effective:

• Senekot
• Pericolace
• Milk of Magnesia
• Maalox
• 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 Fleets enema) and/or suppository to relieve the obstruction from below. If these measures are ineffective, seek medical attention. Guidelines for Managing constipation in

• 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.