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:
- 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 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.
- 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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