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    Long-term stool softener med/supplement management

    SCI-Nurse, over your combined years of experiences, what's your take on long-term usage of the various categories of softeners/laxatives: emollients, bulk-forming, lubricants, hyperosmotics, stimulants?

    I am starting to see and feel that my stool is type 1 on the Bristol and I often feel quite bloated. For what it's worth, I eat a healthy diet with lots of veggies. I shifted away from psyllium over the years (almost 10 years out), but honestly, I'm not so sure that's what I need.

    My pain is being managed on both intrathecal and oral opiates at this point; I wouldn't say I'm on an extreme dose but I am getting a whopping amount. I am fairly active (weight lifter), so it's got me thinking about what the best strategy is going forward, considering a big percentage of this issue is likely secondary to opiate-induced hypoperistalsis.

    What's your success been managing a situation like this? I'm wondering if a PAMORA might be useful as well.

    #2
    Originally posted by paraparajumper View Post
    SCI-Nurse, over your combined years of experiences, what's your take on long-term usage of the various categories of softeners/laxatives: emollients, bulk-forming, lubricants, hyperosmotics, stimulants?
    Softeners (sometimes called emollients) are not laxatives. They are wetting agents which help to prevent your body from absorbing too much water from your stool (which makes it harder and dryer). There are a number on the market, but the one that is safest to use (due to lack of interaction with other meds) remains DSS (docusate sodium, Colace) which can safely be taken routinely at doses up to 1000mg. daily. It is PREVENTIVE; taking it when you are already constipated with hard, dry stool will do nothing.

    Laxatives can be of the osmotic type (like Miralax, magnesium citrate, lactulose, or Milk of Magnesia). They work by pulling water from your body into your colon, thus softening the stool and moving it along through the gut more quickly. Another type is a stimulant, which simply increases peristalsis without pulling in or retaining fluid in the stool. Examples include bisacodyl tablets, senna, prunes/prune juice, and cascera. Long term routine use of either osmotic or stimulant laxatives have been shown to be associated with obstructive megacolon in some people with SCI. Stimulants given in suppository form (bisacodyl, glycerine, Enemeez) have not been associated with obstructive megacolon, and appear to be safe for long-term routine use.

    Lubricants, such as mineral oil or castor oil are not recommended for routine use by anyone, as they can interfere with the absorption of fat soluble vitamins from the intestine, and vitamin deficiencies.

    Bulking agents, which are primarily fiber products such as psyllium, flax seed, or calcium polycarbophil work by absorbing water, and increasing the size (bulk) of the stool, which stimulates the bowel to have a higher rate of peristalsis. If not taken with enough water, they can actually cause bowel obstruction and impaction, so should be used properly. I have seen no studies indicating any ill effects from long term use, but would prefer people get there fiber from their diet if at all possible (30 gm. total daily is recommended).

    Originally posted by paraparajumper View Post
    I'm wondering if a PAMORA might be useful as well.
    Methylnaltrexone, naloxegol, or naldemedine are PAMORAs (peripherally acting mu-opioid receptor antagonists) so are only appropriately used for those whose constipation is mainly caused by their use of opioid drugs, not by their SCI. The jury is still out on long-term use.

    (KLD)

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Thank you SCI-Nurse , great synopsis.

      I'm thinking in my specific situation, I might benefit from routine DSS titrated to effect +/- a PAMORA if not enough. Thoughts? Considering the hard stool is likely secondary to decreased peristalsis and prolonged absorption of water from the stool.

      Comment


      • SCI-Nurse
        SCI-Nurse commented
        Editing a comment
        Are you taking a lot of opioids? (KLD)

      • paraparajumper
        paraparajumper commented
        Editing a comment
        Pretty good amount.

        Methadone 10 mg/day
        Nucynta 100 mg/day
        Intrathecal Morphine 1.2 mg/day

      #4
      You might benefit from Pamora given the opiods you are on. I would tell you to talk to your health care provider about that. I would also encourage you to increase your fluid intake and your fiber intake. It might help some.
      ckf
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

      Comment

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