# Help - Vicodin and severe constipation



## 15502 (Dec 15, 2006)

Hi,I am new to this site - I have had IBS for the last several years with intermittent severe lower abdominal cramping, and bowel movements on the average of 2-3 per week, sometimes less. About 4 months ago, I started taking vicodin (1 tablet 2-3 times per week)for upper back pain. To "prevent" constipation I started drinking Citrucel - no change, increased water to eight 8oz glasses daily - no change, and started taking one stool softener daily - still no change. Considering that the vicodin dosage is so small, I had hoped for results sooner. The only thing that DOES work is almost a full cup of prune juice. Is this safe? I can't take the constant cramping and "still full" feeling, yet nothing else seems to work! I'm going crazy wondering why these things aren't working for me! I did have to use an enema twice, 3 months apart. I don't want to stop taking the pain meds yet but just desperately want something (but not a stimulant laxative) to work!! Is it possible to become prune juice dependent? Is there something else I can take that won't cause bowel dependency? Should I increase the stool softener dosage when I take the pain meds? I'm confused! My bowel schedule is exactly the same, if not worse, before I started the fiber/stool softener regimen! I've only addded 1 vicodin per day, no more than 2-3 times per week. Any help would be greatly appreciated. This is a wonderful website! Thank you.


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## Kathleen M. (Nov 16, 1999)

Prune juice is safe. It contains an natural osmotic laxatives. All the osmotics (natural or otherwise) do is pull water into the stool.There are other osmotic laxatives but they work the same as the prune juice. You might talk to the doctor to see if you are a candidate for Zelnorm or the other new chronic constipation drug.. I know this...its been a long day...Amitza. But what you are doing isn't a stimulatory laxative so there isn't dependance issue.Some people do get really constipated from fairly low doses of narcotics, you might discuss with the doctor if something non-narcotic might be something to try as there are other pain meds.K.


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## eric (Jul 8, 1999)

I know its a rock and a hard place since your taking vicodin for back pains, but usally they are not good on the IBS.I am not totally sure how this works with vicodan.This is brand new also"Patients treated with opioids often develop constipation due to delayed colonic transit and reduced gastrointestinal tract secretions. New findings from Coates and colleagues[9] showed that the serotonin (5-hydroxytryptamine [HT]) signaling system may also play a role in opioid-induced constipation, which represents a pharmacologically induced functional disorder. Serotonin is secreted from enterochromaffin cells, and is an important activator of reflexes in the bowel. Rectal mucosal biopsies from patients with opioid-induced constipation (n = 14; 50% women) were compared with those from healthy controls (n = 14; 50% women). Enterochromaffin cells were identified by immunohistochemistry, serotonin content was identified by enzyme-linked immunosorbent assay, and levels of the selective-serotonin reuptake transporter (SERT) were measured by mRNA levels. The authors found that SERT levels were significantly lower in patients with opioid-induced constipation compared with controls (P < .05), whereas there was no difference in serotonin levels and enterochromaffin cell numbers between the 2 groups. Although the mechanism of opiate-associated changes in SERT levels was not addressed, this study suggests that agents that stimulate the serotonin pathway may prove useful in opioid-induced constipation."http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/316101372That would be a drug like zelnorm.There is a lot of evidence on serotonin and IBS.


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## 15502 (Dec 15, 2006)

Thank you for your replies!!! I am surprised by the amt. of constipation involved for such a small dose of the pain med. My doctor (and pharmacist) both said to take stool softeners and I should have no problem. No matter what I take, I don't feel any different, constipation-wise. I've also been drinking up to eight 8oz glasses of water a day - doesn't help either. Sometimes I find that even ibuprofen is constipating. Not only that, but with the pain pill I usually break it in half and if I need the other half, I'll take it about an hour later. When I see my doctor again in January, I'll ask about receiving other medication but in the meantime, should I just continue with the prune juice then? Seems to be the only thing that works, but I have to drink a lot of it. Also, is there such a thing as "too much fiber causing constipation?" Everyone says "up the fiber" but I do and still no results.Also, being new to the whole IBS thing, I sometimes (maybe once a month) get EXTREMELY severe lower abdominal pain that comes in waves, which could be comparable to "labor pains". It is so severe (and usually happens at places like work where there's no privacy) that people are ready to call for help. The pain comes for about a minute...then goes, then repeats itself. I run to the bathroom, but nothing happens - not even an urge to go! Shy bowel I guess - can't go in public. But the pain is horrific and if I'm lucky, after doing "lamaze" for a 1/2 hour drive home, I'll have "success" in the bathroom. Is this IBS related? I've had colonoscopy six months ago and everything was fine.


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## Kathleen M. (Nov 16, 1999)

There are people who get so bad with something called slow transit constipation that they do get to the point that more fiber just makes it worse, but I'm not sure your to that point yet.Even though fiber is standard treatment for constipation it won't help everyone. Usually people can tolerate quite a lot of fiber. They usually recommend getting 30 grams or more and even with supplements a lot of people don't reach that depending on what their diet is.Pain is apart of IBS, so it could be related to the IBS, although it isn't the only thing that causes pain. Pain with IBS can be severe.Prune juice is not the only source of sorbitol (what is in it that is the osmotic laxative) A fair number of energy bars (the low carb ones) sugar free candies and gum all also have sorbitol or other sugar alcohols, as do the prunes themselves. So you may be able to get the sorbitol from other things to get enough if drinking that much prune juice every day gets boring. There was a report in the medical literature about someone who was in the hospital for severe diarrhea and it turned out it was the sugar-free gum that she consumed in larger than normal quantities.Some people use magnesium oxide supplements for the osmotic properties so you might try that as well. Usually 200-600 miligrams. The USRDA is around 400 miligrams so you may need extra anyway depending on your diet.http://digestivehealthorg.com/?page_id=59 says that 4-5 prunes has 6 grams of sorbitol and 8 ounces of prune juice has 15 gramsK.


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## 16636 (Sep 29, 2006)

I was told by my gastro that dependency is an issue with some osmotic laxatives. According to him, all osmotics don't work the same way. Sorbitol, which I had been using for 2 years, did eventually require that I increase the dose pretty significantly. Prunes actually have sorbitol as well and he instructed me not to eat them to stimulate a bowel movement.Miralax is supposedly a safer osmotic although I couldn't tolerate the amount of bloating associated with it. I don't know how he feels about long term lactulose use, but it worked well for me the one time I took it. But the gas was pretty bad!Dana


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