Hey guys,

Just came home last night from a partial glossectomy and neck dissection. I am finally on the right pain med and doing well, however I have had an incredibly difficult time with constipation since I first began taking pain meds way back in September. I finally had an enema at the hospital just before I left (man, the stuff you tell strangers online! . I am wondering what else I can be doing to combat that. I know it is important to stay hydrated so I am working on that, and they also gave me colace to try as well. The thing is, I was taking 300 mg of colace and 2 senekot tablets daily and I was not having much success at all (very painful, infrequent, etc). what have you guys found works best?

Colette

Sounds oh so familiar. I wasn't about to give up the pain pills or patches yet they caused the constipation. The prescription laxatives did not work, nor did folk remedies like prune juice etc and I was in imminent danger of ruining some resident's day by needing a bowel obstruction procedure.
Glycerin suppositories to the rescue. You can buy them at any drugstore without a script. I used them daily. It's important to follow the instructions literally: not to go into squeamish details but full insertion and holding it in for 20 minutes are needed for this method. No risk of overdose, no bad side effects, and it works when all else fails. As usual a nurse, not a doctor knew the answer to a common patient side effect. IMO it would not hurt to try a suppository
Keep the Faith
Charm

[quote] I finally had an enema at the hospital just before I left (man, the stuff you tell strangers online! .[/quote]

Hi Colette

at least you gave the rest of us a giggle . Tis true though, nothing medical is sacred on this board.

In my own past experience with severe constipation the most effective thing was the mechanical means as Charm has alluded to. The product we used was called a micro enema (brand name Microlax) and was a gel that came in a tube that you inserted about an inch (had a little nozzle thing to facilitate this) and then squeeze. We learned to do it the bathroom as the results were sometimes quite spectacular. These things are available over the counter at the pharmacy.

Also, I think lots of fluids and not waiting too long before "evacuating" might make your life easier (and less painful).

I reiterate Charm, nurses have more solutions than doctors with this stuff as they are the ones who get to do the digital evacuation when other methods fail and that is not fun for nurse OR patient. Now you know why the nurses in hospital ask about your bowels every day

Congratulations on coming home after your surgery. I wish you the best in your recovery. I'm not sure what your diet is yet (smoothies or soft foods), but there are a couple of dietary things you can do to help. Please continue to take your meds and hydrate as instructed, but some foods may help. I have IBS (with alternating constipation & diarrhea). Foods with lots of soluable fiber (dissolves easily in water) help with both constipation & diarrhea. I had good luck with canned pumpkin and there is lots of that around this time of year, so if it works for you, stock up. You can add butter or olive oil with salt/pepper and I love it. The more fat you add to it, the thinner an smoother it gets and keeps your calorie count up. Oatmeal and avocados worked well for me, too. If the oatmeal texture is too thick or course for you at this point, you can chop it up more with a coffee grinder before you cook it or you could use infant oatmeal. Also, you may want to add Benefiber to your smoothies or soft foods. I use something called acacia fiber, which I call my "magic powder". When you have constipation, you do sometimes have to get things moving by mechanical means, but if you have to do it all of the time, you may "train" your sphincter muscles/evacuation process to rely on that stimulous to go. Good luck! Things will all come out in the end (haha!)...couldn't resist!

Colette, sorry to hear about your troubles. I can relate. After all the various pills, potions and suppositories - which I hasten to add didn't work very well - I got the advice that did the trick from, yes, my RO's nurse.

To be blunt: a box of rubber gloves.

Not easy, but the, er, hands on approach pretty much saved my life.

Best of luck with whatever strategy you decide to try.

You might consider adding Docusate Sodium/Sennosides to your daily medication regimen. It's over the counter and one brand name is Senokot-S. 1 tablet 2 times daily usually works but you may take up to 4 tablets 2 times daily. Adding one tablet every day until relief and then staying at that dose is a pretty standard protocol. This combination medication both increases bowel motility and softens stool.

Good luck.

Rubber gloves hands on approach - wow talk about self help
suppositories are tricky in that they simply will not work if you don't resist the urge to expel them for at least 20 minutes to about a half an hour. It is harder than you think to wait that long but it takes that long for the gylcerin to dissolve and do its job. Cutting it short ensures failure. The nurse warned me to use a timer or else I would be seeing her and her rubber gloves.
There is no disagreement that manual evacuation will work, but I think the majority of OCF posters have avoided that drastic last resort.
Charm

Charm, would that I could have! But I really did try everything else under the sun. After two weeks of near-constant agony, my five-fingered rubber friends were essential. Glad that most people here have managed to bypass, as you say, that drastic last resort.

David

OUCH. But sometimes a man has to do what a man has to do.
The nurses and residents at your cancer center owe you big time.
Charm

Actually Charm I feel I owe the RO nurse! Took her a bottle of champagne the other day when I had my regular post-scans (clear!) visit with my doctor. Dunno what I would've done had she not broached the latex subject.

Live and learn!