Constipation is unfortunately one of the side effects of some of the pain meds people with sickle cell take. Pain meds (especially Morphine), can affect the GI tract by slowing the motility (movement) of the small intestine. The longer food sits in your small intestines, the more nutrients, minerals, fats and water are absorbed from it—thus making it harder and harder to pass, leading to constipation.
Untreated constipation can actually develop into more serious complications like a paralytic ileus (which means that part of the bowel is completely unable to move because of all the food cemented there), which can lead to perforation of the bowels (caused by all the pressure), which can lead to peritonitis (inflammation/infection) which can lead to death. So you see…constipation can become a HUGE problem if not addressed properly.
The first remedy is WATER! You can never drink enough water in my estimation. Since constipation is triggered by the lack of water in the digested food, pouring water into it should soften up the stool and break things up. I heartily recommend drinking an extra glass of water anytime you take a pain pill, not only for constipation, but for your sickle cell as well.
One of the recommendations that you will hear many people talk about is prune juice. Prune juice is cheap, found in all grocery stores, and works wonders. I used to hate the taste of prune juice, but when I’m in a crises, I drink that stuff like it’s going out of style. I don’t know how it works, but for some reason, prune juice prevents or improves constipation. Warmed prune juice tends to work quicker (if you are really constipated you might want to go this route), because it gets fast tracked into the intestines since the stomach doesn’t have to work so long in heating it up to body temperature.
Another alternative is Senna pills or Senna tea. I would rather do prunes over Senna, but to each their own. This is also a natural laxative from the plant Senna. The leaves are crushed and formed into tea bags, or the concentrate is the pill form. Some people that use Senna complain of cramps and bloating with it. Also, in my experience, Senna doesn’t work as well if you already have had constipation for several days. However, if you have chronic constipation and want to go natural, I recommend a cup of Senna tea every night.
If you want instant results (and love to torture yourself), you could try a saline laxative. I only did this once, it was SO AWFUL! I had tears running down my face. It’s also known as a salt water flush. It is done by mixing sea salt (not regular salt) with 32 ounces of water. If you can keep that nasty, disgusting stuff down (I gagged and chucked it), then it goes through your system within an hour. You will feel cramps the whole time, but it works like Drano almost (and is just as caustic to your intestines I believe). The salt draws water into the intestines (because wherever salt goes, water follows). In addition, the salinity is too high for the intestines, and your body will expel it in about an hour. It also shifts your electrolyte balance, so I recommend drinking Gatorade once you are done. I don’t think I would ever try this again and probably wouldn’t have done it if I wasn’t so desperate at the time. Proceed at your own risk with this one.
Going the pharmaceutical route, you could try Miralax. Miralax is an osmotic laxative, which means that it draws water back into your digestive system, thereby softening it and allowing it to pass. Miralax has the perks of giving you no gas, cramps or bloating. It comes in the liquid or dry form that can be mixed with water. You can get this from your local pharmacy.
Another thing your doctor might order is a pill form of a laxative like Colace. Colace doesn’t actually work on the intestines as a stimulant, but it softens the stool by allowing water and fats to come back in. The problem with Colace is that it works on the latest meal you had right before you took it, but can’t really reach where the hard stuff is at the middle/bottom of the small intestine that is causing the blockage. It can be used daily however, just to keep you regular, or if you take pain meds daily, it is recommended for daily use.
Of course, you could also go with the back end of things, and use an enema (oil, salt, tap water) which breaks up the stool at the exit, thereby allowing the hardest stuff (that has been there the longest) to pass. The thought is that after that the rest of the stool will come on down. You have to try to hold the enema in for as long as possible for best results, and it can be hard to hold this in for longer than 10 minutes.
Another option is Dulcolax oil suppository. Known as the silver bullet in some circles;), Dulcolax works by lubricating the back end, thereby making it easier for stool to go through. It doesn’t actually work on the stool or intestines, it just lubricates whatever is at the exit of the cave so you can bear down easier.
Alright…I’ll stop talking about stool now;) I hope one of these will help you when you do hit that wall of constipation. Remember to drink lots of water, don’t say no to prunes, and take care of mild constipation before it becomes a huge, big issue.