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Suggest Treatment For Constipation When Diagnosed With Severe Osteoarthritis
Question: Dear Doctor,
I am suffering from sever constipation and have to take a lot of laxatives. I am 71 and suffer also from moderately severe osteoarthritis as well as anxiety,
I think my constipation may be partly caused by the medication I am on. This is the list of medications and tests I've had and will be having because of the multiple rib fractures I got three weeks ago when I slipped on a wet floor.
1 The most worrying is the morphene because I know it is a dangerous drug but it does help with the pain. On the box it says 10mg/5ml. I am prescribed 500mg for 14 days. Three weeks ago when I was taken to hospital after the accident the morphene dose was increased a little. Please tell me if liquid morphene comes in different strengths because I know little about it. My family disapprove of me taking it.
2 I am prescribed BuTrans 10 mcg/hr, changed every 3 days because they irritate my skin.
3 Paracetamol, 8x500mg a day. I try to keep it to 6 tablets and I also take NAC to support my liver, (I do not drink or smoke)
4 Since the accident I have been given ibuprofen 400 mg in 2 divided doses of 200mg. To protect my stomach I take them with Omaprozole, 2 a day.
5. For sleep I am given 2 10mg Zolpidem at night and 20 mg Temazepam
6. I take 20 mg Diazepam in 4 divided doses for anxiety.
7. The constipation is only relieved twice a week by taking at least 20 Dulcolax each time.
8. After emptying my bowels I take two sachets of Dioralyte to replace lost minerals. I mix it with water.
9. I take Vit D-3 and also Glucosamine Gold which contains MSM, Glucosamine, Chondritin, Quercetin, Ginger and XXXXXXX Hip.
10. Im afraid I eat too much sugar but I only weigh 8st 9lbs. I am 5ft 1in. tall.
11. I am a non-smoker and drink alcohol only at Christmas.
12. I eat what I consider to be a balanced diet which includes meat, salmon, vegetables and fruit. I have tried eating prunes but it does not help with the constipation.
13. The bowel cancer test I had about 9 months ago was negative.
14.The hospital doctor said that when studying the results of the scans for my broken ribs he noticed I am constipated.
15. Last Saturday I had an MRI scan to look at my soft tissues, partly because of the fracture.
16. On September 12th I am due to have a 'virtual colonoscopy'.
17. Whilst in hospital I was given a blood test. I also had some iodine put into a vein for th 'doughnut scan'.
18. I am taking 2x10 mg of Amitriptyline for arthritic pain and depression, but I do not feel depressed.
19. I drink quite a lot of water, often adding some Dioralyte to it.
That is all I can think of. My ribs are getting better. The constipation is very bad though. Also I have suffered with it since I was three, off and on, but nowadays my bowels are never normal.
Is there anything you can suggest to help with the constipation? Would changing my medication or my diet help?
Kind regards,
Mrs Anne Doney
I am suffering from sever constipation and have to take a lot of laxatives. I am 71 and suffer also from moderately severe osteoarthritis as well as anxiety,
I think my constipation may be partly caused by the medication I am on. This is the list of medications and tests I've had and will be having because of the multiple rib fractures I got three weeks ago when I slipped on a wet floor.
1 The most worrying is the morphene because I know it is a dangerous drug but it does help with the pain. On the box it says 10mg/5ml. I am prescribed 500mg for 14 days. Three weeks ago when I was taken to hospital after the accident the morphene dose was increased a little. Please tell me if liquid morphene comes in different strengths because I know little about it. My family disapprove of me taking it.
2 I am prescribed BuTrans 10 mcg/hr, changed every 3 days because they irritate my skin.
3 Paracetamol, 8x500mg a day. I try to keep it to 6 tablets and I also take NAC to support my liver, (I do not drink or smoke)
4 Since the accident I have been given ibuprofen 400 mg in 2 divided doses of 200mg. To protect my stomach I take them with Omaprozole, 2 a day.
5. For sleep I am given 2 10mg Zolpidem at night and 20 mg Temazepam
6. I take 20 mg Diazepam in 4 divided doses for anxiety.
7. The constipation is only relieved twice a week by taking at least 20 Dulcolax each time.
8. After emptying my bowels I take two sachets of Dioralyte to replace lost minerals. I mix it with water.
9. I take Vit D-3 and also Glucosamine Gold which contains MSM, Glucosamine, Chondritin, Quercetin, Ginger and XXXXXXX Hip.
10. Im afraid I eat too much sugar but I only weigh 8st 9lbs. I am 5ft 1in. tall.
11. I am a non-smoker and drink alcohol only at Christmas.
12. I eat what I consider to be a balanced diet which includes meat, salmon, vegetables and fruit. I have tried eating prunes but it does not help with the constipation.
13. The bowel cancer test I had about 9 months ago was negative.
14.The hospital doctor said that when studying the results of the scans for my broken ribs he noticed I am constipated.
15. Last Saturday I had an MRI scan to look at my soft tissues, partly because of the fracture.
16. On September 12th I am due to have a 'virtual colonoscopy'.
17. Whilst in hospital I was given a blood test. I also had some iodine put into a vein for th 'doughnut scan'.
18. I am taking 2x10 mg of Amitriptyline for arthritic pain and depression, but I do not feel depressed.
19. I drink quite a lot of water, often adding some Dioralyte to it.
That is all I can think of. My ribs are getting better. The constipation is very bad though. Also I have suffered with it since I was three, off and on, but nowadays my bowels are never normal.
Is there anything you can suggest to help with the constipation? Would changing my medication or my diet help?
Kind regards,
Mrs Anne Doney
Brief Answer:
Questions answered in sequence
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone carefully through your query and understand your concerns. Let me try to address the issues one by one:
1. Morphine is very safe and practically the best for resolving pain. The problem with it is that it is habit forming and develops dose tolerance. In other words the dose that is enough to produce the desired action in today's date would not be sufficient for the same outcome subsequently. I think that rather than going by your family's mental bias you should follow what your doctor says.
2-6. No issues at all.
7. Good enough but you should take it twice daily on regular basis
8. Not needed, but can still be taken.
9,10. Ok
11. Try to cut down on smoking.
12-17. Ok
18. But still you should continue to take it.
19. Good enough.
You need not worry about the ribs.
Regarding the constipation, slowing down of the bowel movements is the likely cause. Our bowels have a forward propulsive movement which moves the food forward as it is digested, absorbed and finally eliminated as feces. The key lies in regularization of the same. My suggestions would be to:
* Avoid long gaps between meals. Take small but frequent meals.
* Spicy food has to be avoided.
* It is very important to exercise regularly.
* High dietary fiber intake has to be ensured. Plenty of green leafy vegetables are to be taken. Fiber supplements like psyllium husk can also be taken along. This has to be taken daily at dinner irrespective of whether the problems are present. Restoralax can be taken.
* Please go through the following for a list of fiber rich foods:
http://www.yyyyyyyyyyyyy.com/yyyyyyyyyyy/063008p28.yyyy
Hopefully that would help.
Let me know if I could help further.
Regards
Questions answered in sequence
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have gone carefully through your query and understand your concerns. Let me try to address the issues one by one:
1. Morphine is very safe and practically the best for resolving pain. The problem with it is that it is habit forming and develops dose tolerance. In other words the dose that is enough to produce the desired action in today's date would not be sufficient for the same outcome subsequently. I think that rather than going by your family's mental bias you should follow what your doctor says.
2-6. No issues at all.
7. Good enough but you should take it twice daily on regular basis
8. Not needed, but can still be taken.
9,10. Ok
11. Try to cut down on smoking.
12-17. Ok
18. But still you should continue to take it.
19. Good enough.
You need not worry about the ribs.
Regarding the constipation, slowing down of the bowel movements is the likely cause. Our bowels have a forward propulsive movement which moves the food forward as it is digested, absorbed and finally eliminated as feces. The key lies in regularization of the same. My suggestions would be to:
* Avoid long gaps between meals. Take small but frequent meals.
* Spicy food has to be avoided.
* It is very important to exercise regularly.
* High dietary fiber intake has to be ensured. Plenty of green leafy vegetables are to be taken. Fiber supplements like psyllium husk can also be taken along. This has to be taken daily at dinner irrespective of whether the problems are present. Restoralax can be taken.
* Please go through the following for a list of fiber rich foods:
http://www.yyyyyyyyyyyyy.com/yyyyyyyyyyy/063008p28.yyyy
Hopefully that would help.
Let me know if I could help further.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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