Old 11-13-2017, 08:09 AM #1 (permalink)
ctollar's Avatar
New Member
 
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
ctollar ctollar is offline
New Member
ctollar's Avatar
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
Default Morphine and constipation

Hi all,

Quick question.... My dad was recently put into hospice and is on the Morphine cocktail. The problem is he is severly constipated from the medicene and the stool softner and laxatives are causing severe stomach cramping as well as "sludge" type bowel movements. He is on Senna for the laxative. Any thoughts on how we can relieve his pain. It is so very awful to watch him in terrible pain.
ctollar is offline   Reply With QuoteReply With Quote
Old 11-13-2017, 10:47 AM #2 (permalink)
KarenNWendyn's Avatar
Member
 
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
KarenNWendyn KarenNWendyn is offline
Member

KarenNWendyn's Avatar
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
Default Re: Morphine and constipation

There are 2-3 drugs used for management of opioid-induced constipation. These include Movantik (Naloxegol) and Relistor (Methylnaltrexone). They are not cheap. It’s important to continue with stool softeners and lots of fluids. Discuss with your doctor or hospice team as they likely have a protocol for managing this common problem.
KarenNWendyn is offline   Reply With QuoteReply With Quote
Old 11-13-2017, 12:33 PM #3 (permalink)
Scotiaspirit's Avatar
Member
 
Join Date: 2015
City: Dartmouth
State: Nova Scotia
Country: CA
Diagnosed: 11/2015
Interest: I have been diagnosed with ALS.
Posts: 130
Scotiaspirit is on a very distinguished road
Scotiaspirit Scotiaspirit is offline
Member
Scotiaspirit's Avatar
Join Date: 2015
City: Dartmouth
State: Nova Scotia
Country: CA
Diagnosed: 11/2015
Interest: I have been diagnosed with ALS.
Posts: 130
Scotiaspirit is on a very distinguished road
Default Re: Morphine and constipation

I am on opioid meds for pancreatic and gastric nerve pain. For slow bowel evacuations, I take Domperidone, Resotran which need prescription for, and take OTC Senna, Laxaday(Restoralax) and 30 ml of Lactulose when needed, if things get really sluggish.
Scotiaspirit is offline   Reply With QuoteReply With Quote
Old 11-13-2017, 12:42 PM #4 (permalink)
lgelb's Avatar
Extremely Helpful Member

Forum Moderator
 
Join Date: 2009
City: Seattle
State: WA
Country: US
Diagnosed: 09/2009
Interest: I lost a loved one to ALS/MND.
Posts: 4,872
lgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond repute
♥ lgelb lgelb is offline
Extremely Helpful Member

Forum Moderator

lgelb's Avatar
Join Date: 2009
City: Seattle
State: WA
Country: US
Diagnosed: 09/2009
Interest: I lost a loved one to ALS/MND.
Posts: 4,872
lgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond reputelgelb has a reputation beyond repute
Default Re: Morphine and constipation

I would also ensure that hospice re-evaluates the "cocktail." Even at the end of life, PALS do not necessarily require large morphine doses to manage air hunger; not knowing the dosages prescribed, some hospices, for example, are more familiar with the pain relief requirements of terminal cancer patients as their guide for morphine administration. And there are many interventions besides opiates that can bring comfort, from music to massage -- it is a total package.
lgelb is offline   Reply With QuoteReply With Quote
Thanks from
patoyeah (11-21-2017)
Old 11-13-2017, 01:26 PM #5 (permalink)
ctollar's Avatar
New Member
 
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
ctollar ctollar is offline
New Member
ctollar's Avatar
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
Default Re: Morphine and constipation

The hospice nurse came in and gave him an enema, finger probe, and as a last result a suppository. He is on stool softners and I just don't get it. Why all the problems even with them??
ctollar is offline   Reply With QuoteReply With Quote
Old 11-13-2017, 03:45 PM #6 (permalink)
KarenNWendyn's Avatar
Member
 
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
KarenNWendyn KarenNWendyn is offline
Member

KarenNWendyn's Avatar
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
Default Re: Morphine and constipation

Lactulose is a wonderful drug for med-induced constipation. Just make sure to take LOTS of water with it.

Some folks on morphine are going to have a tough time even with a good bowel program. With ALS, the problem is also going to be exacerbated by generalized immobility and inability to “bear down”.
KarenNWendyn is offline   Reply With QuoteReply With Quote
Old 11-13-2017, 06:34 PM #7 (permalink)
Very Helpful Member
 
Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
KimT KimT is online now
Very Helpful Member

Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
Default Re: Morphine and constipation

I'm writing down everything Karen and Laurie posts. Ever since I started Remeron in 2003, I've had constipation. When I was running and drinking lots of water, it was managed without meds. Now that I'm not as active it is managed with psyllium which, I know is only temporary. I'll have to find the right combo that won't throw me into SVT. Thank you both for the info.

I developed hemorrhoids from Oxy and even though I'm off it they didn't go away. I'm getting them banned after the holidays because I don't want to be in bed with a burning butt.

Laurie, your suggestion of other things that help pain and promote relaxation is a wonderful reminder.
KimT is online now   Reply With QuoteReply With Quote
Old 11-14-2017, 07:35 AM #8 (permalink)
ctollar's Avatar
New Member
 
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
ctollar ctollar is offline
New Member
ctollar's Avatar
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
Default Re: Morphine and constipation

So the saga continues. He has been able to go but it is sludgy.... Still in a lot of pain. I hate seeing him go through this.
ctollar is offline   Reply With QuoteReply With Quote
Old 11-14-2017, 10:27 AM #9 (permalink)
Very Helpful Member
 
Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
KimT KimT is online now
Very Helpful Member

Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
Default Re: Morphine and constipation

When you say sludgy, do you mean pudding consistency that is hard to pass or something else. Does it seem like he is passing a normal amount? You can have blockages even with diarrhea. Could his pain be gas or some form of stomach irritation besides constipation? I really empathize because I've had bowel issues and it makes life miserable so I can't imagine how miserable it must be when confined to a bed 12/7.
KimT is online now   Reply With QuoteReply With Quote
Old 11-14-2017, 10:36 AM #10 (permalink)
ctollar's Avatar
New Member
 
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
ctollar ctollar is offline
New Member
ctollar's Avatar
Join Date: 2017
City: North Port
State: Florida
Country: US
Diagnosed: 03/2017
Interest: I am a caregiver for someone with ALS/MND.
Posts: 35
ctollar is on a distinguished road
Default Re: Morphine and constipation

It is sludgy like pudding. He says that he feels like he has to keep going. The nurse will be by today to check on him again. The pain is irritation from trying to poop so much. More like burning at the site with additional stomach cramping right before he tries. Honestly, he has had so many different medications I would be suprised if there is anything left. To top it off he is down to 2-3 feeds a day...
ctollar is offline   Reply With QuoteReply With Quote
Old 11-14-2017, 06:37 PM #11 (permalink)
Very Helpful Member
 
Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
KimT KimT is online now
Very Helpful Member

Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
Default Re: Morphine and constipation

My guess is that he has painful internal hemorrhoids. Try putting a Preparation H suppository in him. They usually can relieve the burning in a short time. I had burning so badly I thought I would have to go to the emergency room. I put one in and another in about 45 minutes later. They help shrink the irritated tissue. It worked. It can't hurt to try.

I'm so sorry he and you are going through this.
KimT is online now   Reply With QuoteReply With Quote
Old 11-14-2017, 07:25 PM #12 (permalink)
KarenNWendyn's Avatar
Member
 
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
KarenNWendyn KarenNWendyn is offline
Member

KarenNWendyn's Avatar
Join Date: 2017
City: Talent
State: Oregon
Country: US
Diagnosed: 07/2017
Interest: I have been diagnosed with ALS.
Posts: 164
KarenNWendyn has a spectacular aura aboutKarenNWendyn has a spectacular aura about
Default Re: Morphine and constipation

While hemorrhoids certainly are possible, he could also have areas of pressure sores in the perianal area causing localized burning pain. Before giving something like Preparation H, have the hospice nurse (or doctor) carefully inspect the area for signs of skin breakdown.

Another issue with morphine is some patients get what’s called a paralytic ileus, which is a fancy way of saying the gut just isn’t moving. This can cause a bowel obstruction. Sometimes sludge or diarrhea can leak out past the blockage. Diarrhea can also exacerbate skin breakdown around the angus. He really does need a good exam.
KarenNWendyn is offline   Reply With QuoteReply With Quote
Thanks from
patoyeah (11-21-2017)
Old 11-14-2017, 07:44 PM #13 (permalink)
Very Helpful Member
 
Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
KimT KimT is online now
Very Helpful Member

Join Date: 2014
City: The Beach
State: South
Country: US
Diagnosed: 08/2015
Interest: I have been diagnosed with ALS.
Posts: 1,967
KimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud ofKimT has much to be proud of
Default Re: Morphine and constipation

Quote:
Originally Posted by ctollar View Post
The hospice nurse came in and gave him an enema, finger probe, and as a last result a suppository. He is on stool softners and I just don't get it. Why all the problems even with them??
I hope she was gentle with the enema because that could cause a tear in thin or already irritated skin. My housemate got a small tear from a routine rectal exam at a gastro's office.
KimT is online now   Reply With QuoteReply With Quote
Old 11-20-2017, 12:29 PM #14 (permalink)
Scotiaspirit's Avatar
Member
 
Join Date: 2015
City: Dartmouth
State: Nova Scotia
Country: CA
Diagnosed: 11/2015
Interest: I have been diagnosed with ALS.
Posts: 130
Scotiaspirit is on a very distinguished road
Scotiaspirit Scotiaspirit is offline
Member
Scotiaspirit's Avatar
Join Date: 2015
City: Dartmouth
State: Nova Scotia
Country: CA
Diagnosed: 11/2015
Interest: I have been diagnosed with ALS.
Posts: 130
Scotiaspirit is on a very distinguished road
Default Re: Morphine and constipation

I have had problems with a paralytic ileus several times since Feb 2017, since getting my Peg put in. I have to take opioid meds for pain (non ALS related) and they can really mess up bowel motility. If you have access to a stethoscope, or have a nurse listen for bowel sounds in four areas of the mid lower to lower abdomen. If the sounds are absent, I would suggest you ask your medical practioner to see about a scan or xray of the abdomen to see if an ileus or a blockage is present. For me, to keep things regular, in addition to the prescribed motility meds, I take restoralax x1 daily, senna (when needed) if my poop gets hardened, and LACTULOSE 30ML (when needed) if things get really sluggish. I take in lots of water, 1.5 litres per day to keep things regular. I only take senna and Lactulose if I go 2.5 or more days without bowel evacuations.
Scotiaspirit is offline   Reply With QuoteReply With Quote
Thanks from
patoyeah (11-21-2017)
Old 11-20-2017, 04:18 PM #15 (permalink)
Member
 
Join Date: 2016
City: Boston
State: MA
Country: US
Diagnosed: 09/2013
Interest: I am a caregiver for someone with ALS/MND.
Posts: 212
KateEmerson is a jewel in the roughKateEmerson is a jewel in the roughKateEmerson is a jewel in the rough
KateEmerson KateEmerson is offline
Member
Join Date: 2016
City: Boston
State: MA
Country: US
Diagnosed: 09/2013
Interest: I am a caregiver for someone with ALS/MND.
Posts: 212
KateEmerson is a jewel in the roughKateEmerson is a jewel in the roughKateEmerson is a jewel in the rough
Default Re: Morphine and constipation

One of members, Diane Huberty, has a very informative website alsfrombothsides.org. Her section called " Toilet Troubles" was very helpful to us when my PALS was having a lot of constipation problems.
KateEmerson is offline   Reply With QuoteReply With Quote
Reply

Tags
constipation, cramping, dad, hospice, morphine, pain, problem


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off

Similar Threads
Thread Thread Starter Forum Replies Last Post
morphine Mahealani People With ALS - "PALS" 14 06-25-2011 11:24 AM
constipation with ALS tinapavey@comcast.net General Discussion About ALS/MND 22 11-11-2010 12:26 AM
Constipation DEANNE General Discussion About ALS/MND 4 02-18-2010 11:06 AM
constipation kellyh General Discussion About ALS/MND 11 01-26-2010 10:25 AM
ALS and constipation? cris Current Caregivers (CALS) 11 09-23-2009 10:40 PM


All times are GMT -5. The time now is 09:31 AM.

 

Who we are

"We are a volunteer-driven online community that originated in 2003. We are a resource for anyone affected by ALS and MND. We are a community of like-minded and compassionate individuals. Together we are the ALS Forum and together we build this online resource and online community."

 

Want to help?

Have you found our website helpful? Do you enjoy having a place to talk to people that are knowledgeable about ALS and MND? If you have found it helpful to chat with people at different stages of the ALS/MND journey we encourage you to get involved.

Copyright © 2016