Additional Options: Opioid Antagonists And A New Laxative
Opioid antagonists work peripherally binding to the opioid receptor and prevent the constipating effect from narcotics.
Unlike laxatives, peripherally acting μ-opioid receptor antagonists directly affect how opioids cause constipation however, the pain-relieving effect of the opioid is not blocked.
FDA-approved PAMORA regimens include:
Lubiprostone is also used for opioid-induced constipation , but is not an opioid antagonist. Pharmacologically it is a type-2 chloride channel activator and is classified as an osmotic laxative.
- Amitiza is FDA-approved for treatment of OIC in adults with chronic noncancer pain, including patients with chronic pain related to prior cancer or its treatment who do not require frequent opioid dosage escalation. Can lead to nausea and stomach pain side effects.
- It is also approved for irritable bowel syndrome with constipation and idiopathic chronic constipation.
How Does Anesthesia Cause Constipation
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Deterrence And Patient Education
Lifestyle Changes
Whenever an opiate is prescribed, the patient should be educated on the prevention of constipation. This means eating an adequate fiber in the diet, drinking ample water, exercising to encourage motility of the bowels, limiting intake of other painkillers, and using a laxative. Other alternatives instead of milk of magnesia include the use of docusate or polyethylene glycol. The changes in lifestyle should start at the same time as the opioid therapy and continue for the duration of treatment.
Dietary
There are many fiber-rich foods that one can eat to treat constipation. Fruits like apples, bananas, prunes, pears, raspberries, and vegetables like string beans, broccoli, spinach, kale, squash, lentils, peas, and beans are often recommended. One can also eat almost any type of bran products and nuts. When eating foods with fiber, it is important not to consume more than 25 to 30 grams per day otherwise it can lead to a bloating sensation.
By Dr. Jemiel Nejim and Inara Nejim
Unfortunately, constipation is a common side effect of surgery. It can happen for a few different reasons: the anesthesia used during the procedure, pain medications youre taking or how much and what youre eating and drinking.
Steps to Take Before Surgery
If you have concerns before your surgery about constipation, the best thing to do is to ask your surgeon or care team about it. Some things to try:
Steps to Take After Surgery
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Constipation After Surgery Is Normal
It is common to have constipation after surgery, even if your surgeon didn’t mention it during discharge. As high as 30 percent of women experience severe constipation in the days following the procedure. Dr. Kirtly Parker Jones shares her strategies on how to prevent and treat post-surgery constipation.
Dr. Jones: Things your surgeon didn’t tell you. This is Dr. Kirtly Jones from Obstetrics and Gynecology, and today on “The Seven Domains,” we’re going to be talking about constipation after surgery at “The Seven Domains of Women’s Health” on The Scope.
So I got a call from a friend of mine across the country who just had surgery. She said, “I had terrible constipation. Why didn’t they tell me about this?” And I went, “Yeah, why don’t we tell people about this?”
So for women who have elective surgery, that means it’s not an emergency surgery and it’s something that you could prepare for, it turns out that there are things that you could do prior to surgery to help your gut get moving faster, and there are certainly things your surgeon could tell you and prescribe for you that you could use in case you have problems afterwards.
But constipation after surgery is extremely common, with estimates as high as 30% in women who are having surgery after either pelvic surgery or maybe a hip replacement or a knee replacement. So it’s common.
And number three, they’re going to give you narcotics, both during surgery and afterwards, which completely slows your gut down.
Reasons For Constipation After Surgery May Include:
- Your dog has been fasted prior to surgery
- Your dog has not been eating well during their hospital stay or the first few days at home
- Your dog has not been drinking enough post-surgery
- Anesthesia can temporarily slow down the intestinal tract
- Certain pain medications can cause constipation
- Restricted mobility can cause constipation
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Treatment For Hydrocodone Addiction
A person struggling with hydrocodone addiction does not have to be alone. There are many inpatient treatment programs for opioid use disorder that immerse the individual in a community of love and support. Getting away from everyday life is often the first step toward recovery.
Treatment programs in inpatient drug rehab centers may be tailored to the individual. Many take a holistic approach, aiming to heal a persons mind, body and spirit. The best programs go beyond treating the addiction and also address underlying issues that may contribute to substance misuse.
Some treatment plans include medication-assisted treatment for opioid addiction, which combines medication with various treatment methods such as behavioral therapy, counseling, and support groups. Other important aspects of treatment may be learning life skills, exercising coping techniques and rebuilding family relationships.
To learn more about the dangers of snorting hydrocodone and to explore treatment options, contact us today.
This page does not provide medical advice.
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Why Does Anesthesia Cause Constipation
Constipation after surgery is caused by a combination of factors. General anesthesia slows down your digestive system, and the slower it is, the harder your stool. You may be given other medications during surgery that also slow your gut. And some pain medications like opioids, given after surgery, also slow digestion. In addition, not eating or drinking before and after surgery, lying in bed, and being inactive all can contribute to constipation.
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Restore Gut Flora With Probiotics
Taking probiotics to replenish the good bacteria after antibiotics is widely accepted as a common best practice. The concept of using probiotics after antibiotics is extensively studied and suggested by many published studies as a natural effective way that may help to restore the gut flora faster. This is especially important, considering it make the body anywhere between a few weeks to a few months to recover by itself .
Aga Guidelines On Treatment Of Opioid
In the 2019 American Gastroenterological Association guidelines for opioid-induced constipation, laxative use is strongly recommended as a first-line agent.
- For patients with opioid-induced constipation who do not respond to laxatives, naldemidine and naloxegol have a strong recommendation for use, with methylnaltrexone having a conditional recommendation. All of these agents are recommended over no treatment.
- The intestinal secretagogue Amitiza was FDA-approved for OIC in 2013, but AGA makes no recommendations in the guideline due to an evidence gap.
- No recommendations are made for use of the selective 5-HT agonist prucalopride because the available evidence is insufficient to determine a true effect. Motegrity is not currently FDA approved for OIC, even though some clinicians may consider its use off-label.
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Coping With Constipation Caused By Opioid Medication
Patients experiencing chronic pain caused by arthritis often take one or more medications for pain relief.
Unfortunately, constipation is a common side effect of many pain-relief medications especially opioid pain medications . Commonly prescribed opioid pain medications can cause constipation because they slow down bowel motility.
While prescription pain medications, or analgesics, are commonly referred to as painkillers or narcotics, the preferred medical term is opioid pain medications, or opioids, which are the terms used in this article.
- Codeine
See How to Understand Chronic Pain vs. Acute Pain
Chronic pain is also closely linked to depression, so some patients may be taking an antidepressant medication in addition to an opioid pain reliever. Some antidepressants, such as amitriptyline , sertraline , and imipramine , can also cause constipation. Obviously, patients taking both opioids and antidepressants are at an increased risk for developing constipation.
However, there are effective remedies to address constipation caused by pain medication, including a wide range of self-care techniques. Fortunately, many of the self-care techniques to reduce constipation are helpful in alleviating arthritis symptoms, and are generally healthy lifestyle choices.
For severe constipation, there are also a number of medications and other medical treatments available.
Enjoy The Magic Of Prunes
Youve heard it before, but the rumours are true: prunes are magic for constipation. Prunes , prune juice , and dried plum powder are natural remedies to regulate your bowel movements. The medical community has backed the use prunes for constipation, citing that they can be very effective at alleviating constipation and symptoms.
In fact, a study published in Alimentary Pharmacology and Therapeutics performed a trial with two patient groups who suffered with constipation. One group ingested 100 grams of dried prunes and the other group took 22 grams of psyllium each day. After 3 weeks, the prune group had improved stool frequency and stool consistency compared with psyllium. In other words, prunes are proven to be effective at relieving constipation.
Tip: Prunes are both preventative and reactive. Start consuming 100 grams of prunes in the days leading up to your surgery and throughout recovery especially if taking opioid prescription pain medication.
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Constipation From Antibiotics: Treatment
Treating constipation from antibiotics may be a little different than other types of constipation. The main difference is because the gut flora is also compromised. This means that it may take the body more time to rebuild the gut flora and recover. According to research, this time can be anywhere between a few weeks to a few months to recover .
A few important things you should know:
- Digestive Issues: During this time, you may notice additional digestive issues such as bloating and gas. Since the body depends on a healthy gut flora to properly digest the foods you eat, digestion may not always be ideal.
- Constipation medicine and laxatives are often used, but they are not designed to restore the damaged gut flora. So when you stop with the constipation medicine, you may get constipated again.
- Treatment: For these reasons, when you treat constipation from antibiotics, it is important to address both issues: relieve the constipation when needed and rebuild the gut flora.
Is It Normal To Be Constipated After Surgery
Dr. Rx
If you already suffer from constipation, it is important to mention this to your doctor and surgeon so that you may be proactive. This may include attempting to determine the cause of your constipation so you can start treating it before your surgery. And prevent recurrence or worsening of the constipation postoperatively. Dr. Shria Kumar
Constipation after surgery is very common. It may even be the most common complication after surgery. Prevention is key. Once constipation occurs it can be more difficult to fix.
While constipation is often not serious, it can be uncomfortableand even more so after surgery.
Bloating and gas can be painful. And straining to pass a bowel could affect the bodys healing. That is especially true if the surgery involved the abdominal area.
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How Do Local And General Anesthesia Differ
âDoctors will need you to take general anesthesia for long and extensive procedures. You breathe gas through a mask or get an injection and fall asleep. When you wake up, the surgery is over.
General anesthesia needs expert care. Since you’re unconscious, your heartbeat, respiration, oxygenation, and blood pressure must be watched carefully. You may need help in breathing, too.
While you’re unconscious, you may vomit and suck the vomited material into your lungs. This can cause aspiration pneumonia, a dangerous condition. For your safety, your doctor will want you to fast for a few hours before anesthesia.
General anesthesia is given to you by an anesthesiologist after your doctor assesses your health in advance.
Local anesthesia, on the other hand, is simpler. Since you’re awake â with only part of your body numbed â it’s safer. Side effects like nausea and vomiting are not as common as those after general anesthesia.
Dog Anesthetic Side Effects And Risks
Any time medications are used, including anesthetic drugs, there is the risk of unpleasant reactions. Reactions can range from mild and no big deal, or catapult into catastrophic and even life-threatening situations.
However, in most cases, risk of death is more likely on the drive to the hospital than from dog anesthesia. Mild dog anesthetic side effects include injection site swelling or a faint decrease in a dogs cardiac output. Catastrophic effects include anaphylactic shock or death.
Other adverse reaction risks to dog anesthesia include not making sure your pup has been fasting prior to being anesthetized. If the pet hasnt properly fasted, your dog may vomit while unconscious and the vomit can be accidentally sucked into the lungs.
Sucking vomit into their lungs can trigger an episode of aspiration pneumonia which can be life-threatening. More rare reactions to dog anesthesia are side effects like seizures, visual impairments, clotting disorders , and system organ failures of the liver, kidney, or heart.
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Why Is Constipation After Surgery Common
After surgery youve essentially created the perfect storm for constipation. Pain medication, lack of exercise/ activity, diet changes, and anesthesia are all proven contributors to constipation. In fact, opioid pain medication alone cause constipation in as many as 40% of patients. In other words, post-op constipation in some capacity is very common.
Dr. Frisch explains constipation after surgery as multifactorial. He explains that constipation can be triggered by stress and surgery is stressful. A change in diet and the type of food you eat can also cause constipation. Add in decreased fluid intake and dehydration, the medication themselves, as well as anesthesia, and there is an impact.
Stay Hydrated: Drink And Drink Some More
After surgery, keeping hydrated is extremely important. In order for your bowels to work properly and for you to easily pass stool, you need to be hydrated. If you dont have enough water in your intestines or colon, your body will soak up the water that would otherwise make up a healthy stool.
After surgery, youre more susceptible to dehydration. Opioid pain medication can dehydrate you. In addition, some laxatives can also contribute to dehydration. If youre constipated, add extra drinking water into your routine. Aim to drink 8+ cups of water per day. Herbal teas also count towards your water intake.
Tip: If your drink contains alcohol, added sugar, or caffeine, it will not be as hydrating. Aim to drink 8 cups of water per day.
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How Does General Anesthetic Work
The exact mechanisms that produce the state of general anesthesia are not well known. The general theory is that their action is induced by altering the activity of membrane proteins in the neuronal membrane, possibly by making certain proteins expand.
Of all the drugs used in medicine, general anesthetics are an unusual case. Rather than a single molecule acting at a single site to produce a response, there is a huge variety of compounds, all of which generate quite similar but widespread effects, including analgesia, amnesia, and immobility.
The chemical makeup of general anesthetic drugs ranges from the simplicity of alcohols chemical makeup to the complexity of sevoflurane.
General anesthetics are known to act at a number of sites within the central nervous system. The importance of these sites on the induction of anesthesia is not fully understood. These sites include:
- Cerebral cortex: This is the brains outer layer, which is involved in tasks relating to memory, attention, and perception, among other functions.
- Thalamus: Its roles include relaying information from the senses to the cerebral cortex and regulating sleep, wakefulness, and consciousness.
- Reticular activating system: This is important in regulating sleep-wake cycles.
- Spinal cord: The spinal cord passes information from the brain to the body and vice versa. It also houses circuitry that controls reflexes and other motor patterns.
Side Effects Of Dental Anesthesia
It’s also important to discuss the potential side effects of dental anesthesia with your dental professional before undergoing any procedure. This allows you to feel prepared and confident in your treatment option, which is something to smile about.
Side effects of local anesthesia in dentistry tend to be rare. Sometimes numbness is felt beyond the affected part of the mouth. Eyelids and cheek muscles can also droop until the numbness subsides. Other less common concerns include:
- temporarily losing the ability to blink
- hematomas
- a racing heartbeat
- nerve damage
Side effects of sedation caninclude headache, nausea, and drowsiness. These side effects usually do not last long. Other side effects of sedation are:
- A headache a few days after the procedure
- Pain at the site of the needle
- Difficulty urinating
- Hematoma
- Nerve damage
Your dental professional should monitor general anesthesia side effects during and after treatment. Here are the side effects of general anesthesia:
- Nausea and vomiting
- Confusion when regaining consciousness
- Chills and shivering, hypothermia
Rarely, general anesthesia has the potential to cause more serious complications like postoperative delirium or cognitive dysfunction, where memory loss is more long-term.
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Managing Constipation After Surgery
By Dr. Jemiel Nejim and Inara Nejim
Unfortunately, constipation is a common side effect of surgery. It can happen for a few different reasons: the anesthesia used during the procedure, pain medications youre taking or how much and what youre eating and drinking.
Opioid medications are often used to manage pain after surgery, but they commonly cause constipation. Studies show that 40 95% of patients taking these medications will experience this side effect. To minimize it, anesthesiologists at HSS carefully construct a pain medication plan using different types of drugs, including acetaminophen , nonsteroidal anti-inflammatories , opioids, anesthetic medications and medications for nerve pain. This is done to maximize pain relief and minimize the use of opioids, as well as their side effects.
Steps to Take Before Surgery
If you have concerns before your surgery about constipation, the best thing to do is to ask your surgeon or care team about it. Some things to try:
Steps to Take After Surgery
At HSS, we conduct a thorough medication education session when preparing to send patients home. A nurse goes over all prescriptions, explaining how to take each medication to effectively manage constipation at home. Wherever you have your surgery, be sure you know how to properly take your medications to avoid this side effect before you go home.
At home, there are a couple of general rules to follow to help prevent or manage constipation: