Does constipation affect pain med. absorption?

Question

I have very advanced, severe Crohn;s disease. I take NSAIDS, steroids, and narcotics, for this condition and a spine condition (all but 3 of my discs have disintegrated completely, so my spinal column bones rub up against each other where I haven't had disc replacements). These two conditions set off a chain reaction of pain throughout my whole digestive track, and my spine, neck, head, hips, arms, and legs. So obviously I need my meds to work to their fullest potential. 

Even without narcotics I suffer from chronic constipation. I only have a bowel movement about every three weeks, then I have a flare up of horrific gastro symptoms which can last anywhere from days to weeks. The constipation is made worse by narcotics, which everyone knows is a side effect. I've noticed the longer I go without moving my bowels the less effective my pain medication is. I also see pill fragments in my stool when I finally go, sometimes even whole pills. Whenever I have flare ups and either have normal movement or diarrhea there are no pill fragments, and my pain medication works wonderful. For about a week after the flare ups subside my pain meds work as they should, and then they begin to get less and less effective as I get more and more built up. I was wondering if anyone else experiences the same thing.  And are pain meds broken down and absorbed in the small intestines as well as the stomach?  I asked an ER doctor once and he just laughed and never answered, after that response there was no way I was asking a dr. again.

PaperJams · Answer

I found this because I have noticed rhe same thing and was looking it up. When I'm late into my constipation my pain meds barely work once I have a bowel movement they are 100 times more effective. That Dr that laughed should have looked into it instead of laughing that's the difference between Drs that make discoveries and those that are just waiting for their shift to be over to spend that money. BTW I do not have crohns but I do have a form of IBS.

Marymendoza · Answer

If you look up coconut oil it will help flush you out I have UC and my children seem to be following in my footsteps.. make sure you get the oil that is in cooking section take ABOUT 4 tbl. Spoons in coffee or tea of alone and it will lube everything and make it come out.. I had my large intestine removed last year and I have BM ABOUT EVERY DAY. no large intestine keeps poop from forming I have not screamed or passed out from pain in a year until I swelled up from chrones a few weeks ago... Also pain free diet or foods and clean eating has really helped me and my family... Google pain free food.. good luck you can also look up Mayo clinic large intestine removal for severe pain and suffering from intestinal issues... Good luck get some coconut oil....

CirceTheGoddess · Answer

Sorry for my typos as I am in mobile actually looking fir answers to help me and came across this place and saw one so similar I had to post sorry about the typos.

CirceTheGoddess · Answer

Hello there. I too have spine and Castro disorders and diseases. I have ulcerative colitis or rather ulcerated mucosa of the colon on top of it I have malabsorption and splenic flexic syndrome. I took have two extra vertebrae in the lower half of my back in which war broke off during a motorcycle accident they had to be set and put back on but they need to be removed also ever since childbirth as a baby I have had severe scoliosis where my rib cage sits 7 inches away from each side meaning right and left rib cage one is up Hugh one is down lower sitting on top if my intestines. Anyhow moving on I would like to say that if you are having issues with your pain meds and going to the bathroom every 3 weeks because I have been there do to my mouth or action not feeling my pain medication which I am on a fentanyl patch due to malabsorption but I still have to take a break through and if I am not absorbing this means the medication will not work what my doctor recommended me to do is to take a drug called linzess I take a 290 milligram capsule before I take my pain medication but you cannot take it right before you eat because if you have a malabsorption problem you will not get the nutritional value from your food because everything will be broken down and excreted as diarrhea after you have had the bouts of diarrhea from Lizness  and you are sure you are done in the bathroom you may only then take your oral pain medication if you take it before it too will be expelled. It sounds to me that your painmed doctor needs to speak to your gastro specialist because this is a major problem. I recommend the Lizness for extreme Constipation and de wding on I sirance sometimes they will not cover it as there  are other drugs similar to it that are less expensive Lizness is about 400$/ bottle sometimes the gastro doctors can give you samples that come in a 4 pill bottle but I always have to take it 2 to 3 times a day and I have to fit it in when I'm not taking my pain medication it's very confusing and I wish there was a better way to do it but I'm always in pain and I'm pretty much debilitated although I am a master student it's very hard so I can sympathize with you because I have very big problems with my gastro and my back ask your gastro to help you time a pill relief and evacuation so that you can get your pain meds to absorb if it has a malabsorption problem they may have to go in and figure out a little more of what's causing the malabsorption so you are able to get your pain medication to work effectively you may want to try the fentanyl patch which does not have anything to do with the intestinal balance as it goes through the bloodstream they have a very low dose and only 25 mcg/h that way your intestines will not rot ulcers with the pill just sitting there backed up with your constipation it may be something you want to try the fentanyl patch does not offer highs and lows so no one will get high off of it unless you start abusing it and opening the patch up which I do not see you being a drug abuser you just wish for your pain meds to work effectively as I did as well so ask about these medications maybe they could help you as I've been in your place once before I hope this helps and if not maybe just gives you I thought to ask your doctor about malabsorption so they can get you on the proper medications so you can have a quality of life again have a great day and please be well

-Barbie

Pain_is_my_world · Answer

The answer is absolutely yes. My child was run over by a semi-trailer he has similar bowel issues and a similar cycle. Firstly the whole pills in your stool, if they are a long acting drug like Targin it's exactly what should happen the pill delivery mechanism for many long acting drugs are called ghost pills, it basically works like a tea bag, they are designed by the manufacturer to survive intact the entire trip through your body intact and pass out unchanged just like a tea bag remains unchanged while the tea itself is leached out. Secondly you are very correct in stating that some pills are specifically designed to be absorbed in different parts of the tract, intestine or bowel. Absolutely your impactaction in your bowel and much much higher as your constipation worsens will effect absorption if the pill can't move through at the correct rate and in fluid it can't do it's job. Never ever crush long acting tablets you can overdose and kill yourself among other things. Instead crush fast acting like endone every 4 - 6 hours for relief though this will add to the constipation. If you are not on Targin ask your doctor about it, it helps prevent constipation. Lastly fix your problem instead of trying to compensate for it. A number of things can get you regular. First by flax seed and blitz it slightly. Take several tablespoons a day, you may need half a cup full a day to begin with. The most important thing you can do is buy specifically a cold press juicer for 6 weeks have nothing but juice. No fruit juice just vegetable with a few green apples to activate the enzymes. You need carrot, broccoli or kale, betroot and green apples, organic if possible live on this. If you really can have organic coffee enemas everyday. Lastly buy yourself a book by Dr Max ****** - Healing the Hopeless. It's life altering to read. I am not particularly into alternative or anything but I'm giving you the above advice because it simply works. It took me 6 months of desperate research to get to it, I had no choice, my 14 year old was suicidal from the pain and he was being rushed by ambulance every day for horrific uncontrollable neuropathic pain and being injected with massive doses of fentanyl, nothing worked this gave him back his life. Be very very wary of sugar it's an inflammatory and terrible for pain and can inflame the intestinal track. Also avoid gluten and dairy, add back into your diet either gluten or dairy one at a time and watch how you feel for at least a week or two one of these things may be damaging your stomach and inflaming it making absorption difficult at best. Take the highest dose pure absorbic acid your bowels can tolerate, cheaply you can buy it from some chemist and most health food stores in packets as a white powder. Go up to 10 teaspoons a day spread out over the whole day and then back down or up by one teaspoon a day until you reach bowel tolerance. Bowel tolerance is reached at the point you have diareah when it onsets back off by one teaspoon per day until you find the point just below diareah. Pure absorbic acid helps at very high levels 8 - 10,000mg per day with pain, particularly bone pain. It also aids hugely in opiod absorption. Good luck.

Pain_is_my_world · Answer

The answer is absolutely yes. My child was run over by a semi-trailer he has similar bowel issues and a similar cycle. Firstly the whole pills in your stool, if they are a long acting drug like Targin it's exactly what should happen the pill delivery mechanism for many long acting drugs are called ghost pills, it basically works like a tea bag, they are designed by the manufacturer to survive intact the entire trip through your body intact and pass out unchanged just like a tea bag remains unchanged while the tea itself is leached out. Secondly you are very correct in stating that some pills are specifically designed to be absorbed in different parts of the tract, intestine or bowel. Absolutely your impactaction in your bowel and much much higher as your constipation worsens will effect absorption if the pill can't move through at the correct rate and in fluid it can't do it's job. Never ever crush long acting tablets you can overdose and kill yourself among other things. Instead crush fast acting like endone every 4 - 6 hours for relief though this will add to the constipation. If you are not on Targin ask your doctor about it, it helps prevent constipation. Lastly fix your problem instead of trying to compensate for it. A number of things can get you regular. First by flax seed and blitz it slightly. Take several tablespoons a day, you may need half a cup full a day to begin with. The most important thing you can do is buy specifically a cold press juicer for 6 weeks have nothing but juice. No fruit juice just vegetable with a few green apples to activate the enzymes. You need carrot, broccoli or kale, betroot and green apples, organic if possible live on this. If you really can have organic coffee enemas everyday. Lastly buy yourself a book by Dr Max ****** - Healing the Hopeless. It's life altering to read. I am not particularly into alternative or anything but I'm giving you the above advice because it simply works. It took me 6 months of desperate research to get to it, I had no choice, my 14 year old was suicidal from the pain and he was being rushed by ambulance every day for horrific uncontrollable neuropathic pain and being injected with massive doses of fentanyl, nothing worked this gave him back his life. Be very very wary of sugar it's an inflammatory and terrible for pain and can inflame the intestinal track. Also avoid gluten and dairy, add back into your diet either gluten or dairy one at a time and watch how you feel for at least a week or two one of these things may be damaging your stomach and inflaming it making absorption difficult at best. Take the highest dose pure absorbic acid your bowels can tolerate, cheaply you can buy it from some chemist and most health food stores in packets as a white powder. Go up to 10 teaspoons a day spread out over the whole day and then back down or up by one teaspoon a day until you reach bowel tolerance. Bowel tolerance is reached at the point you have diareah when it onsets back off by one teaspoon per day until you find the point just below diareah. Pure absorbic acid helps at very high levels 8 - 10,000mg per day with pain, particularly bone pain. It also aids hugely in opiod absorption. Good luck.

Pain_is_my_world · Answer

The answer is absolutely yes. My child was run over by a semi-trailer he has similar bowel issues and a similar cycle. Firstly the whole pills in your stool, if they are a long acting drug like Targin it's exactly what should happen the pill delivery mechanism for many long acting drugs are called ghost pills, it basically works like a tea bag, they are designed by the manufacturer to survive intact the entire trip through your body intact and pass out unchanged just like a tea bag remains unchanged while the tea itself is leached out. Secondly you are very correct in stating that some pills are specifically designed to be absorbed in different parts of the tract, intestine or bowel. Absolutely your impactaction in your bowel and much much higher as your constipation worsens will effect absorption if the pill can't move through at the correct rate and in fluid it can't do it's job. Never ever crush long acting tablets you can overdose and kill yourself among other things. Instead crush fast acting like endone every 4 - 6 hours for relief though this will add to the constipation. If you are not on Targin ask your doctor about it, it helps prevent constipation. Lastly fix your problem instead of trying to compensate for it. A number of things can get you regular. First by flax seed and blitz it slightly. Take several tablespoons a day, you may need half a cup full a day to begin with. The most important thing you can do is buy specifically a cold press juicer for 6 weeks have nothing but juice. No fruit juice just vegetable with a few green apples to activate the enzymes. You need carrot, broccoli or kale, betroot and green apples, organic if possible live on this. If you really can have organic coffee enemas everyday. Lastly buy yourself a book by Dr Max ****** - Healing the Hopeless. It's life altering to read. I am not particularly into alternative or anything but I'm giving you the above advice because it simply works. It took me 6 months of desperate research to get to it, I had no choice, my 14 year old was suicidal from the pain and he was being rushed by ambulance every day for horrific uncontrollable neuropathic pain and being injected with massive doses of fentanyl, nothing worked this gave him back his life. Be very very wary of sugar it's an inflammatory and terrible for pain and can inflame the intestinal track. Also avoid gluten and dairy, add back into your diet either gluten or dairy one at a time and watch how you feel for at least a week or two one of these things may be damaging your stomach and inflaming it making absorption difficult at best. Take the highest dose pure absorbic acid your bowels can tolerate, cheaply you can buy it from some chemist and most health food stores in packets as a white powder. Go up to 10 teaspoons a day spread out over the whole day and then back down or up by one teaspoon a day until you reach bowel tolerance. Bowel tolerance is reached at the point you have diareah when it onsets back off by one teaspoon per day until you find the point just below diareah. Pure absorbic acid helps at very high levels 8 - 10,000mg per day with pain, particularly bone pain. It also aids hugely in opiod absorption. Good luck.

redwood72 · Answer

I really would like to find out the same answer. I know 100% for a fact it affects  painkillers. I have been on methadone for years and when I get extremely constipated I start noticing withdrawal symptoms, and my methadone does not provide relief and it gets worse. Now after I originally looked it up I assumed it was just the constipation causing these withdrawal effects, although as soon as I have a good bowel movement the next day when I take my methadone I get a kick from it for a good week until I am even more constipated then before.  I have been on methadone for years and it does not give any effects other than a prevention of sickness after the stabilization period. I have been on the same dose for years. So why is it I get no effect when constipated and actual get opiate withdrawals then the day after a large relief I get a buzz from the methadone. It isn't all in my head I have been doing it for years and know this for a fact.

Gastrocity · Answer

I am having the exact same issue. Medication will begin taking longer to work and than not working as well. My back actually begins to hurt with it also. I get gastro. Can spew even. Once my bowls begin to work I get nausea from the meds. Than after a few days, return to normal. Some times with less tolerance for my pain meds. I don't care what anyone says. Reading someone's post suggesting the same exact things happening, makes me believe fully. Thank you for ur post

Gastrocity · Answer

I am having the exact

Brenndy · Answer

If your constipation is not improving or causing other digestive symptoms; whether it be the anal canal, large or small bowel, or stomach, and you do not cut back and/or take a stool softener, I don't object to giving considerable thought to using a transdermal-like method for achieving pain relief.  

No two people react the same to a medication.  Read with an open mind the comments regarding pain patches.  For some, they are a life-saver, and others dislike them.  Do what is best for you.

sandee1818 · Answer

I would not worry about your doctor increasing your medications without you needing the increase. Doctors while they do realize tolerance is an issue do not generally increase your dosage without you the Pt asking for an increase.

BP88 · Answer

Try your best not to end up on the fentanyl patch.  Your tolerance will skyrocket very quickly and for a lot of us including me it was a nightmare withdrawing from it.  I'd rather IV or IM morphine than go back on the fentanyl.

forgeahead · Answer

Thank you for the research, I too have researched and everything I found says no that constipation doesn't affect absorption. I am on hydrocodone (Lortab) 10/500, 2 tablets by mouth 4 times daily. I am sure it is pill fragments, my pills are bright pink, that's the way they go in, and that's the way they come out. I do however have mal-absorption issues in my small intestines. That's why I was wondering if the pills were absorbed at all by the small intestines. Crohns can occur anywhere in your digestive tract, and I happen to fall into a small category of people that are affected in the stomach as well. But all my tests have indicated that my stomach is functioning fine. 

I hesitate talking to my dr. about it. I'm afraid he'll decide to put me on medications that can either be injected or in a patch, and as far as I know those meds are stronger. Since this is a life-long condition I prefer to stay on the weakest meds possible, because I know as time progresses my condition and tolerance will worsen.

jamlws · Answer

I remember a few posts like this so I would in past questions and see if you can find them. 
Good luck to you,
Jamie

sandee1818 · Answer

I will. I called and left a message for my friend who is a doctor I am waiting for his return call:)

Sarajmt · Answer

Sandee:  Please do post the answer.  I looked as well.  I found a lot of pages about absorption mechanics and mal absorption.  Butno direct answers to this question.  This is one that is important.

sandee1818 · Answer

Your question prompted me to do some research. For the past hour I have been searching the net for answers. The question is asked alot, so do not feel embarrassed. 
In answer to this question the answer is no each time. 
I believe your experiencing tolerance issues. 
If your taking a long acting medicine like Oxycontin pills fragments in your bowel movements are normal and has nothing to do with the absorption. 
I am going to keep looking into this and call a friend who is a doctor and ask him. 
I will post the answer when I can:)

Brenndy · Answer

Greetings,

You did not mention which medication (narcotics) you are taken, nor any OTCs or otherwise.  That being said, however, majority of medications, if entered orally, are absorbed through out 'gut' wall lining.  Do you have any malnutrition issues, i.e. excessive rapid weight loss (intentional or non-intentional)?  Perhaps a B12 deficiency/anemia/s?
Best and natural method in tacking constipation is water, and lots of it.  

Last, but not least, I'd recommend seeking the aid of a GI physician, and perhaps even a nutritionist.  BMs at 3-week intervals is most definitely not healthy.  Please consider these thoughts and best wishes to you in your endeavor.  Remember:  You and only you are the keeper of your castle......

BP88 · Answer

I'm no doctor but I highly doubt that constipation plays a role in absorption of pain medication.  Most narcotics are metabolized in the liver which comes before your colon.  The only way I could see constipation affecting medicine absorption is if you're plugging them up your rectum, which I highly doubt you're doing.  Could the Chron's disease create digestive/breakdown issues within your GI tract?  I'm pretty sure pills are tougher to breakdown than food.

Are you certain that you're seeing pills and not something else in your stool?

What narcotics are you currently taking and which pills are not breaking down?

Either ask for a different route of administration or you COULD and I DON'T RECOMMEND IT ESPECIALLY IF IT'S A LONG-ACTING MEDICATION..... crush your pills into grit and mix/swallow with water.  That way it'll absorb much easier.

Sarajmt · Answer

Hi!  I am so sorry that you're in this situation.  But you've found a good spot for support.  It's late so not many people are around.  More will be around tomorrow.

Yours is an excellent question.  I don't know the answer but maybe someone here will know.  It does make sense.  If you're passing whole pills, they certainly wouldn't have been absorbed.  I think you're on to something.

I must say I'm surprised that a doctor would laugh at such an honest question.  It must have been to cover his own ignorance.  But please don't let one doctor's unwarranted response stop you from asking questions of your doctors.  And this is one question that you deserve an answer.  If it is interfering with your medication, you would need another delivery system.  That would be an important part of your treatment.

Do check back.  Probably someone will know the answer.  And do keep us updated on how you're doing.