All of the opiates work roughly the same way, though some are more constipating than others, and that's the "side effect" we're looking for. It appears that the constipating effect doesn't diminish over time like the pain relief does, so a constant dose generally does the trick. Some folks here use codeine with good success. I'd strongly suggest trying Lomotil first, mainly because it causes the smallest  amount of mental fuzziness that opiates are known for (most long-term users say they don't get this effect). In addition, Lomotil is by far the easiest of the opiates to get, and your doctor won't get harrassed by anyone for prescribing it. In some places you can only get long-term opiates from pain management specialists, and they don't know a darn thing about J-pouches.

If you're on long-term opiates you'll develop tolerance to them, and you should expect them to work less well at usual doses if you need them for pain. 

In my experience these medications are most valuable at bedtime, but I suppose if you slow the gut enough (even during the day) you might get better water absorption, and that might reduce toilet trips. Most folks on around-the-clock opiates seem somewhat unhappy with the results, but I might be reading too much into it, and they might be worse off without the meds.

I'd suggest reserving the word "diarrhea" for loose stools ***with urgency***. It is normal for a J-pouchers to have soft stools. If all you want to do is thicken your stools, soluble fiber (e.g. Metamucil, Konsyl, Benefiber, Citrucel) are vastly better choices than opiates.

Long term opiate use is not dangerous, particularly if you are using it for slowing the gut. The only real danger is if you use them for pain relief and need ever increasing doses for the same analgesic effect. This is how and why people overdose. They keep increasing the dose trying to get pain relief and wind up suppressing respirations until they stop breathing.

The other potential issue is that you may need higher doses for pain relief, such as after surgery, if you take opiates on a chronic basis. 

But, Scott is correct that there isn't the tolerance effect for the GI actions of opiates. Plus, codeine is pretty weak compared to morphine or oxycodone.

The other issue is the "hassle factor" of getting opiates on a regular basis. The new Federal laws require a paper Rx (no faxing or electronic scripts), a 30 day supply only is allowed, and no refills (a new Rx is needed each time). In addition, there is a limit on how many scripts can be written before an appointment must be made. Lastly, no mail orders, so you have to pick up in person for each script. I put up with that for about a year, and finally asked my doc to switch me to tramadol instead of hydrocodone. So far, it seems to work about the same and I can get it mail order. It does have the same constipating effect as opiates.

Like Scott, I think you are better off using Lomotil first, unless you need something for pain.

Jan

I'm in year 5 of my J-Pouch.  I currently take Tramadol and it works just ok, but I would like something better.  I don't think getting the med will be an issue as I was lucky enough to have a Dr. who's son also has a J Pouch.  So he completely understands the pain med purpose. I tried lomotil and Imodium and all I got was dry mouth.  We started with Tramadol but haven't ventured further.

As for the codeine phosphate, what is a normal dosage and how many bowel movements could I expect in 24 hours?  I'm currently having to go roughly every 2 hours during the day and 4 hours at night.

It comes in 30 and 60mg pills. Typical adult dose is 30mg. Like anything, start small and gradually increase your daily dose to what works. No more than every 4-6 hours. 

Another drug to consider is paragoric, which contains all the opiates and is specifically for treatment of diarrhea. 

I never had problems getting opiate prescriptions from my doctor (my primary doctor would order it). It was just a big hassle for me. I had to keep close track of my supply and put in the request a week or two in advance to give my doc time to write it and the pharmacy to fill it. I am lucky that I have Kaiser, so the pharmacy is on the same campus as the doctor's office and they messenger the scripts. Most people have to pick up the script themselves and take it to their pharmacy. If you are in a pain management program, I think they dispense.

Jan

Hi, been using codeine phosphate 6/8 day for at least10 years to slow bms. Have liver tests 6 monthly, so far so good. Lomotil /immodium had no effect on me so changed to Panadeine Forte. Hope this helps. Heather