My jpouch is gone 5 yrs now, I have an end ileostomy, but wanted to know if anyone in the group knows whether taking pain meds with an ostomy can cause an obstruction as it can with a jpouch. I'll be having hand surgery which I'm told is "very painful" and will probably be needing something, even tho I typically do everything I can to "tough out" pain. Does anyone have suggestions/recommendations on what to take, or ask for, to avoid obstructions?
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Opiates slow down the gut, which can lead to constipation. This isn’t really an obstruction except in the most serious cases, but it can feel a lot like one. I suspect (with little basis) that opiates can also increase the likelihood of a post-operative ileus, but I don’t think this happens much, if at all, after hand surgery.
My strategy to minimize opiate use after surgery is to maximize Tylenol (acetaminophen) and NSAID use, and only add the opiates to cover pain that breaks through that combination. NSAIDs can cause pouchitis, so the “maximum” NSAID dose and duration for a J-poucher should take that into account. One important obstacle to this strategy is that it’s hard to persuade doctors (especially those who don’t know you well) to prescribe pure opiates without combined NSAID or acetaminophen, and the combination drug can’t safely be added to an already maximized amount of NSAID and acetaminophen. If you explain that your purpose is to use as little opiate as possible they may be convinced that it’s logical and safest.
Hi.. I unfortunately don't have any suggestions but would agree with Scott's approach. The issue might be finding a prescription med that contains only codeine and not the acetaminophen or NSAID part. Something called "tincture of opium" might contain just the codeine but I don't know if it's available in the US.
Good luck with the operation...you're wise to be thinking ahead.
I was given Gabapentin for post surgical pain. Didn't need any morphine and only had a couple days on Tylenol.
I definitely wouldn’t use tincture of opium, since that would cause intense constipation. There are plenty of opiates: OxyContin, dilaudid, etc., but so many people abuse them that it’s become difficult to get them legitimately.
@Scott F posted:I definitely wouldn’t use tincture of opium, since that would cause intense constipation. There are plenty of opiates: OxyContin, dilaudid, etc., but so many people abuse them that it’s become difficult to get them legitimately.
I second that about avoiding opiates including tincture of opium. Not only do they slow the gut down too much which makes obstructions harder to resolve, they also cause emotional instability, so whatever you are bothered by will seem a lot worse unless you have just had your dose. And withdrawal is very unpleasant. It's a roller coaster to be avoided. I speak from my own experience.
Thanks so much, all. I will be hopefully meeting w/the surgeon one more time prior to surgery, and will feel much better about discussing various meds. One last question, do opiates have the same effect on an ostomy as they do a jpouch (constipation, possible ileus?)
@n/a posted:Thanks so much, all. I will be hopefully meeting w/the surgeon one more time prior to surgery, and will feel much better about discussing various meds. One last question, do opiates have the same effect on an ostomy as they do a jpouch (constipation, possible ileus?)
I think they slow the entire GI system down, so upper GI too. But I'm not positive.