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Had spinal fusion surgeries with varying degrees of opioid constipation. Taking H20 and Metamucil. Advice?

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Practicing since : 2002
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My wife, following f(5) spinal fusion surgeries, has varying degrees of opioid constipation. With therapy and activity using two canes, and increase H20, the need for the opioids has lessened but the issue of the irritable bowel has sporadically become bothersome. As we continue the increased h20 and Metamucil with the Colace the nature and consistency of her stools seems to be improving. Adding antispasmodics isn't something she wants given her sensitivity to medication. Any other suggestions.
Posted Sun, 27 Oct 2013 in Digestion and Bowels
Answered by Dr. Deepak Kishore Kaltari 5 hours later
Brief Answer:
Water intake and mobilization

Detailed Answer:
Greetings of the day
Dear XXXX,

Being a Pediatric Surgeon I encounter many such cases of constipation following spine Surgery. I would like to suggest you the following

1. Water intake should be adequate at least 2.5liter per day
2. Mobilize her regularly, take her for walks. Intestinal motility improves with mobilization.
3. Avoid constipating diet especially containing refined flour like biscuits and other baked products.
4. Add natural fiber to her diet in form of vegetable salad.
5. If constipation is very severe then retention enema with glycerine and normal saline will help.
6. Bowel movements can also be promoted by re-instating bowel training.
7. Certain fruits like pomegranate are also known to promote bowel movements.

Believe me it requires lot of patience from both the physician and the patient to treat constipation. But trying it will definitely help. Many of operated cases of operated anorectal malformation who have post operative constipation (they also have neurological component to it as many of sacral vertebrae are absent)
Do respond to it. As infant and children are not capable of following instructions do respond to it, I strongly believe that it should help your wife too.

I wil be happy for any other query you have.

Take care
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