Nicole Hemmenway

The Dreaded Discussion – OIC

A few days ago, one of my dearest friends and I were talking about constipation. The conversation surprised me, as I never knew she dealt with irregular bowel movements. As we talked about her daily consumption of Metamucil and fiber, I immediately thought back to a certain topic that was extremely difficult for me to discuss during my pain journey.

For years, I remember readily participating in the medical field’s dance. I willingly played the game of tug-of-war between the medicines needed to ease my pain versus the severity of side effects arising from taking such drugs. I dealt with secondary complications of migraines, nausea, vision and hearing impairment, cognitive problems (short-term memory loss), acid reflux, inflammation and disequilibrium.

Yet the most challenging problem from taking my medications, specifically opioids, was constipation. Rather, opioid-induced constipation (OIC). Opioid-induced constipation refers to a decrease in bowel frequency as well as stools that are hard and difficult to pass. It is estimated that around half of all patients taking opioids are affected by OIC.

For those reading who have experience with OIC, if you are like me, this topic is not something you want to discuss with anyone. Yet you must!

First, I was unsure what constituted constipation. Was it having a bowel movement every other day, twice a week, once a week or every other week? Then there was embarrassment of speaking about a topic that seemed so private. I just didn’t feel comfortable sharing gastrointestinal complaints and bowel habits with my doctors. This uneasiness was intensified because I always had someone with me during my appointments; and even though it usually was one of my parents, I still felt self-conscious and mortified speaking about poop. Lastly, there was the fear that the course of treatment would be discontinued due to having too many adverse reactions.

Constipation became the elephant in my exam room. I avoided the conversation like one would avoid the plague. However when I began having bowel movements about twice a week, I recognized the seriousness and gravity of the issue. I knew I had to talk about it.

I hesitantly explained the frequency and dark, rough appearance of my stools. My doctor took immediate action. He put me on stool softeners and laxatives, while making me drink fiber and other prescription liquids. I was thankful for his proactive approach and constant inquisition about my bathroom habits. His probing made it easier for me to be honest.

The problem soon became finding adequate, lasting relief. Nothing seemed to fully fix the issue at hand; I would only find temporary reprieve. I tried herbal remedies, over-the-counter supplements and acidophilus. I even saw a gastroenterologist who prescribed two stronger medications to help with bloating and bowel functioning.

Being unable to release the ever-increasing toxins left my stomach in utter distress. With my tight, bulging abdomen extending outward, there were days when I looked pregnant. I could not even stand straight, because of the electrifying pain. I would be keeled over, holding my stomach, in utter torment.

More so, it was a painful ordeal whenever I did go to the bathroom. Being blocked and constricted meant I had to push to pass any stool. I would be stuck in the restroom for a lengthy amount of time, trying to release hardened bowels. The straining would cause me to grunt and sweat, as my inflamed sphincters became raw and sore, and my skin would tear.

Having OIC was extremely frustrating. It was excruciating to have a bump the size of bowling ball form in my abdomen, and I hated not knowing how my body would react to foods or when I would be able to use the restroom. I caused plumbing issues (clogging pipes) for an entire apartment building twice. Following the second incident, my mom began removing my firm and indestructible stools from the toilet and throwing in the trash. There were also periods when my mom had to give me suppositories. And when hospitalized, a nurse would have to come to my room every other evening to administer an enema.

I remember fighting it every night. As I cried, clenched, and squeezed, my nurse would just pat my head. She kept telling me it would be over soon and I was going to be okay. Although she assured me there was nothing to be embarrassed about, enemas destroyed the little self-worth I had left. To put it mildly, opioid-induced constipation made me miserable.

While I am thankful pain isn’t a predominant force in my life anymore, it will always be part of me.  Pain continues to shape my world today. Looking back on the challenges I faced on my road to relief, I am cognizant of the role opioids played in my healing. While they were not the answer for me, I realize they are extremely helpful and beneficial to millions. Yet the side effects – especially opioid-induced constipation – can be crippling and devastating to deal with.

I guess I wanted to share this with everyone because I think a new discussion needs to occur. I would assume many of us have experienced opioid-induced constipation in some capacity. For me, the challenge had always been discussing my severe constipation. I felt humiliated and embarrassed. I was in my early twenties and could not believe this was happening to me. There were moments when I just wanted to throw my arms in the air and cry.

So I ask you:

  • Do you feel opioid-induced constipation is still a taboo topic?
  • What have been your personal challenges?
  • Do you feel comfortable talking about opioid-induced constipation?
  • What are the roadblocks you see gaining relief from OIC?
  • Has your doctor approached the subject of OIC, and is he/she understanding?

To those who can personally relate, hang in there. You are not alone. Remember to continue to be proactive in your care. It takes courage to discuss such personal issues, so I applaud you for bravely speaking about an uncomfortable topic like OIC. Like everything else, I believe answers are coming. Don’t give up. Medical advances happen every day. In the meantime though, try to watch your diet so you do not exacerbate the problem, drink plenty of water, talk to your doctor if you notice signs of constipation, and be patient and kind with yourself.

Believing in miracles,

Nicole Hemmenway

Author of – No, It Is NOT In My Head: The Journey of a Chronic Pain Survivor from Wheelchair to Marathon