Opiates and elimination

Pain is nature's little message that something is not as it should be. This is nothing new and probably lies at the heart of opiate use. Pain that persists or frequently recurs has often lost its value as a reminder to act so it seems reasonable to avoid it. Since opiates don't actually stop the sensation as much as stopping the distress pain induces they don't interfere with our ability to react to it. The same cannot be said for anaesthetic drugs which do. Barbiturates are often the general anaesthetic of choice because they induce such a deep state of sleep the patient can't interfere during surgery while local anaesthetics block all sensation making it impossible to know what you are doing. Opiates are an excellent choice when you wish to carry out a very painful procedure on yourself. Unfortunately this is not the case when it comes to an excruciating case of constipation coz it's usually the opiate that caused it when you are using every day.
The polite phrase "straining on ones stool" conjures amusing images but can be quite dangerous and the level of pain is not part of some bodily retribution for interfering in its daily routine. I hate to be alarmist but the possibility of a stroke is real and the possibility of bursting a blood vessel somewhere else equally so. When examining my handiwork I look for bright red streaks which indicate mechanical damage due as much to the dryness of the "stool" as its size. To avoid any further damage to the mucous membrane which is by the way an excellent site for the absorption of drugs, it is safer to break the stool up by hand before you end up dead on the floor with a protruding stool. A spoon is an excellent tool to use but a pencil or pen could do but exercise extreme care as it is not difficult to perforate the wall leading to an embarrassing hospital admission or worse. Gently manipulate the probe so that it repeatedly digs into the offending turd reducing it to a pile of rubble instead of the house brick it was previously. A bit of this and the bits usually come out easily.
My first experience of doing this was on someone else when I was a trainee nurse working in an orthopaedic ward where problems of this nature are not rare. In this case the patient was an alcoholic who had not been given the can of beer the doctor had ordered in his notes. Worse still his elimination had not been recorded in his notes daily as it should be. The reason for this oversight was the negligence of the nursing staff who through small minded prejudice about their patient's prior behaviour were putting him at risk of severe discomfort or worse and themselves in the position of carrying out an unpleasant procedure but that's what trainees are for. I accompanied the R.N. to the utility room with the patient and she put him on a commode chair to facilitate easy access before using a teaspoon by holding the broad end as a probe and roughly inserted it into the old man's anus and began moving it around and all this to the man's cries of distress until he demanded "let the boy do it!". The nurse happily looked at me, proud of herself it seemed and asked "would you like to do this?" as if I could say no. I took the spoon/probe and proceeded carefully with only a bare idea of what I had to do but it wasn't too long before the man could eliminate the offending matter without pain or distress. As I returned him to his bed I made a point of telling him that his doctor had prescribed him a can of beer to be taken in the evening and he should ask for it as he was entitled to it and unlikely to get it otherwise. He didn't even know about it which says something about the care drug addicts receive in hospital.
Having learned the procedure I was able to perform it on myself instead of enduring the pain of constipation but the best method really is to take something orally that will loosen the stool and prevent the problem ever occurring. In my first entry on this I mentioned Colloxyl and Danthron which is a bit too strong for me whereas Sennokot does the job nicely. If the problem isn't so severe attention to diet can be sufficient and is a better approach in general.