I haven't pooped in sixteen days. help? (gross, sorry)

April 18, 2014 8:26 AM

I broke my back, got loads of morphine and now my stomach is screwed up. cannot see a doctor, bedridden post surgery at home. details inside.

after my accident, which damaged my L5 vertebrae pretty significantly, I got transported to a hospital and within a few days I had surgery. they kept me to recuperate and had me on loads of morphine and other intravenous painkillers for nearly three weeks. and then they sent me home.

I had a rather poor reaction to the painkillers. my belly bloated up, the abdomen hurt and it generally felt like a thunderstorm inside my stomach. I have never farted this much in my life. for nearly eight days before and after surgery I ate next to nothing. my appetite has been back for one week.

I am now lying at home in bed, unable to even sit or go to the bathroom. I have to stay like this for two months and I recently found out I cannot find a qualified doctor (read: not totally inexperienced) who will make house calls. there is no way I can get to a hospital short of taking an ambulance to the ER.

so here I am, unable to poop for sixteen days straight. I don't feel bad but I wonder where the food went I did eat the last week. I have never been unable to go this long. so, dearest hivemind, any thoughts on how bad this is? at what point do I need to really worry? do I wait here, do I ask for a laxative to be gotten from a pharmacy and try even though I don't feel like I could go?

thank you for your advise. I swear this is not trolling, gross subject or not.

posted by krautland to Health & Fitness (36 answers total)

Can you say where you are located? Is it in the US?
posted by roomthreeseventeen at 8:28 AM on April 18, 2014

krautland's profile indicates China.
posted by spikeleemajortomdickandharryconnickjrmints at 8:33 AM on April 18, 2014

16 days without a poo is definitely a problem that needs to be taken care of asap.

I had this exact problem immediately after my own back surgery a couple of years ago. I couldn't fit into the pants I wore to the hospital because I was so bloated. And, yeah, I couldn't poop. Morphine's an amazing pain-kiler, but constipation is a real bad side-effect.

You don't necessarily need a prescription laxative. I'd give an OTC suppository a try first. Worked for me.
posted by Thorzdad at 8:33 AM on April 18, 2014 [4 favorites]

So sorry! Been there, done that.

I'm sure you're not eating much, but eat apples, grainy stuff, water, if you can.

In order: you should be taking senna + colace pills with every painkiller (there is an expression that the hand that prescribes painkillers, should also be prescribing laxatives). These are over-the-counter.

Next step: Miralax. In your case I'd probably make a cocktail of Miralax with prune juice (a nurse made a few of these for me). Again, take daily, over-the-counter.

Next up: magnesium citrate (liquid). Drink the bottle.

Next up: Time for the suppositories/enemas. Sounds awful. Do it anyway, because the next option after that is manual disimpaction via the ER. That was enough motivation for me, anyway.

Honestly, after 16 days, it may well be time to go straight to the end of this list.
posted by Dashy at 8:38 AM on April 18, 2014 [6 favorites]

Response by poster: I am in shanghai.

I should mention they gave me a laxative on my last day at the hospital because even then I had gone very little. it produced a tiny amount, almost not worth speaking about. since then sixteen days.
posted by krautland at 8:38 AM on April 18, 2014

My experience post-major abdominal surgery was somewhat similar. Morphine and other opiates can drastically reduce bowel movement. I had the double whammy of traumatized bowel and opiate inhibition. I was told to ambulate (walk slowly around the hospital floor) the day after my abdomen was stapled back up in order to get bowel function back.

There can be serious complications (note: not a doctor) to having an immobilized bowel, up to rupture and sepsis. I would say do whatever you can to get to the hospital and get checked out. Laxatives may not be enough to return you to normal if bowel function has been seriously disrupted. If that means calling an ambulance to get to an ER, I would do it.
posted by Existential Dread at 8:39 AM on April 18, 2014 [1 favorite]

enema?
posted by spikeleemajortomdickandharryconnickjrmints at 8:39 AM on April 18, 2014 [2 favorites]

I would suggest calling the hospital (perhaps they have a nurse hotline? Or call the department that performed your surgery?) and asking their opinion on what you should do given your local options. That may well be ambulance to the ER.

It is actually possible (though unlikely) to become so constipated you rip apart your own intestines. Don't do that. Get help for this.
posted by asperity at 8:40 AM on April 18, 2014 [4 favorites]

Call a doctor before you try anything. If you have to take an ambulance to be seen, then do it. This can probably be resolved easily but this could get very bad very quickly. Do not mess with this. Seriously.
posted by kinetic at 8:42 AM on April 18, 2014 [10 favorites]

Response by poster: dashy, said laxative did come anally. not as bad as expected at first but then I spent the next three, four hours desperately trying to produce something when there was next to nothing. it basically feels like you have to go when in fact you don't have to.
posted by krautland at 8:42 AM on April 18, 2014

After sixteen days, you need to take the ambulance to the ER. It sucks but it sucks more to have your intestines stop working.
posted by Snarl Furillo at 8:42 AM on April 18, 2014 [15 favorites]

Yeah, nurse here although of course I'm not a doctor and don't know you as an individual, but speaking generally, you need to be taking laxitives regularly until you are actually regular. Can you give yourself an enema or ask a trusted friend to do so? Cuz that's the next step.

Hydrate like hell, eat lots of dried fruit and fiber (fiber without drinking lots of water will just stuff you up more) and also, is there any way you can incorporate movement into your day? Are you on literal bedrest? Because lyings still is also a huge recipe for constipation.

Good luck, sounds miserable.
posted by latkes at 8:43 AM on April 18, 2014 [1 favorite]

Response by poster: kinetic: there is no doctor to call here. I am in china. my chinese girlfriend tried to find one to come here to confirm after one and two months whether I am fit to get up and at least take a shower — simply no dice. so I would have to call an ambulance, get it to pick me up on a stretcher and do the trip to the ER and back, all-in would mean a day off work for the gf (since I cannot even open the door) and a long time out. I'm here to confirm I really really need to do this before doing that.

for the record, I feel perfectly normal. no stomach or abdominal pain.
posted by krautland at 8:44 AM on April 18, 2014

Regarding the folks who are saying you need an ambulance to the ER now:

The medical risk of your situation is if you actually have a bowel obstruction. This is not likely but possible. Something for googling if you're concerned about it.
posted by latkes at 8:45 AM on April 18, 2014 [1 favorite]

Response by poster: latkes, enema is not a problem. yes on full bedrest. not allowed to sit, not allowed to walk even to the bathroom. four screw and two plates in my back next to the spine.
posted by krautland at 8:45 AM on April 18, 2014

If it were just a few days to a week I'd recommend the foul-tasting but exceptionally effective tactic of downing an entire bottle of magnesium citrate.

At 16 days you may be well into the territory of an impaction, though, and this is serious business you may need the....mechanical....help of a nurse with.

I recently found out I cannot find a qualified doctor (read: not totally inexperienced) who will make house calls.

A "totally inexperienced" doctor--or a visiting nurse; can you get one of those?--might still be a good first step. It's poop, not advanced diagnostics.
posted by blue suede stockings at 8:47 AM on April 18, 2014 [2 favorites]

Response by poster: googled bowel obstruction. I have none of the symptoms I found (Cramping and belly pain that comes and goes. The pain can occur around or below the belly button. Vomiting. Bloating and a large, hard belly. Constipation and a lack of gas, if the intestine is completely blocked. Diarrhea, if the intestine is partly blocked.), all I have is excess gas.
posted by krautland at 8:47 AM on April 18, 2014

Are you still taking any painkillers? Because that would both increase constipation and make you less likely to notice the pain.
posted by asperity at 8:49 AM on April 18, 2014 [4 favorites]

Yeah, impaction is probably more likely. I agree with enema and/or mechanical evacuation (lube your finger and stick in in there and try to pull out the poo. Fun, I know.)
posted by latkes at 8:50 AM on April 18, 2014 [2 favorites]

So right now you are left alone at home for hours while your girlfriend works? This does not sound safe in your current condition. If you suddenly spike a fever or decline you would be unable to care for yourself and the medication you are on may be masking symptoms. I know it sucks, but if an on-call dr or nurse is not available then the ER is the safest place for you.
posted by saucysault at 8:52 AM on April 18, 2014

Response by poster: I am not on painkillers and haven't been for 12 days.

yes, I am alone at home for roughly eight hours each day now. it's okay. not in pain. I tried to find an assisted place when they kicked me out of the hospital but was unable to, so I am making the best of it. apart from the boredom it's doable right now.
posted by krautland at 8:57 AM on April 18, 2014

Best answer: I'm confused - who is treating you now? What doctor will eventually be the one to medically release you after 2 months to sit/walk/etc.? When are you going for a follow up visit? I admit I know next to nothing about the healthcare system in China, but certainly someone is managing your care?

You can become so "backed up," so to speak, that you will literally begin to vomit feces. I have seen it happen. You don't want to get to this point, especially as someone who cannot sit up and is at high risk of aspiration if you do vomit.

I am an RN, but not your RN and not your medical provider. I would advise you to to be seen by a doctor as soon as possible, even if you have to be taken by ambulance to get there. The general rule of thumb is that if you have not have a bowel movement for over 2 weeks, you need to be evaluated and treated.

For now: avoid any refined grains (white bread, white rice, etc.). Eat fruit and raw or lightly cooked vegetables. Drink plenty of water (aim for 1 to 1.5 liters a day). Avoid dehydrating liquids like coffee or tea, or anything containing caffeine. Try adding wheat bran or psyllium husk powder to your diet, if it's available where you are. Take docusate (generic name for Colace) and/or milk of magnesia IF it's okay with your medical provider. Try an enema or suppository (again, if OK with your provider).

Milk of mag will not work if you have a fecal impaction and can cause pain & cramping if that's the case. If you have an impaction, an enema may also fail as they typically work too quickly for stool to adequately soften. Manual disimpaction is an option, but I wouldn't do it without gloves and lubricant - otherwise you risk damage to the rectum. Have your girlfriend bring those home after work if you're going to try that.

Did you receive any take-home paperwork when you left? Specifically, doctor's instructions regarding diet, activity limitations, and what to do in case of problems/complications? Now would be the time to review that paperwork, if you have it.

Good luck, and please come back to add a note to let us know how this worked out.
posted by pecanpies at 9:16 AM on April 18, 2014 [6 favorites]

If you cannot sit on a toilet, then are you going to try to do this laying down? I think that would be difficult just by itself.
posted by Houstonian at 9:24 AM on April 18, 2014

Why don't you get one of these available but "inexperienced" doctors to pay you a visit. Otherwise I think you need to go to the hospital.
posted by J. Wilson at 9:48 AM on April 18, 2014 [1 favorite]

More specific directions for manually removing poop.
posted by latkes at 9:54 AM on April 18, 2014

As a geriatric nurse (constipation, everywhere, all the time) I typed out a long answer and then deleted it. Because this is not an uncommon problem and I'm guessing even new docs would be able to help you out. At this point you should ask for a house visit.
posted by pintapicasso at 9:57 AM on April 18, 2014 [4 favorites]

googled bowel obstruction. I have none of the symptoms I found.... all I have is excess gas.

You're already at 16 days. Once you hit the three week mark, I strongly suggest you go in, as does the Cleveland Clinic (scroll to "When to Call a Doctor" at the bottom). That's a really long time to have old feces piling up and hanging out in your bowel, even without any other symptoms (that you know of).
posted by blue suede stockings at 10:27 AM on April 18, 2014

Here's my timeline of appetite, spinal fracture, and pooping, for sake of comparison:

I burst L1 and was surgically fused T12-L2 (4 screws, 2 plates, Ti cage) along with other injuries. Spent ~ a week in the ICU. They would not let me out of the ICU until I pooped, but was well enough otherwise, so - enema. Not much came out, because I had not eaten in a week - painkillers, trauma, etc, just was not hungry, did not eat (or poop).

Spent a week in a regular unit. Again, did not eat; nausea from meds, lack of appetite, etc. I did ingest one Ensure a day. Peed, did not poop. Was taking colace/senna regularly. Again, enema before discharge, again not much came out.

Two weeks in rehab hospital, which was also a nursing home, so nurses and aides very aware of constipation issues. This is where a nurse made me the 'bombs' of Mirilax + prune juice. I started eating in the last week there. Daily colace + senna in addition to Mirilax + prune juice, and had 2x magnesium citrate bottles. Did not poop until last day; that was a full month after the surgery (but, a few enemas, and a marked lack of intake), and they were threatening to take me back to hospital for disimpaction at that point.

So: lots of changes in input and in output.

Krautland, do you have a brace? Any follow-up care or PT scheduled?
posted by Dashy at 11:26 AM on April 18, 2014

Best answer: I'm an ER doctor. If there is no pain or nausea (no symptoms whatsoever aside from constipation, in fact) this is not a life threatening emergency. It could turn into one but it isn't one now.

You need to get way more serious about taking care of this, though. Don't just sit and wait for something to happen. You are beyond constipation and into what's called 'obstipation'. It started with the narcotics and now the lack of mobility is probably exacerbating it. This is why you don't feel like you can go, but trust me, you CAN go. And you NEED to go. So get on it!

The 'laxative' that you got anally was probably a suppository. One single suppository is not going to do much here, and that was a long time ago. You need to get on a 'bowel regimen' as soon as possible. Do not wait until you are in pain to do this. The pain from severe constipation can feel like your abdomen is going to explode. Don't just take a single dose of a laxative and expect something to happen, and assume it didn't work if nothing happens. You need to start taking a laxative regularly and increasing the dose or adding another medication until you get results. Don't go straight to the big guns like mag citrate if you haven't tried even the basics yet. You can try more suppositories or an enema, but you might have an impaction down below (i.e. a hard ball of poop) that will block them from getting anywhere and being effective. If I were you I'd be trying both ends right now, and getting on a very fiber-rich diet.

If you start to feel pain or like you can't eat/are nauseated and vomiting, you will be in trouble and you will need a doctor. So get aggressive about this now, please!
posted by treehorn+bunny at 11:51 AM on April 18, 2014 [18 favorites]

Best answer: It is actually possible (though unlikely) to become so constipated you rip apart your own intestines

no.

Doctor here as well. Hydration and ambulation if possible should be your mainstays of treatment. There's an escalating order of things to try: stool softeners (docusate) and osmostic laxatives (Miralax, or polyethylene glycol mixed in water) go first. Typically, in a situation like this you should avoid fiber because if you are obstructed further down, they can lead to exquisite bloating and cramping and can make the situation worse. Moving up the ladder of poop, you have Mag citrate and enemas (either balanced electrolytes like Fleets, or in some cases, soap water). At the top, you can use the solution used to prepare colons for colonoscopy, GoLytely or similar brand. I have had to give this by stomach tube before.

The worse thing that will happen is bowel obstruction due to impacted stool, then any means possible, you need to get to a hospital. The symptoms are severe (*severe*) abdominal pain, vomiting, rigid abdomen, inability to pass gas, inability to eat due to vomiting. Be as aggressive as you need to prevent this from happening.

good luck and speedy recovery!
posted by Slarty Bartfast at 1:26 PM on April 18, 2014 [5 favorites]

This may be outdated or something you've already checked out, but I saw this number listed online as a hospital that provides house calls:
Ruijin Hospital
197 Rui Jin Er Lu
Shanghai 200025
021 6324 0090 x 2101 (24 hour house calls)
posted by three_red_balloons at 6:16 PM on April 18, 2014 [1 favorite]

Response by poster: >I'm confused - who is treating you now? What doctor will eventually be the one to medically release you after 2 months to sit/walk/etc.? When are you going for a follow up visit?

nobody is treating me now. they did surgery on me, let me recouperate at the hospital for six days and then discharged me. an ambulance brought me home. orders are to stay in bed and not move for two months and at the end take an ambulance to get checked out and cleared. I will get a brace for one month and then be allowed to walk. the reason chinese hospitals release you is that they make no money from patients who already had surgery — they want to get rid off them. the only paperwork I have are loads of x-rays and instructions for exercises I am supposed to do in bed to strengthen my back.

>Why don't you get one of these available but "inexperienced" doctors to pay you a visit.
this is china. inexperiences here means someone who wouldn't be considered a doctor elsewhere. these are people who have taken a few classes but cannot find a teaching hospital to get the necessary certifications. I have been told in no uncertain terms to stay clear of them. my girlfriend is a pharmacist, so I trust her advice on this.

dashy, your experience sounds a lot like mine.

>Ruijin Hospital
I know this hospital well. it is sadly the most overrun hospital in shanghai. I will still try and call. thank you.
posted by krautland at 10:51 PM on April 18, 2014

Did you poop yet?

Please update as you feel comfortable doing so. Your recent experience sounds awful and now I'm worried about you.
posted by Slarty Bartfast at 9:04 AM on April 19, 2014 [3 favorites]

Response by poster: okay, here is an update:

I ended up taking laxatives. first day three packs, nothing. following day four packs, the recommended dosage for my weight. again, nothing. the following day I took five packs. it took another 24 hours of massive turmoil inside my stomach and abdomen but then the floodgates opened. I now know what it's like to be inside a real shitstorm.

I think I filled 16 trash bags over the following three days. the first night was incredibly difficult and painful. it came in tiny doses, liquid, for 24 hour straight. I thought it would never end. the second day wasn't much better. it just wouldn't stop. on the third, I went from untold numbers of tiny goings to four massive ones. massive as in too-large-to-hold-with-both-hands. (hello plastic gloves, still awful.)

after that I was fine. I am fine now. I am properly going, albeit still in bed. I have an ambulance ride scheduled to get evaluated on june 3rd where it will be determined at the hospital whether or not I can walk using a massive and unflattering back brace that I'm supposed for the first month. it will be nearly 40C in shanghai that time of year but I couldn't be happier. I can't wait to be out of bed and walking again.

thank you to everyone who was here to help me. you made a huge difference.
posted by krautland at 12:04 PM on May 4, 2014 [4 favorites]

I'm happy you pooped.
posted by spikeleemajortomdickandharryconnickjrmints at 12:34 PM on May 4, 2014 [8 favorites]

The human body is both awesome and gross. So glad to hear you pooped!
posted by saucysault at 2:22 PM on May 4, 2014 [1 favorite]