From the Guidelines
It is normal for patients to experience sensations similar to needing a bowel movement after a new colostomy, and in this case, considering the patient is on morphine, opioid-induced constipation (OIC) should be suspected and managed accordingly. The patient's sensation of needing to have a bowel movement could be related to OIC, which is a common side effect of opioid use, as seen in studies such as 1. This condition can lead to constipation, hard stools, and straining during defecation.
Management of OIC
To manage OIC, the following strategies can be considered:
- Osmotic or stimulant laxatives, as recommended in the american gastroenterological association institute technical review on the medical management of opioid-induced constipation 1
- PAMORAs (peripheral mu-opioid receptor antagonists) such as naloxegol, alvimopan, or naldemedine, which have been shown to increase bowel movements and reduce straining in patients with OIC 1
- Secretagogues like lubiprostone or selective 5HT4 agonists like prucalopride, which can also help improve bowel habits in patients with OIC 1
Pain Management
For pain management, continuing with the prescribed morphine and considering non-opioid pain medications like acetaminophen or NSAIDs, if appropriate, is recommended. Ensuring the colostomy appliance is properly fitted is also crucial, as pressure or irritation around the stoma can contribute to discomfort. Gentle movement, position changes, and relaxation techniques may help manage the discomfort.
Monitoring and Follow-up
It is essential to monitor the patient's bowel movements, pain levels, and overall condition, and to follow up with the healthcare team to adjust the treatment plan as needed. If pain becomes severe or is accompanied by fever, significant abdominal distension, or absence of output from the stoma, contacting the healthcare provider immediately is crucial, as these could indicate complications requiring prompt attention.
From the Research
Normal Bowel Movements After Colostomy
- It is common for patients to experience alterations in bowel habits after a colostomy, including constipation or the feeling of needing to have a bowel movement (BM) 2.
- The sensation of needing to have a BM after a new colostomy can be caused by various factors, including constipation, gas, or stool buildup in the colon.
Management of Constipation After Colostomy
- Conservative measures, such as dietary changes, can be effective in managing constipation in patients with a colostomy 2.
- A study found that dietary interventions alone relieved constipation in 60% of patients with a colostomy, suggesting that a trial of dietary modifications may be beneficial before initiating pharmacotherapy 2.
- Bowel protocols, which may include medications such as senna, bisacodyl, and lactulose, can also be used to manage constipation in critically ill patients, including those with a colostomy 3.
Opioid Use and Constipation
- Opioid use, such as morphine, can contribute to constipation in patients with a colostomy 3, 2.
- The use of opioids can slow down bowel movements, leading to constipation and the feeling of needing to have a BM.
- Bowel protocols may be activated by nurses based on initiation criteria, including opioid use, to help manage constipation in patients with a colostomy 3.