QUESTION: My brother had a lung removed 2 weeks ago today. To manage the postoperative pain, he's wearing a 50mg fentanyl* patch and is taking 5mg of oral oxycodone in staggered doses every 2 hours as needed. He is also suffering from extreme constipation. The doctor prescribed docusate**twice daily and Milk of Magnesia and prune juice to help solve the problem, but that treatment isn't working, and my brother is miserable! Tonight he tried a Fleet enema and applied warm compresses to his abdomen. Earlier today, he tried a suppository without results. Any help you can give us would be greatly appreciated.

ANSWER: It is likely that the pain medications are part of the reason for the constipation. In some people, those medicines cause constipation because they slow the motility of the gastrointestinal tract. If your brother's pain medications are the cause of his constipation, then the best solution is to reduce them. That isn't usually the best choice after major surgery. However, there are ways to administer potent analgesics that can minimize adverse gastrointestinal effects. This would require the help of a pain management specialist and the use of a pumping device to administer small doses of pain reliever over time.

Sometimes (usually when pain control must be long term) the pump is implanted, but there are also external pain pumps. Both types, which work exceptionally well and cause minimal adverse effects, are referred to as "patient-controlled analgesia" (PCA). The pain medication is administered by the pump intramuscularly or subcutaneously, so less of the drug is usually needed to achieve pain relief. Less of the drug also means fewer adverse effects. Although I have experience with the use of those devices, it is beyond my current scope of practice. Talk to your brother's doctors about pain relief and the adverse effects of some pain-relieving medications. They should want to help you.

In addition, your brother's intestinal bacteria may be either out of balance or deficient in number because of antibiotics that he may have received. A solution to that problem would be the daily use of a good probiotic supplement. We highly recommend a brand called Florajen 3. In addition, he might want to consider taking fructooligosaccharides (FOS), which are simple sugars that nourish the bifido bacteria in Florajen 3.

When I talk to people who have severe constipation, I recommend 1 capsule of Florajen 3 and a half teaspoon of FOS (twice daily for 1 week and then once daily on an ongoing basis). I've been following that regimen for almost 10 years. I always make sure to pack my Florajen 3 and FOS when traveling. Florajen 3 and FOS are available in most good health food stores. If you can't find them locally, they are available from us online.

Also, your brother's constipation might be relieved if he increases his water consumption. When people aren't feeling well, they tend to not drink enough water. Water - lots of it - is important.

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* The primary use of the fentanyl patch is to provide a continuous delivery of pain reliever to a patient with on-going pain. These patches are especially useful after a surgical procedure but are also helpful in the management of cancer pain, or after injury.

** Docusate is used to treat constipation due to hard stools, in painful anorectal conditions, and for people who should avoid straining during bowel movements.