Question: 

One of the patients wanted advice on pain medication that dissolves better and faster that won’t be almost whole in her output.

Response:

Regardless of pain medication or not, what you want to keep in mind when taking oral medications are the following:  watching for medications that affect stoma output (either color, pH or quantity), inactive ingredients, absorption issues or side effects.

Keep in mind there are alternative routes other than oral where medications can be absorbed. These include transdermal, buccal, subcutaneous, sublingual, intravenous or intramuscular.  For example, B12 can help with energy & is best absorbed as an intramuscular injection completing bypassing the stoma & output.

You want to stay away from extended or sustained release formulations for example pain SR medications (MS contin, Dilaudid SR or oxycontin). Most oral medications are broken down in the stomach & absorbed in the small bowel; however SR medications are coated with a matrix or resin that are then time released & most of the medication is absorbed to some extent in the colon. Too much medication released at once can cause an overdose so these should never be cut, crushed, opened or modified.

Use Immediate Release (IR) medications instead as these medications are designed to release ingredient shortly after ingestion with a quick onset.  Liquid medications are also generally preferred because they’re well absorbed early on in the digestive tract. Be aware of sugar & choose sugar free formulations instead as too much sugar can cause diarrhea which will negatively affect your stoma & thus output. Ileostomates especially should be aware of carbs & other chemicals found in foods associated with digestive issues called FODMAPs (Fermentable Oligo, Di, Mono-saccharides And Polyols). Some polyols (eg sorbitol, mannitol, malitol & xylitol) can cause diarrhea as they actually have osmotic laxative properties.  Be careful of Tylenol Suspension, Robitussion, NyQuil & other cough/cold products as they contain sorbitol.

Common pain medications come in liquid sugar free formulations such as acetaminophen & ibuprofen (NSAID aka Non Steroidal Anti-Inflammatory Drug).  Keep in mind that NSAIDs can discolour feces red/pink or even black.

In summary, look for sugar free (including FODMAP free) liquid acetaminophen to use for pain medication that won’t negatively affect your stoma & output.  The other alternative is looking for alternate routes other than oral including intramuscular, intravenous, sublingual, buccal or subcutaneous forms that completely bypass the oral route & thus wouldn’t affect your stoma or output at all.

Before trying any new pain medication or medication in general, please talk to your pharmacist and/or doctor to ensure they’re able to monitor you for safety & efficacy.